Lamotrigine and hemodialysis in bipolar disorder: case analysis of dosing strategy with literature review

Authors


  • This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The author declares that he had no conflict of interest.

Corresponding author:
Kenneth R. Kaufman, MD, MRCPsych
Departments of Psychiatry, Neurology, and Anesthesiology
UMDNJ-Robert Wood Johnson Medical School
125 Paterson Street, Suite #2200
New Brunswick, NJ 08901, USA
Fax: 1-732-235-7677
E-mail: kaufmakr@umdnj.edu

Abstract

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.

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