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A new rapid titration protocol for lamotrigine that reduces the risk of skin rash
  • +11
  • 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
Yoonhyuk Jang
Seoul National University Hospital
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Jangsup Moon
Seoul National University Hospital
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Narae Kim
Seoul National University Hospital
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Tae-Joon Kim
Ajou University School of Medicine and Graduate School of Medicine
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Jin-Sun Jun
Kangnam Sacred Heart Hospital
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Yong-Won Shin
Seoul National University Hospital
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Hyeyeon Chang
National Center for Mental Health
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Hye Ryun Kang
Seoul National University Hospital
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Soon-Tae Lee
Seoul National University Hospital
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Keun-Hwa Jung
Seoul National University Hospital
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Kyung-Il Park
Seoul National University Hospital
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Ki-Young Jung
Seoul National University Hospital
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Kon Chu
Seoul National University Hospital
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Sang Kun Lee
Seoul National University Hospital
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Abstract

Aims 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 administer 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 Conclusion These findings demonstrate the value of the novel tolerance induction protocol for lamotrigine, which could widen the available application of lamotrigine in various situations.