Combining-Lamotrigine-Carbamazepine
From Psychiatrienet
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Adding carbamazepine to lamotrigine.
General information- 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- Start carbamazepine with a daily dose of 200 mg and increase dose based serum concentration if necessary. Check lamotrigines effect after 2 weeks of therapy and adapt dose if necessary. [6]
Cave- Abrupt stop of carbamazepine can cause serious lamotrigine rash as lamotrigine levels increase.[7]
- Carbamazepine likely speeds the metabolism of lamotrigine, but the clinical significance is unclear.[8][9]
- Lamotrigine may increase blood levels of carbamazepine metabolites, which can result in neurotoxicity (data about this are contradictory).[8][9]
- These two agents have less significant pharmacologic interactions than do lamotrigine and valproate.[8][9]
- ↑ 1.0 1.1 Farmacotherapeutisch Kompas; Toxicologie (dutch)
- ↑ 2.0 2.1 Farmacotherapeutisch Kompas - lamotrigine (dutch)
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- ↑ WHO Collaborating Centre for Drug Statistics Methodology ATC=N03AF01
- ↑ KNMP; Informatorium Medicamentorum 2023; Monografie "carbamazepine" (Dutch)
- ↑ Schalekamp T. et al, Interacties met Psychofarmaca, Stichting Health Base, Houten, 2002.
- ↑ Koch HJ et al. Clinically relevant reduction of lamotrigine concentrations by carbamazepine. J Clin Psychiatry 2005;66:400-1
- ↑ 8.0 8.1 8.2 Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21
- ↑ 9.0 9.1 9.2 Levy RH et al, Metabolic Drug Interactions, Lippincott Williams & Wilkins, Philadelphia, 2000.
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