From the Research
The best augmenting medication for a patient taking Lamictal (lamotrigine) 200mg daily is aripiprazole, as it has been shown to be effective in combination with lamotrigine for the long-term treatment of patients with bipolar I disorder (manic or mixed) 1. When considering augmentation strategies for lamotrigine, it's essential to evaluate the specific condition being treated and individual patient factors. For bipolar disorder, several options can be considered:
- Aripiprazole, which has been studied in combination with lamotrigine, showing a delay in time to manic/mixed relapse, although not statistically significant 1.
- Lithium, often considered a first-choice augmentation strategy, typically started at 300mg twice daily and titrated to achieve blood levels between 0.6-1.2 mEq/L.
- Valproate (Depakote), another effective option, usually started at 250mg twice daily and gradually increased to therapeutic levels (50-125 μg/mL).
- For patients with depression, adding an SSRI like sertraline (50-200mg daily) or bupropion (150-300mg daily) may be beneficial.
- For treatment-resistant epilepsy, adding levetiracetam (Keppra) starting at 500mg twice daily or topiramate (Topamax) starting at 25mg daily and slowly titrating upward can improve seizure control. It's crucial to consider potential drug interactions, as some medications may decrease lamotrigine levels (carbamazepine, phenytoin) while others may increase them (valproate) 2, 3, 4, 5. Regular blood monitoring is essential when combining mood stabilizers, and dose adjustments of lamotrigine may be necessary when adding certain medications to maintain therapeutic efficacy while minimizing side effects.