Lamotrigine in pregnancy
Before a planned or in case of an existing pregnancy the attending doctor must be informed about the therapy with Lamotrigine. A dosage of the medication must be found that is free of seizures and exposes the child to the lowest possible risk. A monotherapy at low dosage should be aimed for.
Mothers who take Lamotrigine during pregnancy may have an increased risk of malformations in the child. These include cleft lips and palate. There is no indication of the influence on mental development so far, but there are only a few studies.
When breastfeeding, the active substance can pass over to the child via breast milk. In studies, however, these children were inconspicuous. The child should be examined regularly and the benefits and risks of breastfeeding should be discussed in detail with the doctor.
Dosage
Lamotrigine should always be taken as directed by your doctor. The dose to be taken is very individual and varies with different influencing factors. The doctor will initially prescribe a low dose and gradually increase it over weeks, because lamotrigine must be taken slowly.
There are fixed schedules for the dosage of lamotrigine, usually the dose is increased by a maximum of 50 mg within two weeks. Otherwise there is a high risk of sometimes serious side effects. Usually adults and adolescents over 13 years of age take between 100 mg and 400 mg lamotrigine, in children the dose depends on body weight.
The dose also depends on the possible use of other antiepileptic drugs. The prescribed dose is taken once or twice a day, independently of meals. The tablets must be swallowed whole.
Overdose may cause side effects, in the worst case loss of consciousness and coma. The patient should never stop the treatment with Lamotrigine without consulting the doctor, the dose must be gradually reduced over a few weeks. Sudden discontinuation may cause seizures and worsening of epilepsy.
How much Lamotrigine must be taken depends on various individual factors: In the laboratory, the lamotrigine level in the blood can be determined after a blood test. The standard values are between 3 mg and 14 mg per liter. The blood sample is taken in the fasting state, i.e. before any food is consumed.
The lamotrigine level can be used to check the regular intake by the patient and to determine whether the level is within the so-called “therapeutic range”. In case of an overdose and an increased level in the blood, the risk of side effects increases. An underdosage can lead to seizures resistant to therapy.
The level may be increased due to disturbance of liver and kidney function, possible interaction with other drugs may also increase or decrease the level. Even at an optimal level, seizures can still occur. In this case, the intake should be increased in consultation with the doctor or the therapy should be combined with another anti-epileptic drug.
- Age of the patient
- Taking other antiepileptic drugs
- Kidney and liver metabolism
The discontinuation of Lamotrigine should be discussed in detail with the doctor.As a rule, epilepsy requires permanent medication, and most patients receive lifelong treatment. Lamotrigine, like other anti-epileptic drugs, should not be discontinued suddenly. This can lead to new seizures.
Lamotrigine should be discontinued as slowly as possible, but at least over a period of two weeks. The dose is gradually reduced. If discontinuation is necessary due to severe side effects, such as skin reactions, the dose may be stopped abruptly.
Patients taking Lamotrigine for bipolar disorder do not necessarily have to discontinue the drug. Here too, a doctor should be consulted in advance. In clinical studies there have been isolated cases of seizures in bipolar patients, but these are not beyond doubt due to the discontinuation of Lamotrigine.
