From the Research
The recommended protocol for tapering lamotrigine involves a gradual reduction of 25-50 mg every 1-2 weeks, with slower tapers for patients on higher doses or those with a history of seizures. This approach is based on the most recent and highest quality study available, which emphasizes the importance of a gradual taper to minimize withdrawal symptoms and reduce the risk of seizure recurrence 1.
Key Considerations for Tapering Lamotrigine
- Begin by decreasing the daily dose by approximately 25% of the original dose, then continue reducing by similar increments every 1-2 weeks until reaching about 25-50 mg daily, at which point the medication can be discontinued.
- For patients on higher doses (>400 mg daily), consider smaller percentage reductions (10-15%) per step.
- The taper should be extended over at least 4 weeks, with longer durations (8-12 weeks) for those with seizure disorders or who have been on the medication long-term.
- Patients should be monitored for mood changes, sleep disturbances, and the emergence of neurological symptoms during the tapering process, as these may indicate the need for a more gradual reduction schedule.
Importance of Gradual Taper
The slow taper is particularly important with lamotrigine because abrupt discontinuation can trigger seizures even in patients taking it for non-epileptic conditions 2. Additionally, the combination of lamotrigine with other medications, such as valproic acid, can increase the risk of adverse reactions, including toxic epidermal necrolysis (TEN) 2.
Monitoring and Adjustments
During the tapering process, patients should be closely monitored for any signs of withdrawal symptoms or seizure recurrence. If any adverse effects are observed, the taper schedule may need to be adjusted to a more gradual reduction. This approach prioritizes the patient's safety and well-being, minimizing the risk of complications and ensuring a successful tapering process.