Kaufman KR. Lamotrigine and hemodialysis in bipolar disorder: case analysis of dosing strategy with literature review.
Bipolar Disord 2010: 12: 446–449. © 2010 The Author. Journal compilation © 2010 John Wiley & Sons A/S.
Objective: Medical conditions and associated procedures/treatments may impact therapeutic blood levels of pharmacologic agents in the illnesses we treat. The use of anti-epileptic drugs in the treatment of psychiatric disorders, most commonly bipolar disorders, and epilepsy is a case in point. This report addresses the impact of hemodialysis on lamotrigine efficacy in bipolar disorder.
Method: Case analysis with literature review.
Results: A bipolar disorder patient stabilized on lamotrigine 200 mg total daily dose was admitted to the hospital with end-stage renal disease. With three consecutive days of hemodialysis, treatment-emergent hypomanic features were noted by the patient and confirmed in psychiatric consultation. When lamotrigine was increased to 250 mg total daily dose, the bipolar features remitted.
Conclusion: Lamotrigine titration may be required in bipolar disorder patients undergoing hemodialysis secondary to the associated hemodialysis extraction factor. Therapeutic drug monitoring is recommended in these patients.