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Bipolar Disord. 2010 Jun;12(4):446-9. doi: 10.1111/j.1399-5618.2010.00818.x.

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

Author information

1
Departments of Psychiatry, Neurology, and Anesthesiology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA. kaufmakr@umdnj.edu

Abstract

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.

[Indexed for MEDLINE]

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