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Lamotrigine + level-altering drugs

Interaction at a glance

• Valproate inhibits clearance
• lamotrigine exposure ≈ 2×
• Change doses slowly; watch rash/toxicity

Mechanism

• Lamotrigine is mainly glucuronidated

Magnitude / time course

• Valproate inhibits clearance
• lamotrigine exposure ≈ 2×
• Estrogens induce clearance
• levels often ↓ ~50%

Clinical consequence

• CBZ/PHT/PB also lower lamotrigine
• Change doses slowly; watch rash/toxicity

Self-check

• About how much can valproate raise lamotrigine exposure?
  About 2×.
• About how much can estrogens lower lamotrigine levels?
  About 50%.

Drugs in this interaction (11)

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