skip to main content

Apixaban missed dose — GPhC CRA MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiovascular TherapeuticsApixaban missed doseGPhC CRA

A patient previously stable on lamotrigine 200 mg twice daily has taken none for eight days because of vomiting. They have no rash and ask to restart the full dose tonight. What is the safest plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Obtain a re-titration plan rather than restarting the maintenance dose

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

Option D is correct: after an interruption exceeding roughly five half-lives, lamotrigine should generally be re-escalated using the appropriate initiation schedule because restarting too high increases serious-rash risk. The precise schedule also depends on interacting medicines. Options A, B and C all restart substantially above a safe initiation pathway. Option E makes an unsupervised antiseizure substitution and equivalent milligram dosing does not exist. Seizure risk during the interruption also warrants timely clinical review.

Reference: Lamotrigine SmPC: https://www.medicines.org.uk/emc/product/4737/smpc