Conversion to lamotrigine monotherapy from valproate monotherapy in older adolescent patients with epilepsy

Robert J. Baumann, Toufic A. Fakhoury, Robert P. Kustra, Alain Vuong, Anne E. Hammer, John A. Messenheimer

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Pharmacokinetic interactions can make necessary anti-epileptic medication (AED) changes hazardous for children with epilepsy. We report the utility of a dosing algorithm designed to maintain stable trough lamotrigine (LTG) concentrations during conversion from valproate (VPA) to LTG monotherapy in adolescents aged 16-20 years. Methods: Patients were enrolled into the study if they required a change in their AED regimen due to lack of efficacy or intolerable side effects. Conversion to LTG monotherapy took place in a four part treatment algorithm. Lamotrigine was escalated according to a target dose of 200 mg/day over 8-weeks. Valproate was withdrawn over a period of 2-6 weeks, depending on the initial dose. Lamotrigine dose was further escalated to 500 mg/day and continued for four weeks as monotherapy. Trough serum concentrations of LTG were measured during each phase of the trial. Results: Twelve of 16 patients completed the study. After the LTG escalation to 200 mg/day, mean trough serum concentrations of 8.0 μg/mL did not differ significantly from the 9.5 μg/mL after VPA withdrawal or the 9.2 μg/mL after 4 weeks of monotherapy at 500 mg/day. Adverse events led to premature discontinuation for one subject. Two subjects withdrew due to worsening seizures during LTG monotherapy possibly due to non-compliance. Limitations of the trial include the open label design and small sample size of the sub-analysis. Conclusion: In adolescent patients, this algorithm produces stable LTG serum concentrations with favorable tolerability during a transition from VPA to LTG monotherapy.

Original languageEnglish
Pages (from-to)2461-2465
Number of pages5
JournalCurrent Medical Research and Opinion
Issue number10
StatePublished - Oct 2007


  • Adolescents
  • Conversion
  • Epilepsy
  • Lamotrigine
  • Monotherapy
  • Valproate

ASJC Scopus subject areas

  • Medicine (all)


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