Psych CASC / OSCE · Psychopharmacology — lamotrigine
Explaining lamotrigine titration and rash safety (CASC)
CASC-style communication station: polarity rationale, slow titration with valproate, OCP interaction, balanced SJS counselling without false reassurance or terror, written safety plan.
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Station instructions (candidate)
You have 7 minutes. Explain why lamotrigine fits depression-pole prevention, how you will start it slowly because she is on valproate, how her combined pill affects levels, and which rash symptoms mean stop-and-seek-help. Balance honesty about rare serious rash against the cost of untreated bipolar depression. Do not guarantee zero risk. Do not dismiss fear. Do not invent exact national tablet strengths if unsure — explain principles and that the written schedule follows product guidance.[1][2][3][4]
References6ShowHide
- [1]Goodwin GM, Bowden CL, Calabrese JR, et al. A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder J Clin Psychiatry, 2004.PMID 15096085
- [2]Yuen AW, Land G, Weatherley BC, et al. Sodium valproate acutely inhibits lamotrigine metabolism Br J Clin Pharmacol, 1992.PMID 1524964
- [3]Sabers A, Ohman I, Christensen J, et al. Oral contraceptives reduce lamotrigine plasma levels Neurology, 2003.PMID 12939444
- [4]Guberman AH, Besag FM, Brodie MJ, et al. Lamotrigine-associated rash: risk/benefit considerations in adults and children Epilepsia, 1999.PMID 10403224
- [5]Messenheimer JA, Guberman AH Rash with lamotrigine: dosing guidelines Epilepsia, 2000.PMID 10756418
- [6]Geddes JR, Calabrese JR, Goodwin GM Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials Br J Psychiatry, 2009.PMID 19118318