Lamotrigine dosing for pregnant patients with bipolar disorder

Crystal T. Clark*, Autumn M. Klein, James M. Perel, Joseph Helsel, Katherine L. Wisner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

83 Scopus citations


Objective: Little information is available on the need for dosage changes for lamotrigine in pregnant women with bipolar disorder. The authors present new data on serial serum levels of lamotrigine in pregnant patients on lamotriginemonotherapy. They also review the epilepsy literature on use of lamotrigine during pregnancy. Method: Lamotrigine serum sampleswere obtained from eight mother-infant pairs at different time points during pregnancy and the postpartum period. Results: All of the women were taking lamotrigine throughout pregnancy. Serumlevelto-dose ratios were lower during pregnancy than the postpartum period. Lamotrigine was taken once daily in doses ranging from 100 mg to 300 mg. Three patients had an increase of 50 mg to their daily dose across pregnancy. The change in serumlamotrigine levels in the postpartum period ranged from a 30% decrease to a 640% increase compared with the first level obtained during pregnancy. Level-todose ratios obtained within 4 weeks after delivery reflected a mean level 402% greater than the baseline level during gestation. Compared with the third trimester, lamotrigine serum concentration increased an average of 154% within 5 weeks after delivery. The most dramatic increase in lamotrigine serum level early after delivery occurred at 1.5 weeks. The mean infant cord level was 66% of the maternal serum level at delivery. The mean breastfed infant serum level was 32.5% of the maternal serum levels. Conclusions: The pattern of lamotrigine changes during pregnancy in these women with bipolar disorder was consistent with that described in the epilepsy literature.

Original languageEnglish (US)
Pages (from-to)1240-1247
Number of pages8
JournalAmerican Journal of Psychiatry
Issue number11
StatePublished - Nov 1 2013

ASJC Scopus subject areas

  • Psychiatry and Mental health


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