From the Research
Tapering off lamotrigine should be done gradually over at least 2 weeks to minimize the risk of seizure recurrence or mood destabilization. A typical tapering schedule involves reducing the dose by 25-50 mg every 1-2 weeks, with slower reductions for those on higher doses. For example, someone taking 200 mg daily might reduce to 150 mg daily for 1-2 weeks, then 100 mg daily for 1-2 weeks, then 50 mg daily for 1-2 weeks before stopping completely. Patients with epilepsy generally require slower tapering than those taking it for mood disorders. During the tapering process, patients should monitor for breakthrough seizures, mood changes, or withdrawal symptoms such as headache, dizziness, or irritability. Abrupt discontinuation can trigger seizures even in patients without epilepsy or cause severe mood destabilization in bipolar disorder. The gradual reduction allows the brain to adjust to decreasing levels of the medication, as lamotrigine works by stabilizing neuronal membranes through inhibition of voltage-sensitive sodium channels and modulation of glutamate release. Any tapering should be done under medical supervision, with the schedule potentially adjusted based on individual response.
Some key points to consider when tapering off lamotrigine include:
- The risk of seizure recurrence or mood destabilization is higher with abrupt discontinuation, as seen in studies on benzodiazepine withdrawal 1, 2
- A gradual tapering schedule can help minimize this risk, as suggested by studies on antipsychotic tapering 3, 4
- The tapering schedule may need to be adjusted based on individual response, with slower reductions for those on higher doses or with a history of epilepsy
- Patients should be monitored closely for breakthrough seizures, mood changes, or withdrawal symptoms during the tapering process
It's worth noting that the provided evidence on benzodiazepine withdrawal and antipsychotic tapering may not be directly applicable to lamotrigine tapering, but the principles of gradual tapering and close monitoring can still be applied. The most recent and highest quality study on tapering antipsychotics suggests that slower tapering over months or years may be associated with a lower risk of relapse 4. However, the specific tapering schedule for lamotrigine should be determined on a case-by-case basis, taking into account the individual patient's medical history and response to the medication.