Lamotrigine Valproate

Myoclonic Not mentioned Lamotrigine Valproate Valproate Topiramate (children with severe myoclonic epilepsy of infancy) Second-line Clobazam6 Clonazepam Lamotrigine Levetiracetam Piracetam6 Topiramate... 

Anticonvulsants, such as lamotrigine, valproate, or CBZ, with or without other mood stabilizers... 

Co-administration of valproate is one of the most important risk factors for skin reactions to lamotrigine valproate co-medication was present in 74 and 64% of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis respectively (44). 

Primidone use Is associated with decreases In CBZ, lamotrigine, valproate, tiagabine, and zonisamide serum levels. Primidone levels are increased by nicotinamide and Isonlazid. Hydantoins increase the plasma concentrations of primidone, phenobarbital, and PEMA. CBZ Increases levels of phenobarbital derived from primidone. Primidone levels are decreased by succinimides, CBZ, and acetazolamide. 

The authors suggest that sertraline may competitively inhibit the glu-curonidation of lamotrigine. Evidence so far appears limited to this case report. In view of the increased risk of rash with increased lamotrigine levels (see also Lamotrigine + Valproate , below), it may be prudent to monitor the combination. Further study is needed. 

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" ]. 

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