From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Lamotrigine should be titrated slowly to minimize the risk of serious rash, including Stevens-Johnson syndrome, with a standard final dose of 200 mg/day achieved through slow titration, as recommended by the most recent study 1. The titration protocol should start with 25 mg once daily for 2 weeks, then increase to 50 mg once daily for weeks 3 and 4, with subsequent increases of 50 mg every 1-2 weeks until reaching the target dose, typically 200-400 mg daily (divided into two doses) 1. If the patient is taking valproate, a slower titration schedule is required, starting with 25 mg every other day for 2 weeks, then 25 mg daily for weeks 3 and 4, with subsequent increases of 25-50 mg every 1-2 weeks 1. For patients on enzyme-inducing medications like carbamazepine, phenytoin, or rifampin, a faster titration may be needed, but this should be approached with caution and careful monitoring for adverse effects 1. Some studies have suggested alternative titration protocols, such as a rapid titration protocol that reaches a daily dose of 200 mg in 11 days 2, but these protocols are not widely established and may require further evaluation. It is essential to monitor patients for rash, fever, flu-like symptoms, or lymphadenopathy during titration, and to immediately discontinue lamotrigine if a rash develops 1. Key considerations for lamotrigine titration include:
- Starting with a low dose and gradually increasing to minimize the risk of serious rash
- Adjusting the titration schedule based on concomitant medications, such as valproate or enzyme-inducing medications
- Monitoring patients closely for adverse effects during titration
- Being aware of the potential for severe cutaneous reactions, particularly in the first 8 weeks of treatment.