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

Abstract

OBJECTIVE:

Lamotrigine is one of the most widely used antiepileptic drugs, but it has a critical issue of a skin rash if the starting dose is too high or the escalation rate is too rapid. We investigated the efficacy and safety of a novel and rapid titration protocol for lamotrigine that takes only 11 days to reach a daily dose of 200 mg.

METHODS:

We prospectively enrolled 33 adult patients (age 18-85) who were diagnosed with epilepsy and started lamotrigine administration for the first time at a single tertiary hospital. Our new protocol starts with a subthreshold dose of the drug and then administers a stepwise-incremental dose until reaching the full therapeutic dose within 11 days.

RESULTS:

Of 29 patients analyzed, only two (6.9%) experienced idiosyncratic skin rash before the first follow-up visit at 2 weeks (±3 days). In addition, a therapeutic concentration was reached in more than 75% of studied patients after 2 weeks of lamotrigine administration.

SIGNIFICANCE:

These findings demonstrate the value of the novel tolerance induction protocol for lamotrigine, which could widen the available application of lamotrigine in various situations. However, this study is a preliminary study limited by a small number of patients and its nonrandomized and open-label design, so the current protocol needs more rigorous clinical evaluations before the application to the real clinical setting.

• Authors: Yoonhyuk Jang, Jangsup Moon, Narae Kim, Tae-Joon Kim, Jin-Sun Jun, Yong-Won Shin, Hyeyeon Chang, Hye-Ryun Kang, Soon-Tae Lee, Keun-Hwa Jung, Kyung-Il Park, Ki-Young Jung, Kon Chu, Sang Kun Lee
• Journal: Epilepsia open (Epilepsia Open) Vol. 6 Issue 2 Pg. 394-401 (06 2021) ISSN: 2470-9239 [Electronic] United States
• PMID: 34033264 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.

Chemical References

• Anticonvulsants
• Triazines
• Lamotrigine

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anticonvulsants (therapeutic use)
• Epilepsy (drug therapy)
• Exanthema (chemically induced, drug therapy)
• Humans
• Lamotrigine
• Middle Aged
• Triazines (therapeutic use)
• Young Adult