Discontinuing Lamotrigine 50mg
Lamotrigine 50mg should be gradually tapered rather than abruptly discontinued to minimize the risk of seizures and withdrawal symptoms. 1
Tapering Protocol for Lamotrigine
The WHO guidelines specifically recommend that discontinuation of antiepileptic drugs like lamotrigine should be considered after 2 seizure-free years, with the decision made after careful consideration of clinical, social, and personal factors 1. Abrupt discontinuation is not recommended due to the risk of seizure recurrence and withdrawal symptoms.
Recommended Tapering Schedule:
- Implement a slow, reasonable, collaborative taper
- Start with very small dose reductions (approximately 10% of current dose)
- Each new dose should be 90% of the previous dose
- Monitor closely for withdrawal symptoms throughout the process
- Allow 2-4 weeks between dose reductions
For lamotrigine 50mg specifically:
- Reduce to 25mg daily for 2-4 weeks
- Then reduce to 12.5mg daily for 2-4 weeks
- Then discontinue completely
Monitoring During Discontinuation
During the tapering process, patients should be monitored for:
- Seizure recurrence (especially if lamotrigine was prescribed for epilepsy)
- Mood changes (particularly if prescribed for bipolar disorder)
- Withdrawal symptoms such as:
- Headache
- Nausea
- Dizziness
- Insomnia
- Anxiety
Special Considerations
If Used for Epilepsy
Lamotrigine discontinuation carries significant risk if the medication was prescribed for seizure control. The WHO guidelines specifically state that "discontinuation of antiepileptic drug treatment should be considered after 2 seizure-free years" 1. If the patient has not been seizure-free for this duration, discontinuation may not be advisable.
If Used for Bipolar Disorder
If lamotrigine was prescribed for bipolar disorder, be aware that discontinuation may increase the risk of mood episode recurrence, particularly depressive episodes, as lamotrigine is especially effective at preventing depressive episodes in bipolar disorder 2, 3.
Contraindications to Abrupt Discontinuation
Abrupt discontinuation of lamotrigine is contraindicated due to:
- Risk of seizure recurrence (even in patients without epilepsy)
- Risk of withdrawal symptoms
- Risk of mood destabilization in bipolar patients
Pitfalls to Avoid
- Never discontinue lamotrigine abruptly - this increases seizure risk even in patients taking it for psychiatric conditions
- Don't taper too quickly - rapid tapering can lead to withdrawal symptoms and increased seizure risk
- Avoid discontinuation without medical supervision - patients should be monitored throughout the tapering process
- Don't ignore breakthrough symptoms - if symptoms of the underlying condition emerge during tapering, the taper may need to be slowed or reconsidered
When to Pause or Reverse Tapering
Consider slowing or reversing the taper if:
- Seizures occur
- Significant mood symptoms emerge
- Intolerable withdrawal symptoms develop
The target dose may not be zero for all patients, and some patients whose regimens have been tapered to elimination may benefit from resumption at lower doses 1.