From the Research
Laboratory Monitoring for Lamotrigine
Lamotrigine is generally well tolerated and does not require monitoring of serum levels, unlike lithium 1. However, there are certain laboratory tests that should be monitored during lamotrigine treatment.
- Complete Blood Count (CBC): Monitoring of CBC is recommended, especially when lamotrigine is coadministered with other medications that may increase the risk of blood dyscrasia, such as phenobarbital 2.
- Hematologic parameters: Clinicians should carefully monitor hematologic parameters, including platelet and white blood cell counts, during lamotrigine/phenobarbital treatment 2.
- Liver function tests: Although not specifically mentioned in the provided studies, it is generally recommended to monitor liver function tests during treatment with anticonvulsants like lamotrigine.
Special Considerations
- Phenobarbital coadministration: The combination of lamotrigine and phenobarbital may increase the risk of blood dyscrasia, and close monitoring of hematologic parameters is recommended 2.
- High-risk patients: Patients with a history of allergy or those who are at high risk of adverse effects may require closer monitoring of laboratory tests during lamotrigine treatment 3.
Routine Monitoring
- Serum lamotrigine concentration: Routine monitoring of serum lamotrigine concentration is not recommended as a tool for routine dose adjustment 4.
- CBC monitoring in anticoagulated patients: Routine CBC monitoring in anticoagulated patients may provide some utility in detecting occult bleeding, but the yield of clinically important decreases in hemoglobin detected is low 5.