lamotrigine

Adult Dosing .

Dosage forms:  TAB: 25 mg, 100 mg, 150 mg, 200 mg; ER TAB: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg; ODT: 25 mg, 50 mg, 100 mg, 200 mg; CHEWABLE: 5 mg, 25 mg; blue convenience pack (tab); blue convenience pack (ODT); green convenience pack (tab); green convenience pack (ODT); orange convenience pack (tab); orange convenience pack (ODT)

Special Note

[blue convenience pack (tab) components]

Info: blue 5-wk starter pack contains 25 mg tab x35

[blue convenience pack (ODT) components]

Info: blue 5-wk starter pack contains 25 mg ODT x21 and 50 mg ODT x7

[green convenience pack (tab) components]

Info: green 5-wk starter pack contains 25 mg tab x84 and 100 mg tab x14

[green convenience pack (ODT) components]

Info: green 5-wk starter pack contains 50 mg ODT x42 and 100 mg ODT x14

[orange convenience pack (tab) components]

Info: orange 5-wk starter pack contains 25 mg tab x42 and 100 mg tab x7

[orange convenience pack (ODT) components]

Info: orange 5-wk starter pack contains 25 mg ODT x14 and 50 mg ODT x14 and 100 mg ODT x7

bipolar I disorder, maintenance tx

[pts taking valproate]

Dose: 100 mg PO qd; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk); Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; periodically reassess need for tx after 16wk; see pkg insert for dose adjustment if D/C valproate; taper dose over >2wk to D/C

[pts taking enzyme-inducing AED]

Dose: up to 200 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then 150 mg PO bid x1wk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; periodically reassess need for tx after 16wk; see pkg insert for dose adjustment if D/C enzyme-inducing AED; taper dose over >2wk to D/C

[pts not taking valproate or enzyme-inducing AED]

Dose: 200 mg PO qd; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk); Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; periodically reassess need for tx after 16wk; taper dose over >2wk to D/C

partial seizures

[immediate-release form, valproate adjunct]

Dose: 100-200 mg/day PO divided qd-bid w/ valproate alone; 100-400 mg/day PO divided qd-bid w/ valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[immediate-release form, enzyme-inducing AED adjunct]

Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[immediate-release form, non-valproate, non-enzyme inducing AED adjunct]

Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[immediate-release form, conversion from valproate or enzyme-inducing AED monotherapy]

Dose: 250 mg PO bid; Start: see pkg insert for titration schedule; Info: for conversion to lamotrigine monotherapy; not for initial monotherapy; enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[extended-release form, valproate adjunct]

Dose: 200-250 mg ER PO qd; Start: 25 mg ER PO qod x2wk, then 25 mg ER PO qd x2wk, then 50 mg ER PO qd x1wk, then incr. by 50 mg/day qwk x2wk, then incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, enzyme-inducing AED adjunct]

Dose: 400-600 mg ER PO qd; Start: 50 mg ER PO qd x2wk, then 100 mg ER PO qd x2wk, then incr. by 100 mg/day qwk x3wk, then may incr. by up to 100 mg/day qwk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, non-valproate, non-enzyme inducing AED adjunct]

Dose: 300-400 mg ER PO qd; Start: 25 mg ER PO qd x2wk, then 50 mg ER PO qd x2wk, then incr. by 50 mg/day qwk x3wk, then incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, conversion from AED monotherapy]

Dose: 250-300 mg ER PO qd; Start: see pkg insert for titration schedule; Info: for conversion to lamotrigine ER monotherapy; not for initial monotherapy; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

seizures, Lennox-Gastaut syndrome

[valproate adjunct]

Dose: 100-200 mg/day PO divided qd-bid w/ valproate alone; 100-400 mg/day PO divided qd-bid w/ valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[enzyme-inducing AED adjunct]

Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[non-valproate, non-enzyme inducing AED adjunct]

Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

seizures, primary generalized tonic clonic

[immediate-release form, valproate adjunct]

Dose: 100-200 mg/day PO divided qd-bid w/ valproate alone; 100-400 mg/day PO divided qd-bid w/ valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[immediate-release form, enzyme-inducing AED adjunct]

Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[immediate-release form, non-valproate, non-enzyme inducing AED adjunct]

Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[extended-release form, valproate adjunct]

Dose: 200-250 mg ER PO qd; Start: 25 mg ER PO qod x2wk, then 25 mg ER PO qd x2wk, then 50 mg ER PO qd x1wk, then incr. by 50 mg/day qwk x2wk, then incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, enzyme-inducing AED adjunct]

Dose: 400-600 mg ER PO qd; Start: 50 mg ER PO qd x2wk, then 100 mg ER PO qd x2wk, then incr. by 100 mg/day qwk x3wk, then may incr. by up to 100 mg/day qwk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, non-valproate, non-enzyme inducing AED adjunct]

Dose: 300-400 mg ER PO qd; Start: 25 mg ER PO qd x2wk, then 50 mg ER PO qd x2wk, then incr. by 50 mg/day qwk x3wk, then incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

short-lasting unilateral neuralgiform headache attacks prophylaxis (off-label)

[immediate-release form]

Dose: 150-200 mg PO bid; Start: 25 mg PO qd x1wk, may incr. by 25-50 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[extended-release form]

Dose: 300-400 mg ER PO qd; Start: 25 mg ER PO qd x1wk, may incr. by 25-50 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

neuropathic pain, diabetic (off-label)

[immediate-release form]

Dose: 100-200 mg PO bid; Start: 25 mg PO qd x2wk, then 50 mg/day PO divided qd-bid x2wk, then may incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C

[extended-release form]

Dose: 200-400 mg ER PO qd; Start: 25 mg ER PO qd x2wk, then 50 mg ER PO qd x2wk, then may incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

renal dosing

[immediate-release form]

CrCl 10-50: decr. usual dose by 25%; CrCl <10: 100 mg qod

HD: 100 mg x1 after each dialysis; no supplement; PD: 100 mg qod; supplement not defined

[extended-release form]

significant impairment: consider decr. usual maint. dose

HD/PD: not defined

hepatic dosing

[adjust dose amount]

moderate-severe impairment w/o ascites: decr. usual dose by 25%; severe impairment w/ ascites: decr. usual dose by 50%

Peds Dosing .

Dosage forms:  TAB: 25 mg, 100 mg, 150 mg, 200 mg; ER TAB: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg; ODT: 25 mg, 50 mg, 100 mg, 200 mg; CHEWABLE: 5 mg, 25 mg; blue convenience pack (tab); blue convenience pack (ODT); green convenience pack (tab); green convenience pack (ODT); orange convenience pack (tab); orange convenience pack (ODT)

Special Note

[blue convenience pack (tab) components]

Info: blue 5-wk starter pack contains 25 mg tab x35

[blue convenience pack (ODT) components]

Info: blue 5-wk starter pack contains 25 mg ODT x21 and 50 mg ODT x7

[green convenience pack (tab) components]

Info: green 5-wk starter pack contains 25 mg tab x84 and 100 mg tab x14

[green convenience pack (ODT) components]

Info: green 5-wk starter pack contains 50 mg ODT x42 and 100 mg ODT x14

[orange convenience pack (tab) components]

Info: orange 5-wk starter pack contains 25 mg tab x42 and 100 mg tab x7

[orange convenience pack (ODT) components]

Info: orange 5-wk starter pack contains 25 mg ODT x14 and 50 mg ODT x14 and 100 mg ODT x7

partial seizures

[immediate-release form, valproate adjunct, 2-12 yo, 6.8-13.9 kg]

Dose: 1-3 mg/kg/day PO divided qd-bid w/ valproate alone; 1-5 mg/kg/day PO divided qd-bid w/ valproate and other AEDs; Start: 2 mg PO qod x2wk, then 2 mg PO qd x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; use chewable lamotrigine tab for 2 mg dose; up to 50% higher maint. dose may be needed; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, valproate adjunct, 2-12 yo, >14 kg]

Dose: 1-3 mg/kg/day PO divided qd-bid w/ valproate alone; 1-5 mg/kg/day PO divided qd-bid w/ valproate and other AEDs; Start: 0.15 mg/kg/day PO divided qd-bid x2wk, then 0.3 mg/kg/day PO divided qd-bid x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, valproate adjunct, >12 yo]

Dose: 100-200 mg/day PO divided qd-bid w/ valproate alone; 100-400 mg/day PO divided qd-bid w/ valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, enzyme-inducing AED adjunct, 2-12 yo]

Dose: 5-15 mg/kg/day PO divided bid; Start: 0.6 mg/kg/day PO divided bid x2wk, then 1.2 mg/kg/day PO divided bid x2wk, then incr. by 1.2 mg/kg/day q1-2wk; Max: 400 mg/day; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, enzyme-inducing AED adjunct, >12 yo]

Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, non-valproate, non-enzyme inducing AED adjunct, 2-12 yo]

Dose: 4.5-7.5 mg/kg/day PO divided bid; Start: 0.3 mg/kg/day PO divided qd-bid x2wk, then 0.6 mg/kg/day PO divided bid x2wk, then incr. by 0.6 mg/kg/day q1-2wk; Max: 300 mg/day; Info: round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, non-valproate, non-enzyme inducing AED adjunct, >12 yo]

Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, conversion from valproate or enzyme-inducing AED monotherapy, 16 yo and older]

Dose: 250 mg PO bid; Start: see pkg insert for titration schedule; Info: for conversion to lamotrigine monotherapy; not for initial monotherapy; enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[extended-release form, valproate adjunct, 13 yo and older]

Dose: 200-250 mg ER PO qd; Start: 25 mg ER PO qod x2wk, then 25 mg ER PO qd x2wk, then 50 mg ER PO qd x1wk, then incr. by 50 mg/day qwk x2wk, then incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, enzyme-inducing AED adjunct, 13 yo and older]

Dose: 400-600 mg ER PO qd; Start: 50 mg ER PO qd x2wk, then 100 mg ER PO qd x2wk, then incr. by 100 mg/day qwk x3wk, then incr. by up to 100 mg/day qwk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, non-valproate, non-enzyme inducing AED adjunct, 13 yo and older]

Dose: 300-400 mg ER PO qd; Start: 25 mg ER PO qd x2wk, then 50 mg ER PO qd x2wk, then incr. by 50 mg/day qwk x3wk, then incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, conversion from AED monotherapy, 13 yo and older]

Dose: 250-300 mg ER PO qd; Start: see pkg insert for titration schedule; Info: for conversion to lamotrigine ER monotherapy; not for initial monotherapy; retitrate if tx interrupted for >5 half-lives; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

seizures, Lennox-Gastaut syndrome

[valproate adjunct, 2-12 yo, 6.8-13.9 kg]

Dose: 1-3 mg/kg/day PO divided qd-bid w/ valproate alone; 1-5 mg/kg/day PO divided qd-bid w/ valproate and other AEDs; Start: 2 mg PO qod x2wk, then 2 mg PO qd x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; use chewable lamotrigine tab for 2 mg dose; up to 50% higher maint. dose may be needed; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[valproate adjunct, 2-12 yo, >14 kg]

Dose: 1-3 mg/kg/day PO divided qd-bid w/ valproate alone; 1-5 mg/kg/day PO divided qd-bid w/ valproate and other AEDs; Start: 0.15 mg/kg/day PO divided qd-bid x2wk, then 0.3 mg/kg/day PO divided qd-bid x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[valproate adjunct, >12 yo]

Dose: 100-200 mg/day PO divided qd-bid w/ valproate alone; 100-400 mg/day PO divided qd-bid w/ valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[enzyme-inducing AED adjunct, 2-12 yo]

Dose: 5-15 mg/kg/day PO divided bid; Start: 0.6 mg/kg/day PO divided bid x2wk, then 1.2 mg/kg/day PO divided bid x2wk, then incr. by 1.2 mg/kg/day q1-2wk; Max: 400 mg/day; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[enzyme-inducing AED adjunct, >12 yo]

Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[non-valproate, non-enzyme inducing AED adjunct, 2-12 yo]

Dose: 4.5-7.5 mg/kg/day PO divided bid; Start: 0.3 mg/kg/day PO divided qd-bid x2wk, then 0.6 mg/kg/day PO divided bid x2wk, then incr. by 0.6 mg/kg/day q1-2wk; Max: 300 mg/day; Info: round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[non-valproate, non-enzyme inducing AED adjunct, >12 yo]

Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

seizures, primary generalized tonic clonic

[immediate-release form, valproate adjunct, 2-12 yo, 6.8-13.9 kg]

Dose: 1-3 mg/kg/day PO divided qd-bid w/ valproate alone; 1-5 mg/kg/day PO divided qd-bid w/ valproate and other AEDs; Start: 2 mg PO qod x2wk, then 2 mg PO qd x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; use chewable lamotrigine tab for 2 mg dose; up to 50% higher maint. dose may be needed; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, valproate adjunct, 2-12 yo, >14 kg]

Dose: 1-3 mg/kg/day PO divided qd-bid w/ valproate alone; 1-5 mg/kg/day PO divided qd-bid w/ valproate and other AEDs; Start: 0.15 mg/kg/day PO divided qd-bid x2wk, then 0.3 mg/kg/day PO divided qd-bid x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, valproate adjunct, >12 yo]

Dose: 100-200 mg/day PO divided qd-bid w/ valproate alone; 100-400 mg/day PO divided qd-bid w/ valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, enzyme-inducing AED adjunct, 2-12 yo]

Dose: 5-15 mg/kg/day PO divided bid; Start: 0.6 mg/kg/day PO divided bid x2wk, then 1.2 mg/kg/day PO divided bid x2wk, then incr. by 1.2 mg/kg/day q1-2wk; Max: 400 mg/day; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, enzyme-inducing AED adjunct, >12 yo]

Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, non-valproate, non-enzyme inducing AED adjunct, 2-12 yo]

Dose: 4.5-7.5 mg/kg/day PO divided bid; Start: 0.3 mg/kg/day PO divided qd-bid x2wk, then 0.6 mg/kg/day PO divided bid x2wk, then incr. by 0.6 mg/kg/day q1-2wk; Max: 300 mg/day; Info: round dose down to nearest whole tab size; pts <30 kg may need up to 50% higher maint. dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[immediate-release form, non-valproate, non-enzyme inducing AED adjunct, >12 yo]

Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C

[extended-release form, valproate adjunct, 13 yo and older]

Dose: 200-250 mg ER PO qd; Start: 25 mg ER PO qod x2wk, then 25 mg ER PO qd x2wk, then 50 mg ER PO qd x1wk, then incr. by 50 mg/day qwk x2wk, then incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, enzyme-inducing AED adjunct, 13 yo and older]

Dose: 400-600 mg ER PO qd; Start: 50 mg ER PO qd x2wk, then 100 mg ER PO qd x2wk, then incr. by 100 mg/day qwk x3wk, then incr. by up to 100 mg/day qwk; Info: enzyme-inducing AEDs incl. carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

[extended-release form, non-valproate, non-enzyme inducing AED adjunct, 13 yo and older]

Dose: 300-400 mg ER PO qd; Start: 25 mg ER PO qd x2wk, then 50 mg ER PO qd x2wk, then incr. by 50 mg/day qwk x3wk, then incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; may convert from IR to ER at same total daily dose; do not cut/crush/chew ER tab; taper dose over >2wk to D/C

renal dosing

[immediate-release form]

CrCl <10: decr. usual dose by 50%

HD: decr. usual dose by 50%; supplement after dialysis not defined; PD: decr. usual dose by 50%; supplement not defined

[extended-release form]

significant impairment: consider decr. usual maint. dose

HD/PD: not defined

hepatic dosing

[adjust dose amount]

moderate-severe impairment w/o ascites: decr. usual dose by 25%; severe impairment w/ ascites: decr. usual dose by 50%