II. Mechanism
- See Lamotrigine
III. Pharmacokinetics
- See Lamotrigine
IV. Findings
- Ventricular Dysrhythmia
- Lamictal inhibits voltage-gated Sodium channels
- Wide QRS Complex
- Treat with Sodium Bicarbonate ampules until QRS Complex narrows
-
Serotonin Syndrome
- Lamictal inhibits Serotonin reuptake
- Serotonin Syndrome occurs in 66% with serotonergic coingestion (e.g. SSRI, SNRI)
- Neurologic Effects
- Sedation (most common finding in Overdose)
- Seizures
- Agitation
- Increased Deep Tendon Reflexes (hyperreflexia)
- Myoclonic Jerks
- Miscellaneous
V. Diagnostics
- See Unknown Ingestion
- Evaluate as Unknown Ingestion
- Obtain other toxicologic screening including Acetaminophen level, Serum Glucose
- Electrocardiogram
- Serum Lamotrigine levels >20 ml/L are associated with severe effects (Seizures, Hypotension, intubation)
- High level ingestions >4g are also associated with severe effects
VI. Management
-
ABC Management
- Endotracheal Intubation for airway protection as needed
-
Activated Charcoal
- Consider if <1 hour from time of ingestion, and patient without aspiration risk
-
QRS Widening
- See above (regarding bicarbonate)
-
Seizures
- See Status Epilepticus
- Benzodiazepines
- Phenobarbital
- Consider Propofol and intubation
- Consider Hemodialysis for refractory Seizures or Dysrhythmias
- Disposition
- Admit all symptomatic patients
- If asymptomatic at 4-6 hours after ingestion, may discharge home
VII. References
- Tomaszewski (2020) Crit Dec Emerg Med 34(1): 28
- Carroll and Yakey (2025) Crit Dec Emerg Med 39(5): 38