Drug interactions lamotrigine

Bottiger Y, Svensson J-0, St hle L, Lamotrigine drug interactions in a TDM material. Ther... 

Lamotrigine is not approved for the acute treatment of depression, and the dose must be started low and slowly titrated up to decrease adverse effects if used for maintenance therapy of bipolar I disorder. A drug interaction and a severe dermatologic rash may occur when lamotrigine is combined with valproate (i.e., lamotrigine doses must be halved from standard dosing titration). 

Use caution when combining with lamotrigine because of potential drug interaction. 

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

Use alone or in combina tion with other drugs (e.g, lithiunry catbatnaz-epin antipsychoti(3) for the acute treatment of mania and for rtrainte-nance trealmenl Use caution when combining with lamotrigine because ot potential drug interaction. 

Besag FM, Berry DJ, Pool F. Methsuximide lowers lamotrigine blood levels a pharmacokinetic antiepileptic drug interaction. Epilepsia 2000 41(5) 624-7. 

Morris RG, Black AB, Lam E, Westley IS. Clinical study of lamotrigine and valproic acid in patients with epilepsy using a drug interaction to advantage Ther Drug Monit 2000 22(6) 656-60. 

Lamotrigine 25-50 mg/day 150 mg/day 1% 100% 100% 100% Autoinduction, major drug-drug interaction with valproate No data No data Dose for GFR10-50 ml/min... 

Drug Interactions. Lamotrigine does not inhibit or induce liver enzymes and has a low potential for pharmacokinetic interactions with other drugs. Lamotrigine does not interfere with oral contraceptives. 

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." ... 

Because of its inducing effect on hepatic enzymes, phenobarbitai has many drug interactions, decreasing plasma levels of CBZ, valproate, lamotrigine, tiagabine, zonisamide, warfarin, theophylline, cimetidine, and those of other CYP3A4 substrates. Serum concentrations of phenobarbitai are increased by valproate. 

Valproate, a substrate for hepatic CYP2C19 and CYP2C9, has an extensive pattern of drug interactions. It increases the plasma concentrations of lamotrigine, CBZ, and phenobarbital and the free fraction of phenytoin by either displacing these drugs from plasma proteins or inhibiting their metabolism. Phenytoin, phenobarbital, and CBZ cause decreased plasma concentrations of valproate, whereas felbamate increases valproate levels. 

Kramer G, Dorn T, Etter H. Oxcarbazepine clinically relevant drug interaction witii lamotrigine. Epilepsia (2003) 44 (Suppl 9), 95-6. 

Castberg I, Spigset O. Risperidone and lamotrigine no evidence of a drug interaction. J Clin Psychiatry (2006) 67,1159. 

Drug-drug interactions Lamotrigine Polypharmacy with enzyme inducers is an important susceptibility factor for valproate encephalopathy. Valproic acid-induced hyperammonemic encephalopathy developed exclusively during concomitant treatment with lamotrigine + valproate in a psychiatric setting [174" ]. 

Systematic reviews The major studies on the safety and tolerability of rufinamide were reviewed [157 ]. In placebo-controlled trials and pooled analyses, the most common adverse effects reported with rufinamide were somnolence and vomiting. Headache and pyrexia were also reported more frequently with rufinamide compared to placebo. In terms of drug-drug interactions, rufinamide may slightly increase the clearance of CBZ and lamotrigine and may slightly decrease the clearance of phenytoin and phenobarbital. VPA may significantly decrease the clearance of rufinamide. 

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