Difference between revisions of "Combining-Carbamazepine-Lamotrigine"

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| base = carbamazepine
 
| base = carbamazepine
 
| add = lamotrigine
 
| add = lamotrigine
| info =  
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| info =  
* Carbamazepine is principally metabolized by CYP3A4 (also CYP2C8), but is also a potent inducer of CYP1A2, CYP3A4 and UDP-glucuronosyltransferases.
+
| metabolites_ref = <ref name="informatorium">{{KNMP|carbamazepine}} </ref>
* Lamotrigine is principally metabolised by UDP-glucuronosyltransferases.
 
* This combination of drugs may have possible synergistic effects. However, the pharmacokinetic drug interactions will influence the plasma levels.
 
 
| start =  
 
| start =  
* Carbamazepine can reduce lamotrigine serum concentration considerably. Add lamotrigine according to the general dosing advice. <ref name=”freeman”> {{Pubmed|9433333|Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21}}</ref> <ref name=”bazire”> Bazire S, Pshychotropic Drug Directory 2007, HealthComm UK Limited, Aberdeen, 2007.</ref> <ref name=”levyrh”> Levy RH et al, Metabolic Drug Interactions, Lippincott Williams & Wilkins, Philadelphia, 2000. </ref>
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* Add lamotrigine according to the general dosing advice. Dose adjustment of carbamazepine is not necessary when lamotrigine is added.<ref name="freeman">{{Pubmed|9433333|Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21}}</ref> <ref name="drugscomint">
* Lamotrigine may increase levels of carbamazepine metabolites. <ref name=”freeman”> {{Pubmed|9433333|Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21}}</ref> <ref name=”bazire”> Bazire S, Pshychotropic Drug Directory 2007, HealthComm UK Limited, Aberdeen, 2007.</ref> <ref name=”levyrh”> Levy RH et al, Metabolic Drug Interactions, Lippincott Williams & Wilkins, Philadelphia, 2000. </ref>
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{{Drugscominteract|lamotrigine-with-carbamazepine-1430-0-497-0|lamotrigine|carbamazepine}}</ref>
 
| cave =  
 
| cave =  
* Abrupt stop of carbamazepine can cause serious lamotrigine rash as lamotrigine levels increase. <ref name="Koch"> {{Pubmed|12648898|Koch HJ et al. Clinically relevant reduction of lamotrigine concentrations by carbamazepine. J Clin Psychiatry 2005;66:400-1}}</ref>
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{{CombiCaLa}}
 
}}
 
}}

Latest revision as of 16:05, 22 June 2010

Carbamazepine
Type moodstabilizer
Group anticonvulsant
links
ATC-code N03AF01
Medscape Carbamazepine
PubChem 2554
PubMed Carbamazepine
Drugs.com carbamazepine
Kompas (Dutch) Carbamazepine
Wikipedia Carbamazepine
Lamotrigine
Type moodstabilizer
Group anticonvulsant
links
ATC-code N03AX09
PubChem 3878
PubMed Lamotrigine
Drugs.com lamotrigine
Kompas (Dutch) Lamotrigine
Wikipedia Lamotrigine

Adding lamotrigine to carbamazepine.

Infobord.png General information
  
Carbamazepine
  • Carbamazepine is principally metabolized by CYP3A4, and is a potent inducer of CYP1A2, CYP2C9, CYP3A4 and UDP-glucuronosyltransferases.
  
Lamotrigine
  • Lamotrigine is principally metabolised by UDP-glucuronosyltransferases.
  
Carbamazepine
  
Lamotrigine

 

Eenrichtingbord.png Start lamotrigine
  
Lamotrigine
  • Add lamotrigine according to the general dosing advice. Dose adjustment of carbamazepine is not necessary when lamotrigine is added.[6] [7]
Nietinrijdenbord.png Stop lamotrigine
  
Lamotrigine
Letopbord.png Cave
  • Abrupt stop of carbamazepine can cause serious lamotrigine rash as lamotrigine levels increase.[8]
  • Carbamazepine likely speeds the metabolism of lamotrigine, but the clinical significance is unclear.[6][9]
  • Lamotrigine may increase blood levels of carbamazepine metabolites, which can result in neurotoxicity (data about this are contradictory).[6][9]
  • These two agents have less significant pharmacologic interactions than do lamotrigine and valproate.[6][9]


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