Antiseizure drug doses go up through pregnancy and the levels fall back within days to a couple of weeks of delivery. The dose that was right at 36 weeks becomes toxic in the puerperium, and the classic presentation is a new mother with lamotrigine toxicity - unsteadiness, diplopia, vomiting - blamed on exhaustion.
So write the taper at the time you write the increase. A dated plan in the notes and in the woman's hand, specifying what dose to return to and over how many days, survives the handover between obstetrics, neurology and whoever is actually reviewing her at two weeks postpartum. Nobody else is going to reconstruct it.
The same note should say when the postpartum level will be taken, and by whom. Sleep deprivation lowers the seizure threshold at exactly the moment the level is falling too fast if the taper is too quick - so the plan needs a measurement in it, not just a schedule.
- Write the postpartum taper at the moment you write the antenatal dose increase
- Give the woman a dated copy - she is the only person present at every handover
- Specify the target dose and the number of days, not 'reduce after delivery'
- Book a postpartum level and name who will act on it
- Warn about toxicity symptoms specifically: unsteadiness, double vision, vomiting
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