A new rapid titration protocol for lamotrigine that reduces the risk of skin rash

Jang, Yoonhyuk; Moon, Jangsup; Kim, Na-Rae; Kim, Tae Joon; Jun, Ji Hae; Shin, Yeong-Gil; Chang, Hak; Kang, Hye Ryun; Lee, Sang Kun; Jung, Keun Hwa; Park, Kyung‐Il; Jung, Ki Young; Chu, Kon

doi:10.1002/epi4.12495

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…1 Interestingly, a recent preliminary study reported no increased risk of skin rash when following a specific rapid titration protocol for lamotrigine over the course of eleven days. 2 Whether the dose is titrated over several days or several weeks, the universal agreement in recent literature is that lamotrigine should be initiated at low doses and increased gradually, rather than starting at high initial doses. This gradual increase in dosage is critical in preventing severe cutaneous adverse reactions, including DRESS, SJS, and TEN.…”

Section: Introductionmentioning

confidence: 99%

“…This gradual increase in dosage is critical in preventing severe cutaneous adverse reactions, including DRESS, SJS, and TEN. 1 - 2 Because the mortality rate of these reactions range from 10-35%, avoidance is absolutely critical. 3 , 4 In addition to increased mortality, these reactions have the potential to cause permanent disabilities.…”

Section: Introductionmentioning

confidence: 99%

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Severe Cutaneous Adverse Reactions Associated With High-Dose Lamotrigine for Mood Disorders: A Case Series

Clark

Clair

2022

Innov Pharm

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Drug-induced Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) are rare but life-threatening immune-mediated drug reactions known as Severe Cutaneous Adverse Reactions (SCARs). These severe drug reactions have been associated with many commonly prescribed medications, including sulfonamides, allopurinol, carbamazepine, and several antiepileptic drugs including lamotrigine.1 Although the risk of these adverse events is recognized by many medical providers, the risk may be overlooked when prescribing lamotrigine for mood disorders. Review of the literature and the experience of these cases suggest that the risk of lamotrigine-associated SCARs is increased when starting lamotrigine at high initial doses. Here we present and discuss two cases of SCARs attributed to high-dose lamotrigine prescribed for mood disorders. A third patient also presented with a SCAR related to high-dose lamotrigine prescribed for a mood disorder during this time but was lost to follow-up and was not reachable. All three patients presented to our hospital system from 2019-2020. Due to this clinical experience, we recommend that pharmacists and prescribers alike be alerted of the risk of severe cutaneous drug reactions when lamotrigine is prescribed, particularly at initial doses greater than 25 mg.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe Cutaneous Adverse Reactions Associated With High-Dose Lamotrigine for Mood Disorders: A Case Series

Clark

Clair

2022

Innov Pharm

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“…The maintenance dosage is typically 200–400 mg per day [ 27 ]. It is important to note that LTG should be taken with caution in patients with liver or kidney dysfunction and in those who are pregnant or breastfeeding [ 21 , 28 ].…”

Section: Overview Of Antiepileptic Drugsmentioning

confidence: 99%

Understanding Lamotrigine’s Role in the CNS and Possible Future Evolution

Costa

Vale

2023

IJMS

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The anti-epileptic drug lamotrigine (LTG) has been widely used to treat various neurological disorders, including epilepsy and bipolar disorder. However, its precise mechanism of action in the central nervous system (CNS) still needs to be determined. Recent studies have highlighted the involvement of LTG in modulating the activity of voltage-gated ion channels, particularly those related to the inhibition of neuronal excitability. Additionally, LTG has been found to have neuroprotective effects, potentially through the inhibition of glutamate release and the enhancement of GABAergic neurotransmission. LTG’s unique mechanism of action compared to other anti-epileptic drugs has led to the investigation of its use in treating other CNS disorders, such as neuropathic pain, PTSD, and major depressive disorder. Furthermore, the drug has been combined with other anti-epileptic drugs and mood stabilizers, which may enhance its therapeutic effects. In conclusion, LTG’s potential to modulate multiple neurotransmitters and ion channels in the CNS makes it a promising drug for treating various neurological disorders. As our understanding of its mechanism of action in the CNS continues to evolve, the potential for the drug to be used in new indications will also be explored.

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“…When a physician prescribes a new ASM to a patient for the first time, in-person visits are favored to titrate the dose and monitor adverse effects. For example, lamotrigine may result in serious skin rash [27,28], but as the patient may not be aware of this side effect it is required to manage the patient face-to-face. In addition, for drugs that may cause dose-related adverse events and oxcarbazepine, which requires hyponatremia measurement [29][30][31][32], in-person visits are recommended until dose titration is completed.…”

Section: Epilepsymentioning

confidence: 99%

Telemedicine in epilepsy and encephalitis: previous research and indication guidelines in Korea

et al. 2022

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Telemedicine is an emerging field of medicine that has become more important during the coronavirus disease 2019 (COVID-19) pandemic era and is being studied actively in various medical fields. In neurology, the introduction of telemedicine is accelerating worldwide under the label of teleneurology. So far, few studies have been conducted on telemedicine for patients with epilepsy. In nonmetropolitan areas, video-based clinics have been demonstrated to be effective for seizure control, and smartphone-based diagnosis has also been confirmed to be accurate. Indeed, after the onset of the COVID-19 pandemic, telemedicine has been used to treat patients with epilepsy around the world. Few studies have examined the use of telemedicine for patients with autoimmune encephalitis. One showed that telephone-based evaluation is sufficient to assess the cognitive reserve of leucine-rich glioma inactivated-1-antibody encephalitis patients, thereby diagnosing their dementia. Telephone-based outpatient clinics are temporarily permitted under Korean medical law, and telemedicine can be attempted for clinically stable patients with epilepsy in Korea. In addition, patients with autoimmune encephalitis in stable or improving status may also be candidates for treatment with telemedicine. This review presents evidence for the safety and efficacy of telemedicine to treat epilepsy and encephalitis patients and discusses indication guidelines. Based on our literature review and current Korean medical law, we suggest tentative guidelines for telemedicine in the fields of epilepsy and autoimmune encephalitis.

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A new rapid titration protocol for lamotrigine that reduces the risk of skin rash

Abstract: This is an open access article under the terms of the Creative Commons Attribution NonCommercial NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non commercial and no modifications or adaptations are made.

Cited by 7 publications

References 33 publications

Severe Cutaneous Adverse Reactions Associated With High-Dose Lamotrigine for Mood Disorders: A Case Series

Severe Cutaneous Adverse Reactions Associated With High-Dose Lamotrigine for Mood Disorders: A Case Series

Understanding Lamotrigine’s Role in the CNS and Possible Future Evolution

Telemedicine in epilepsy and encephalitis: previous research and indication guidelines in Korea

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