Lamotrigine Tapering Protocol

Introduction to Tapering

Antiseizure medications like lamotrigine require tapering to prevent withdrawal symptoms and minimize risks of discontinuation, as recommended by the American Academy of Child and Adolescent Psychiatry 1

A gradual tapering schedule over weeks to months rather than abrupt discontinuation is recommended by the American Academy of Child and Adolescent Psychiatry 2
For patients on higher doses or who have been on lamotrigine long-term, an even more gradual taper may be warranted, according to the American Academy of Child and Adolescent Psychiatry 2
Monitor closely for return of symptoms during the tapering process, as advised by the American Academy of Child and Adolescent Psychiatry 2

Develop a clear monitoring plan during the tapering process, as recommended by the American Academy of Child and Adolescent Psychiatry 2
Be aware that return of symptoms may take weeks to months to emerge after dose reduction or discontinuation, according to the American Academy of Child and Adolescent Psychiatry 2
Consider more frequent follow-up appointments during the tapering period to assess for return of the original condition, emergence of withdrawal symptoms, and need for adjustment of the tapering schedule, as suggested by the American Academy of Child and Adolescent Psychiatry 2

The American Academy of Child and Adolescent Psychiatry recommends implementing a gradual tapering schedule with dose reductions of approximately 25% of the most recent dose every 1-2 weeks 3

The American Academy of Child and Adolescent Psychiatry suggests scheduling more frequent follow-up appointments during the tapering period to assess for return of original symptoms, such as bipolar disorder or seizures, and emergence of withdrawal symptoms 4
The American Academy of Child and Adolescent Psychiatry also notes that return of symptoms may take weeks to months to emerge after dose reduction or discontinuation 4

The Centers for Disease Control and Prevention recommends tapering the benzodiazepine first in patients taking both lamotrigine and benzodiazepines who require tapering of both medications, due to greater risks associated with benzodiazepine withdrawal 5, 6

The American Academy of Child and Adolescent Psychiatry advises against abrupt discontinuation, which can precipitate seizures in patients with epilepsy or mood episodes in patients with bipolar disorder 4

Patients with a history of severe rash with lamotrigine require special consideration, as reintroduction after discontinuation carries risk 7