Therapeutic Drug Monitoring of Lamotrigine

OBJECTIVE: To evaluate the usefulness of routine monitoring of serum lamotrigine concentration. DATA SOURCE: Literature was accessed through MEDLINE (1990–January 2001). Key search terms included lamotrigine, pharmacokinetics, and epilepsy. DATA SYNTHESIS: A decision-making algorithm was used to evaluate the clinical evidence to support or refute the routine use of serum lamotrigine concentrations to adjust doses. The value of serum lamotrigine concentration monitoring remains controversial, primarily because clear relationships between concentration and pharmacologic response (either efficacy or toxicity) have not been demonstrated. CONCLUSIONS: Serum concentration monitoring of lamotrigine is not recommended as a tool for routine dose adjustment.

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