Lamotrigine Clozapine

Drug interactions Diuretics" NSAIDs (e.g., ibuprofen)" Lamotrigine Clozapine" Contraceptives HIV protease inhibitors" ... 

Dembowski C, Rechlin T. Successful antimanic treatment and mood stabilization with lamotrigine, clozapine, and valproate in a bipolar patient after lithium-induced cerebellar deterioration. A case report. Pharmacopsychiatry 2003 36(2) 83-6. 

Saba G, Dumortier G, Kalalou K, Benadhira R, Degrassat K, Glikman J, Januel D. Lamotrigine-clozapine combination in refractory schizophrenia three cases. J Neuropsychiatry Clin Neurosci 2002 14(1) 86. 

Pharmacotherapy is the cornerstone of acute and maintenance treatment of bipolar disorder. Mood-stabilizing drugs are the usual first-choice treatments and include lithium, divalproex, carbamazepine, and lamotrigine. Atypical antipsychotics other than clozapine are also approved for treatment of acute mania. Lithium, lamotrigine, olanzapine, and aripiprazole are approved for maintenance therapy. Drugs used with less research support and without Food and Drug Administration (FDA) approval include topiramate and oxcarbazepine. Benzodiazepines are used adjunctively for mania. 

Idris NF, Repeto P, Neill JC, Large CH. 2005. Investigation of the effects of lamotrigine and clozapine in improving reversal-learning impairments induced by acute phencyclidine and D-amphetamine in the rat. Psychopharmacology (Berl) 179 336-348. 

The addition of lamotrigine to clozapine therapy has been associated with rapid improvement of psychiatric symptoms (71) this has been observed in three cases of poor response or resistance to clozapine monotherapy. 

Pharmacodynamic interactions also occur. In particular, the adverse effects of any drug can be increased by other drugs with similar properties. One example is the reciprocal potentiation of the neurotoxic effects of carbamazepine and lamotrigine in patients taking a combination of these drugs (180). Some drugs (for example ciclosporin, clozapine) have a proconvulsant effect and can reduce the efficacy of antiepileptic drugs. 

The possibility of renal dysfunction as a rare adverse effect should be considered. The patient had a history of allergic reactions to lithium, carbamazepine, clozapine, haloperidol, and lamotrigine. 

Antidepressants mirtazapine, nefazodone, sertraline Neuroleptics thioridazine, haloperidol, clozapine, quetiapine, risperidone, sertindole, ziprasidone Mood stabilizers carbamazepine, gabapentin, lamotrigine... 

I Drug-Drug Interactions. Carbamazepine induces the hepatic cytochrome P450 isoenzymes (1A2, 3A4, 2C9/10, and 2D6), which increases the metabolism of many medications, such as anticonvulsants (i.e., lamotrigine, topiramate, and valproate), antidepressants (i.e., tricyclics and bupropion), antipsychotics (i.e., clozapine, haloperi-dol, fluphenazine, olanzapine, and thiothixene), benzodiazepines, oral contraceptives, and protease inhibitors. " Women who receive carbamazepine require higher dosages of oral contraceptives or alternative contraceptive methods." ... 

Carboxyl group clofibrate, ciprofibrate, etodolac, fenoprofen, ibuprofen, ketoprofen, naproxen (racemic > 5), valproic acid and formation of simvastatin and atorvastatin lactones via an intermediate acyl glucuronide Tertiary amines amitriptyline, chlorpheniramine, chlorpromazine, clozapine, cyproheptadine, diphenylamine, doxepin, imipramine, ketotifen, loxapine, promethazine, tripellenamine, trifluoperazine Aromatic heterocyclic amines croconazole, lamotrigine, nicotine (30X velocity than UGT1A3), 1-phenylimidazole, posaconazole, retigabine Primary and secondary amines ... 

Clozapine serum levels are approximately halved by car-bamazepine and possibly by phenobarbital and phenytoin. An isolated case of fatal pancytopenia has been seen in one patient taking clozapine and carbamazepine, and neuroleptic malignant syndrome occurred in another. Sodium valproate can apparently lower serum clozapine levels, and an isolated case report su ests that lamotrigine may raise them. 

A 35-year-old man, who had been taking clozapine for 3 years, became dizzy and sedated about one month after starting to take lamotrigine. His plasma clozapine levels were found to have increased to... 

A study in 11 patients taking clozapine in doses of 200 mg to 500 mg daily, and who were also given lamotrigine in increasing doses over 8 weeks to 200 mg daily found no significant changes in the pharmacokinetics of clozapine. ... 

KossenM, Selten JP, KahnRS. Elevated clozapine plasma level with lamotrigine. chiatry 200V) 5%, 1930. 

Spina W, D Arrigo C, Migliardi G, Santoro V, Muscatello MR, Mico U, D Amico G, Perucca E, Effect of adjunctive lamotrigine treatment on the plasma concentrations of clozapine, risperidone and olanzapine in patients with schizophrenia or bipolar disorder. Ther Drug Monit (2006) 28, 599-602. 

Tiihonen J, Wahlbeck K, Kiviniemi V. The efficacy of lamotrigine in clozapine-resistant schizophrenia a systematic review and meta-analysis. Schizophr Res 2009 109(1-3) 10-4. 

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