Combining-Valproic acid-Lamotrigine

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Valproic acid
Type moodstabilizer
Group anticonvulsant
ATC-code N03AG01
PubChem 3121
PubMed acid%22 Valproic acid valproic-acid
Kompas (Dutch) Valproic acid
Wikipedia Valproic acid
Type moodstabilizer
Group anticonvulsant
ATC-code N03AX09
PubChem 3878
PubMed Lamotrigine lamotrigine
Kompas (Dutch) Lamotrigine
Wikipedia Lamotrigine

Adding lamotrigine to valproic acid.

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General information
  • Valproic acid is principally metabolized by CYP2C9, CYP2C19, CYP2A6 and UDP-glucuronosyltransferases. Valproic acid is an inhibitor of the enzymes CYP2C9, epoxide-hydroxylase and UDP-glucuronosyltransferases.
  • Lamotrigine is principally metabolised by UDP-glucuronosyltransferases.


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Start lamotrigine
  • Lamotrigine generally has no significant effect on valproate levels, however caution is recommended.
  • Start lamotrigine at low dose and check valproate plasma level after 1 week. Change valproate dose if necessary. [5] Very slow titration of lamotrigine is recommended, because lamotrigine-related skin rashes have been reported. [6]
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  • Valproic acid increases the blood level of lamotrigine because of the inhibition of glucuronidation. Adverse reactions, particularly skin rash, may occur with greater frequency or severity. Also other side effects may occur such as ataxia, tremor, sedation, and fatigue. However, such symptoms should improve as the dose of lamotrigine is decreased.[7]
  • Also important, when lamotrigine is added to valproate therapy, valproate concentrations may be possibly decreased.[7]

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