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Combining-Valproic acid-Lamotrigine

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* 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. <ref name=”medicatiebewaking”> Schalekamp T. et al, Interacties met Psychofarmaca, Stichting Health Base, Houten, 2002. </ref>Very slow titration of lamotrigine is recommended, because lamotrigine-related skin rashes have been reported. <ref> {{Pubmed|16225978|Chang CC at al, Toxic epidermal necrolysis with combination lamotrigine and valproate in bipolar disorder. Prog Neuropsych. Biol Psychiatry. 2006 Jan;30(1):147-50}}</ref>
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