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Lamotrigine Monotherapy in Epilepsy: What’s the Optimal Dose?

Lamotrigine Monotherapy in Epilepsy: What’s the Optimal Dose?

lamictal-100-mg-tabletsA new study analysis suggests that for patients taking the antiepileptic drug (AED) lamotrigine as monotherapy, escalating dosage from the start of treatment may result in better efficacy.

Up until now, the optimal dose of lamotrigine, when given as monotherapy, had yet to be determined. The study, conducted using retrospective data from two epilepsy medical centers in Israel, included a total of 188 patients. They evaluated dosage and treatment efficacy as well as adverse effects and retention rate.

The researchers found significant statistical connections between the lamotrigine dosage efficacy and the patient’s age and duration of epilepsy. A total of 46.2% of the patients who had epilepsy for ≥5 years required a higher lamotrigine dose of >250mg daily to control their seizures, while just 35.7% of those with a disease duration of <5 years needed the same level of dosing.

Similarly, for patients aged >30 years old, a higher lamotrigine dose was needed to control their seizures. Fifty-two percent of 31 to 50 year-olds and 53.8% of those >50 years old needed a lamotrigine dose of >250mg daily to control their seizures. Of the 18 to 30 year-olds, just 27.9% required a dosage of >250mg daily.

The authors noted a good level of tolerability for lamotrigine as a monotherapy, with 68% of the patients in the study sample continuing treatment for at least 1 year of follow-up with good efficacy and minor side effects.

A reason for the older participants needing a higher dosage could have been due to changes in metabolism, the authors explained. However, the fact that this high dosage was also needed in 31 to 50 year-old group suggests this is not the only reason.

Overall, the major factors that impact the dosage efficacy of lamotrigine were patient’s age and duration of disease. Due to the statistical significance in difference of efficacy, the authors suggest that certain subgroups of adult epilepsy patients who will be treated with lamotrigine as monotherapy should initiate their doses at 250mg daily or higher.

Source: MPR

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  1. I’m on Lamictal 200mg

  2. My daughter is 15 and on 400mg per day but I understood the dose also to be dependent o her weight.

  3. Be careful, almost went into Steven Johnson syndrome

  4. I’ve been on that for many years now.

  5. Monotheraphy, did NOT work for my daughter. Keppa was first, then Lamictal. she starting having Tonic Clonic seizues 6 years ago, When she was on Keppra and Lamictal as a combo she went 6 months seizure free. I asked Dr. if we could do combo…. She went seizure free for 33 months! She has done so well on combo of Keppra & Lamictal, that Dr. Lowered dosage of Lamictal to a level that side effects ( shaking ) has lowered.

  6. Currently on 600mg of lamictal a day. At one point it was 1,000mg!

  7. I’ve been on lamictal since my last seizure, 11 years ago. I take 200mg/day.

  8. I was told by my doctor the 300mg a day was the highest they were allowed to use and if it didn’t work they would have to put me on something different

  9. What is Steven Johnson syndrome my mom is on 400 mg a day. Plus vimpat 400mg & triliptal 600mg a day still having seizures

  10. My 21 yr old son was just recently diagnosed with in last 2 yrs with epilepsy. He started out on Keppra.This worked for a while.Then he was taking Keppra and lamotrigine.They weaned him of the Keppra and gradually increased his lamotrigine to 200 twice a day.Seem to be working.If it stops working they said they would have to change to medicine

  11. I’ve been on 250 mg am and 300mg pm for about 12 years. No side effects to speak of.

  12. My daughter got steven Johnson syndrome at 14 months taking thia

  13. My dr has me on 400mg twice a day and 1000mg of keppra twice a day

  14. I had Steven Johnson Syndrome from Lamictal!

  15. Lamictal did not work for me. Keppra was added and controlled my myoclonic seizures but I was still having grand mals. My neurologist added Topamax and I’ve been seizure free for almost 6 months, which is the longest I’ve gone in over 10 years. I was on Lamictal 450 mg a day before and it did nothing for me.

  16. My son is taking 100 mg and a 25 mg of lamictal now it suppose to be better then 75 mg twice a day I hope this new upper dose works better so far so good I guess but my son has have seizure since he was 4 yrs old

  17. Monotherapy never worked for me. My last neurologist went from Depakote to Topamax to Lamictal to Keppra. I never took any of those at the same time. The neurologist I have now has me on Keppra XR 2000 mg, Zonegran 250 mg, and Vimpat 400 mg., plus a VNS. I have more control now than I’ve had my entire life. The longest I’ve gone is 3 months seizure free.

  18. I’m taking lamictal and its works for me

  19. My daughter takes 75mg twice daily and thank God this not have seizures.

  20. I have allergies to lamictal, had reactions.. So I’m on keppra and others still… Was on the highest doses that they didn’t want to keep upping them because I was still having partials…. They decided brain surgery and removed my temporal lobe…. A lot to go through for me… Lowered doses of meds and I know I get treated differently but some people don’t know what I went through or have gone through

  21. This medication was horrible for my granddaughter. ..she had hallucinations. .she started having drop seizures. ..she does very well on Keppra and small dose of klonipin. ..every one is different and reacts differently to medication

  22. I’m on Depakote, keppra, vimpat, lamictal. My full dosage lamictal will be 100 mg. He might be able take me off 1 pill keppra I have once full dose. Hate high dosages combined

  23. Im on Lamictal 400mg I was seizure free for 10 months then they started again… the dr. Added 30mg of topamax and I’ve been seizure for for a year now…

  24. Camryn Crill

  25. Lamictal is the only medication that has worked in the 25 years of having grand Mal seizures. I’m now 5 years seizure free thanks to Lamictal.

    • are you now taking lamictal..

  26. I take lamictal tablets but combined with carbatrol

  27. Eff Lamictal. This medication almost killed me when I was 15!!! I’ve found that Zonegran and Top a Max are the best combo for me. Depakote works for my son and Keppra works for my daughter.

  28. I had allergic reactions to trileptal and lamictal when first diagnosed ten years ago, found found 2 months later that I was pregnant… I’ve tried nearly every medication, implant of a VNS & had the back left quarter of my brain removed…only to have the seizures continue through all medications, then switch sides after the brain surgery….my mother, Charlene, has only had me avoid one or two medications that they’d actually given her for migraines.

  29. My neuro told me that the dosage you need depends on the levels of the drug in your blood when tested. It takes 700 mg/day to keep my blood levels ‘safe’ for seizure control. My high dosage freaked me out until she explained it to me that way. Some people may have a safe level at 250 mg; for whatever reason, MY body requires 700mg. If that helps to settle anyone else’s mind, I’m glad! Lamictal is the only mono therapy that’s ever worked for me. Ladies who are considering babies: I also took it throughout my pregnancy and now have a healthy 2-year old boy!

  30. I started having seizures when I turned 18 lamictal was the first medication I was put on started at 5 milligram doses and now I’m up to 300 milligrams a day. I have been on for 11 years now and I have been free from seizures, this medication is a life-saving miracle

  31. I am now 5 and half years seizure free because of Lamictal(the common side effect of being Very itches went away). When i was a kid i had Grand maI and Petit mal then went seizure free for almost 17 yrs a month after my 30th birthday I started having Simple Partial Seizures. Keppra made me very mean and paranoid, Depakote made me a zombie, I couldn’t function, Topamax didn’t work for me. Now that I am doing better, My Husband and I are caring for our 3 yr old who has Simple Partial Seizures and a Son who has Cerebral Dysthymia of his right tempral lobe……they are both on Trileptal and seems to be helping them both

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