# A client on stable maintenance lamotrigine 200 mg/day for 1 year reports missing all doses during a 7-day camping trip. She has no new symptoms today. Which is the nurse's best instruction?

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client on stable maintenance lamotrigine 200 mg/day for 1 year reports missing all doses during a 7-day camping trip. She has no new symptoms today. Which is the nurse's best instruction?

## Option

1. Resume the 200 mg maintenance dose tonight
2. Take the missed doses all at once today
3. Double the next dose to catch up
4. Restart with a slow titration schedule under provider guidance — missing >5 days requires re-titration to avoid SJS **✔ Correct answer**

**Correct answer: 4**

## Explanation

Correct (2): If lamotrigine is missed for more than 5 days (some references >2 weeks), the slow titration schedule must be restarted; sudden resumption of maintenance dose carries the same SJS risk as initial rapid titration. (1) Direct resumption risks rash. (3) Double-dosing increases toxicity. (4) Catch-up dosing is unsafe.

## In-depth explanation

Memory Tip Lamotrigine "5-day rule" — miss >5 days → restart titration. Patient Teaching Travel/vacation: never run out; carry extra supply.

## Clinical scenario

Scenario 30-year-old female on lamotrigine 200 mg/day × 1 year for partial seizures. Missed 7 consecutive days on a camping trip; asymptomatic today.

## Key concepts

- **Missed dose protocol** — Lamotrigine-specific rule that missing >5 days requires re-titration to avoid SJS.
- **Maintenance dose** — Stable target dose continued after titration; lamotrigine 100-400 mg/day depending on indication and co-meds.
- **Adherence counseling** — Patient education emphasizing that lamotrigine cannot be safely restarted at full dose after long lapse.

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