Issues for Surgery
For epilepsy – precipitation of rebound seizures or status epilepticus if omitted.
For treatment of bipolar disorder – risk of rebound bipolar symptoms.
Advice in the Perioperative period
Elective and Emergency Surgery
Patients should be advised to take their regular medications on the day of surgery1, 2, 3.
Abrupt withdrawal of any anticonvulsant drug should be avoided1.
Confirm with the patient if they need to be maintained on a specific manufacturer’s product (see Further Information).
Regular dosing of the patient’s usual oral medication should be re-established as early as possible post-operatively2, 3.
Lamotrigine is only available as oral preparations. If patients cannot resume their usual oral medication post-operatively, the advice of a Neurologist (for epilepsy patients) or Psychiatrist (for bipolar patients), should be sought to determine the most appropriate preparation, dose, route and frequency to be used.
Monitor renal function – refer to specialist information for dosing recommendations if renal impairment occurs post-operatively.
Interaction(s) with Common Anaesthetic Agents
For general information regarding the use of anaesthetic agents in epilepsy patients – see ‘Antiepileptics – A General Overview’.
Central Nervous System (CNS) Depression (also see under Interaction(s) with other Common Medicines used in the Perioperative Period)
Lamotrigine has CNS depressant effects which may be additive with other medicines that also have CNS depressant effects such as1:-
*NB: Tramadol should be avoided in patients with a history of epilepsy due to an increase in seizure risk1.
(Consult British National Formulary for available drugs in each class)
Interaction(s) with other Common Medicines used in the Perioperative Perio d
For general information regarding the use of antiemetics in epilepsy patients – see ‘Antiepileptics – A General Overview’.
CNS Depression (also see under Interaction(s) with Common Anaesthetic Agents for information on opioids)
Lamotrigine has CNS depressant effects which may be additive with antiemetics that also have CNS depressant effects such as cyclizine, droperidol and prochlorperazine*1.
*NB: see ‘Antiepileptics – A General Overview’
MHRA/CHM Advice: Antiepileptic Drugs: updated advice on switching between different manufacturer’s products for a particular drug (November 2017)1
Serious skin reactions including Steven-Johnson syndrome and toxic epidermal necrolysis have developed during treatment with lamotrigine; most rashes occur within the first 8 weeks of treatment1, 4. Rash is sometimes associated with hypersensitivity syndrome. Consider withdrawal if serious rash or signs of hypersensitivity syndrome develop1. If withdrawal of the drug is necessary, consult a Neurologist / Psychiatrist to ensure that an appropriate management plan is in place.