How to Safely Stop Lamotrigine (Lamictal)
Lamotrigine must be tapered gradually over weeks to months with dose reductions of approximately 25% of the current dose every 1-2 weeks, never stopped abruptly, to prevent withdrawal symptoms and minimize risk of seizure recurrence in epilepsy patients or mood destabilization in bipolar disorder patients. 1
Tapering Schedule
The recommended approach is to reduce the dose by approximately 25% of the most recent dose every 1-2 weeks. 1 This gradual schedule is critical regardless of your indication for taking lamotrigine (epilepsy, bipolar disorder, or other conditions).
- For patients on higher doses or who have been on lamotrigine long-term, an even slower taper may be warranted 1
- The tapering process typically takes weeks to months depending on your starting dose 1
- Each dose reduction should be 25% of your current dose, not the original starting dose 1
Critical Monitoring During Tapering
Schedule more frequent follow-up appointments during the tapering period to assess for return of original symptoms and emergence of withdrawal symptoms. 1
Key monitoring points include:
- Return of symptoms may take weeks to months to emerge after dose reduction or discontinuation 1
- For epilepsy patients: monitor for increased seizure frequency or new seizure types 2
- For bipolar disorder patients: monitor for mood destabilization or emergence of depressive/manic episodes 1
- Watch for withdrawal symptoms including psychomotor changes, tremor, tachycardia, and excessive sweating 3
Special Considerations
If you are taking both lamotrigine and a benzodiazepine and need to taper both medications, taper the benzodiazepine first due to greater risks associated with benzodiazepine withdrawal. 1
Drug Interactions Affecting Tapering
Your tapering schedule may need adjustment based on other medications:
- If you're also taking valproate (valproic acid), lamotrigine levels are significantly elevated (approximately doubled), so the taper can proceed as planned 4
- If you're taking enzyme-inducing drugs (phenytoin, carbamazepine, phenobarbital), lamotrigine is cleared faster, and withdrawal symptoms may emerge more quickly 4
Critical Pitfalls to Avoid
Never discontinue lamotrigine abruptly, as this can precipitate seizures in epilepsy patients or acute mood episodes in bipolar disorder patients. 1
- Abrupt discontinuation is no more appropriate with lamotrigine than with antihypertensives or antihyperglycemics 2
- Sudden cessation without medical supervision constitutes unacceptable medical care except in extreme cases 2
- If you have a history of severe rash with lamotrigine, reintroduction after discontinuation carries significant risk and requires special consideration 1
When Tapering May Be Appropriate
For epilepsy patients specifically, discontinuation should be considered after 2 seizure-free years, with the decision made after consideration of clinical, social, and personal factors and with patient/family involvement 2
Clinical Context
Withdrawal reactions to lamotrigine, while not commonly reported, can occur and may include psychomotor inhibition, anhedonia, tremor, tachycardia, and significant hand sweating 3. These symptoms typically resolve spontaneously within days but underscore the importance of gradual tapering rather than abrupt cessation.