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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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History Of TBI, Seizure. On Dilantin, Recommended Gradual Switch To Lamictal. Possibiilty Of Any Contraindication?

I had a tbi from falling down stairs on 11/2009. I ve had one seizure on 7/2010. I ve been on dilantin(460 to keep blood level at 15) the entire time. My neurologist suggested switching to lamictal gradually. I m up to 300 mg. daily on way to 400 mg, then weaning off dilantin. This is scary for me. Will lamictal most likely keep the seizures away as dilantin had been? If I haven t had a rash or side effects on 300 mg. a day, will I most likely not have any? I am worried about having a seizure during dilantin discontinuation.
Mon, 5 Feb 2024
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General & Family Physician 's  Response
Hi,

Normally, if the switching over dose are okay and switch over is gradual, there should not be any problem. However, in my opinion, it may be better, if gradual tapering down dose of Dilantin is accompanied by gradual increasing dose of Lamictal simultaneously, thus subsequently reaching the maximum desired dose of Lamictal and complete weaning off from Dilantin simultaneously. All this exercise can be completed in 3 or 4 phases, each phase lasting for about a month or so.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Satnarain Bansal, General & Family Physician
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History Of TBI, Seizure. On Dilantin, Recommended Gradual Switch To Lamictal. Possibiilty Of Any Contraindication?

Hi, Normally, if the switching over dose are okay and switch over is gradual, there should not be any problem. However, in my opinion, it may be better, if gradual tapering down dose of Dilantin is accompanied by gradual increasing dose of Lamictal simultaneously, thus subsequently reaching the maximum desired dose of Lamictal and complete weaning off from Dilantin simultaneously. All this exercise can be completed in 3 or 4 phases, each phase lasting for about a month or so. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Satnarain Bansal, General & Family Physician