Clinical Medications WorksheetsGeneric Namelamotrigine

Trade NameLamictal

Classificationanticonvulsants

Dose50 mg200mg

RoutePOPO

Time/frequencyQ amQ hs

Peak1.4-4.8 hr

Onsetunknown

Durationunknown

Normal dosage range25 mg every other day for first 2 wk, then 25 mg once daily for next 2 wk; then increase by 25-50 mg/day every 1-2 wk to maintenance dose of 50-200 mg twice daily (not to exceed 400 mg/day)

Why is your patient getting this medicationSeizure disorder, bipolar disorder

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)One proposed mechanism of action of Lamotrigine, the relevance of which remains to be established in humans, involves an effect on sodium channels. in vitro pharmacological studies suggest that lamotrigine inhibits voltage-sensitive sodium channels, thereby stabilizing neuronal membranes and consequently modulating presynaptic transmitter release of excitatory amino acids (e.g., glutamate and aspartate).

Nursing Implications (what to focus on) Contraindications/warnings/interactionsHypersensitivity. Impaired cardiac function.

Common side effectsAtaxia, dizziness, headache, nausea, vomiting, photosensitivity, rash (higher incidence in children, patients caking, VPA, high initial doses, or rapid dosage increases).

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)

Lab value alterations caused by medicineLamotrigine plasma concentrations may be monitored periodically during therapy, especially in patients concurrently taking other anticonvulsants. Therapeutic plasma concentration range has not been established, proposed therapeutic range: 1-5 mcg/mlBe sure to teach the patient the following about this medicationInstruct patient to take medication exactly as directed. Take missed doses as soon as possible unless almost time for next dose. Do not double doses. Do not discontinue abruptly; may cause increase in frequency of seizures. Advise patient to notify health care professional immediately if skin rash occurs or if frequency of seizures increases. May cause dizziness, drowsiness, and blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known. Do not resume driving until physician gives clearance based on control of seizure disorder. Caution patient to wear sunscreen and protective clothing to prevent photosensitivity reactions. Instruct patient to notify health care professional of medication regimen prior to treatment or surgery. Advise patient to carry identification at all times describing disease process and medication regimen.

Nursing Process- Assessment(Pre-administration assessment)Assess patient for skin rash frequently during therapy. Discontinue lamotrigine at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Rash usually occurs during the initial 2-8 wk of therapy and is more frequent in patients taking multiple antiepileptic agents, especially valproic acid. Assess location, duration, and characteristics of seizure activity. Assess mood, ideation, and behaviors frequently. Initiate suicide precautions if indicated.

AssessmentWhy would you hold or not give this med?Do not discontinue abruptly; may cause increase in frequency of seizures.

EvaluationCheck after givingDecrease in the frequency of or cessation of seizures. Decreased incidence of mood swings in bipolar disorders.