Combining-Lamotrigine-Carbamazepine

Lamotrigine
Type moodstabilizer
Group anticonvulsant
links
ATC-code N03AX09
PubChem 3878
PubMed Lamotrigine
Drugs.com lamotrigine
Kompas (Dutch) Lamotrigine
Wikipedia Lamotrigine
Carbamazepine
Type moodstabilizer
Group anticonvulsant
links
ATC-code N03AF01
Medscape Carbamazepine
PubChem 2554
PubMed Carbamazepine
Drugs.com carbamazepine
Kompas (Dutch) Carbamazepine
Wikipedia Carbamazepine

Adding carbamazepine to lamotrigine.

Infobord.png 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.

 

Eenrichtingbord.png Start carbamazepine
  • Start carbamazepine with a daily dose of 200 mg and increase dose based on serum concentration if necessary. Check lamotrigine effect after 2 weeks of therapy and adapt dose if necessary.[6][7]
Letopbord.png Cave
  • Abrupt stop of carbamazepine can cause serious lamotrigine rash as lamotrigine levels increase.[8]
  • Carbamazepine likely speeds the metabolism of lamotrigine, but the clinical significance is unclear.[9][10]
  • Lamotrigine may increase blood levels of carbamazepine metabolites, which can result in neurotoxicity (data about this are contradictory).[9][10]
  • These two agents have less significant pharmacologic interactions than do lamotrigine and valproate.[9][10]


  1. ↑ 1.01.1 Farmacotherapeutisch Kompas; Toxicologie (dutch)
  2. ↑ 2.02.1 Farmacotherapeutisch Kompas - lamotrigine (dutch) Cite error: Invalid <ref> tag; name "ftk" defined multiple times with different content
  3. ↑ Drugs.com lamotrigine
  4. ↑ WHO Collaborating Centre for Drug Statistics Methodology ATC=N03AF01
  5. ↑ KNMP; Informatorium Medicamentorum 2015; Monografie "carbamazepine" (Dutch)
  6. ↑ Schalekamp T. et al, Interacties met Psychofarmaca, Stichting Health Base, Houten, 2002.
  7. ↑ Interactions between lamotrigine and carbamazepine on drugs.com
  8. ↑ Koch HJ et al. Clinically relevant reduction of lamotrigine concentrations by carbamazepine. J Clin Psychiatry 2005;66:400-1
  9. ↑ 9.09.19.2 Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21
  10. ↑ 10.010.110.2 Levy RH et al, Metabolic Drug Interactions, Lippincott Williams & Wilkins, Philadelphia, 2000.
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