{
  "abstract": "Lamotrigine pharmacokinetics alter during pregnancy often necessitating dose increases to maintain levels/seizure control.Objective Evaluating and guiding lamotrigine dose adjustments, mainly postpartum.Methods Retrospective record review of lamotrigine dose adjustments and seizures in pregnant women with epilepsy with due dates from October 2020,Results Data were analysed in 15/18. Nine reported seizures the year prior. Three improved and three worsened in pregnancy and four experienced generalised tonic-clonic seizures (GTCS). Lamotrigine doses, guided by serum levels and/or seizure control, ranged from 50mg–550mg/day pre-pregnancy, increasing to 200–1000mg/day in 12/15(80%) by term. Increases ranged from 50mg to 450mg/day (median 150mg). Postpartum, 8/12 with dose increases had dose reductions advised starting 2-7 days postpartum tapering over the first few weeks. Where needed for enhanced protection, maintenance doses postpartum were advised above pre-pregnancy doses. One feeling vulnerable at early follow-up had the dose increased. Three reported seizures postpartum (2 GTCS: one no dose changes; one had improved postpartum). There were no recorded medication side effects.Conclusion Postpartum, metabolic normalisation requires reduction to avoid toxicity where there has been a significant increase in lamotrigine dose. We advise early stepwise reductions, individualized per patient, largely during the 2-3 weeks postpartum. Our data support this approach.Lina.Nashef@nhs.net",
  "authors": [
    {
      "affiliations": [
        "Kings College Hospital"
      ],
      "name": "Sewell Emily"
    },
    {
      "affiliations": [
        "Kings College Hospital"
      ],
      "name": "Hajihashemi Sahar"
    },
    {
      "affiliations": [
        "Kings College Hospital"
      ],
      "name": "Mantoan Ritter Laura"
    },
    {
      "affiliations": [
        "Kings College Hospital"
      ],
      "name": "Nashef Lina"
    }
  ],
  "title": "184 Dose adjustments of lamotrigine during pregnancy and the postpartum period",
  "uid": "4f62c532-d6af-5e3d-9c5e-0cac4de206bd"
}