Clinical Medications Worksheets
Generic Name Trade Name
lamotrigine Lamictal
Peak Onset Duration
1.4-4.8 hr unknown unknown
Why is your patient getting this medication
Seizure disorder, bipolar disorder
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).
Interactions with other patient drugs, OTC or herbal
medicines (ask patient specifically)
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.
Classification Dose Route Time/frequency
anticonvulsants 50 mg PO Q am
200mg PO Q hs
Normal dosage range
25 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)
For IV meds, compatibility with IV drips and/or solutions
N/A
Nursing Implications (what to focus on)
Contraindications/warnings/interactions
Hypersensitivity. Impaired cardiac function.
Common side effects
Ataxia, dizziness, headache, nausea, vomiting, photosensitivity, rash
(higher incidence in children, patients caking, VPA, high initial doses,
or rapid dosage increases).
Lab value alterations caused by medicine
Lamotrigine 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/ml
Be sure to teach the patient the following about this medication
Instruct 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.
Assessment Evaluation
Why would you hold or not give this med? Check after giving
Do not discontinue abruptly; may cause Decrease in the frequency of or
increase in frequency of seizures. cessation of seizures. Decreased
incidence of mood swings in
bipolar disorders.