Adding lamotrigine to carbamazepine.
- Carbamazepine is principally metabolized by CYP3A4, and is a potent inducer of CYP1A2, CYP2C9, CYP3A4 and UDP-glucuronosyltransferases.
- Lamotrigine is principally metabolised by UDP-glucuronosyltransferases.
- Add lamotrigine according to the general dosing advice. Dose adjustment of carbamazepine is not necessary when lamotrigine is added. 
- 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.
- WHO Collaborating Centre for Drug Statistics Methodology ATC=N03AF01
- Farmacotherapeutisch Kompas; Toxicologie (dutch)
- Farmacotherapeutisch Kompas - carbamazepine (dutch)
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- KNMP; Informatorium Medicamentorum 2015; Monografie "carbamazepine" (Dutch)
- Drugs.com lamotrigine
- Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21
- 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
- Levy RH et al, Metabolic Drug Interactions, Lippincott Williams & Wilkins, Philadelphia, 2000.
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