Adding carbamazepine to lamotrigine.
- Lamotrigine is principally metabolised by UDP-glucuronosyltransferases.
- Carbamazepine is principally metabolized by CYP3A4, and is a potent inducer of CYP1A2, CYP2C9, CYP3A4 and UDP-glucuronosyltransferases.
- Start carbamazepine with a daily dose of 200 mg and increase dose based on serum concentration if necessary. Check lamotrigine effect after 2 weeks of therapy and adapt dose if necessary. 
- Abrupt stop of carbamazepine can cause serious lamotrigine rash as lamotrigine levels increase.
- Carbamazepine likely speeds the metabolism of lamotrigine, but the clinical significance is unclear.
- Lamotrigine may increase blood levels of carbamazepine metabolites, which can result in neurotoxicity (data about this are contradictory).
- These two agents have less significant pharmacologic interactions than do lamotrigine and valproate.
- ↑ Schalekamp T. et al, Interacties met Psychofarmaca, Stichting Health Base, Houten, 2002.
- ↑ Interactions between lamotrigine and carbamazepine on drugs.com
- ↑ Koch HJ et al. Clinically relevant reduction of lamotrigine concentrations by carbamazepine. J Clin Psychiatry 2005;66:400-1
- ↑ 4.0 4.1 4.2 Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21
- ↑ 5.0 5.1 5.2 Levy RH et al, Metabolic Drug Interactions, Lippincott Williams & Wilkins, Philadelphia, 2000.
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