A new rapid titration protocol for lamotrigine that reduces the risk of skin rash. Issue 2 (7th May 2021)

• Record Type: Journal Article
• Authors: Jang, Yoonhyuk; Moon, Jangsup; Kim, Narae; Kim, Tae‐Joon; Jun, Jin‐Sun; Shin, Yong‐Won; Chang, Hyeyeon; Kang, Hye‐Ryun; Lee, Soon‐Tae; Jung, Keun‐Hwa; Park, Kyung‐Il; Jung, Ki‐Young; Chu, Kon; Lee, Sang Kun
• Is Part Of: Epilepsia open. Volume 6:Issue 2(2021)
• Page Start: 394
• Page End: 401
• Publication Date: 2021-05-07
• Subjects: idiosyncratic skin rash -- lamotrigine -- rapid titration -- skin rash -- titration protocol; Epilepsy -- Periodicals; Epilepsy -- Research -- Periodicals; Epilepsy; Periodicals; Fulltext; Internet Resources; Periodicals; 616.853005
• DOI: 10.1002/epi4.12495
• Languages: English
• ISSNs: 2470-9239

Abstract

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.