Adding carbamazepine to lamotrigine.
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- Lamotrigine is principally metabolised by UDP-glucuronosyltransferases.
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- 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.
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