Lamotrigine interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

  What to do: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  4 sources

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

Conditions

Conditions in which Lamotrigine needs care, as documented in this source.

• Depressive Disorder

  Major

  Antiepileptic drugs can increase depression and suicidal thoughts or behaviors in patients receiving these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts and unusual changes in mood or behavior. Caregivers and family should be alert for the emergence or worsening of symptoms. Behaviors of concern should be reported immediately to the healthcare providers.

  9 sources

  1. "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals (2002):
  2. "Product Information. Depakene (valproic acid)." Abbott Pharmaceutical (2001):
  3. "Product Information. Depakote (divalproex sodium)." Abbott Pharmaceutical (2001):
  4. "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome (2001):
  5. "Product Information. Magnesium Sulfate (magnesium sulfate)." Abbott Pharmaceutical (2001):
  6. "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals (2001):
  7. "Product Information. Vimpat (lacosamide)." UCB Pharma Inc (2008):
  8. "Product Information. Banzel (rufinamide)." Eisai Inc (2008):

  Show all 9 sourcesShow fewer sources

  9. "Product Information. Aptiom (eslicarbazepine)." Sunovion Pharmaceuticals Inc (2013):

• Exanthema

  Major

  Severe, potentially fatal reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis have been associated with the use of lamotrigine. The incidence has been reported at approximately 1 in 1000 for adults and up to 1 in 50 for pediatric patients treated with the drug. Life-threatening rashes have usually, but not always, occurred within 2 to 8 weeks of initiating treatment. Therapy with lamotrigine should be administered cautiously in patients with preexisting drug-induced dermatitis, since it may delay the recognition of a potential reaction to lamotrigine. Lamotrigine therapy should be withdrawn promptly at the first sign of a rash. However, discontinuation of treatment may not prevent a rash from becoming life-threatening or permanently disabling or disfiguring. There have been suggestions that the risk of rash may be increased by 1) coadministration with valproic acid, 2) exceeding the recommended initial dosage, or 3) exceeding the recommended rate of dosage escalation of lamotrigine.

  5 sources

  1. "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome (2001):
  2. Wadelius M, Karlsson T, Wadelius C "Lamotrigine and toxic epidermal necrolysis." Lancet 348 (1996): 1041
  3. Chaffin JJ, Davis SM "Suspected lamotrigine-induced toxic epidermal necrolysis." Ann Pharmacother 31 (1997): 720-3
  4. Sachs B, Ronnau AC, Ruzicka T, Gleichmann E, Schuppe HC "Lamotrigine and toxic epidermal necrolysis." Lancet 348 (1996): 1597
  5. Page RL, ONeil MG, Yarbrough DR, Conradi S "Fatal toxic epidermal necrolysis related to lamotrigine administration." Pharmacotherapy 18 (1998): 392-8

• Depressive Disorder

  Moderate

  Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.

  16 sources

  1. "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals (2002):
  2. "Product Information. Klonopin (clonazepam)." Roche Laboratories (2001):
  3. "Product Information. Dilantin (phenytoin)." Parke-Davis (2001):
  4. "Product Information. Cerebyx (fosphenytoin)." Parke-Davis (2001):
  5. "Product Information. Mysoline (primidone)." Elan Pharmaceuticals (2001):
  6. "Product Information. Lyrica (pregabalin)." Pfizer U.S. Pharmaceuticals Group (2005):
  7. "Product Information. Sabril (vigabatrin)." Lundbeck Inc (2009):
  8. "Product Information. Potiga (ezogabine)." GlaxoSmithKline (2011):

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  9. "Product Information. Qsymia (phentermine-topiramate)." Vivus Inc (2012):
  10. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  11. "Product Information. Briviact (brivaracetam)." UCB Pharma Inc (2016):
  12. "Product Information. Diacomit (stiripentol)." Biocodex USA (2018):
  13. "Product Information. Epidiolex (cannabidiol)." Greenwich Biosciences LLC (2018):
  14. "Product Information. Xcopri (cenobamate)." SK Life Science, Inc. (2020):
  15. "Product Information. Fintepla (fenfluramine)." Zogenix, Inc (2020):
  16. "Product Information. Ztalmy (ganaxolone)." Marinus Pharmaceuticals, Inc (2022):

• Heart Diseases

  Moderate

  Lamotrigine may slow ventricular conduction (widen QRS) and induce proarrhythmia in patients with structural heart disease or myocardial ischemia. In vitro studies have shown Class IB antiarrhythmic activity at therapeutically relevant concentrations. Clinical studies have not shown antiarrhythmic activity in healthy individuals, but because of the risk of proarrhythmia, including sudden death, lamotrigine should not be used in patients who have cardiac conduction disorders (e.g., second- or third-degree heart block), ventricular arrhythmias, or cardiac disease or abnormality (e.g., myocardial ischemia, heart failure, structural heart disease, Brugada syndrome or other sodium channelopathies).

  2 sources

  1. "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome (2001):
  2. "Product Information. LaMICtal XR (lamotrigine)." GlaxoSmithKline (2018):

• Hematologic Diseases

  Moderate

  Reports of blood dyscrasias that may or may not be associated with multi-organ hypersensitivity (also known as DRESS) have been reported in patients treated with lamotrigine. These have included neutropenia, leukopenia, anemia, thrombocytopenia, pancytopenia, and, rarely, aplastic anemia and pure red cell aplasia.

  1 source

  1. "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome (2001):

• Liver Diseases

  Moderate

  Lamotrigine is primarily converted by the liver to inactive glucuronide metabolites and subsequently eliminated by the kidney. Approximately 10% of a dose is excreted in the urine as unchanged drug. The plasma clearance of lamotrigine may be decreased and the half-life prolonged in patients with impaired renal and/or hepatic function. However, clinical data are limited. In a comparison of 12 healthy subjects and 24 with various degrees of liver disease, lamotrigine pharmacokinetics were significantly altered only in patients with severe cirrhosis. Therapy with lamotrigine should be administered cautiously and at reduced dosages in such patients.

  7 sources

  1. Cohen AF, Land GS, Breimer DD, Yuen WC, Winton C, Peck AW "Lamotrigine, a new anticonvulsant: pharmacokinetics in normal humans." Clin Pharmacol Ther 42 (1987): 535-41
  2. Peck AW "Clinical pharmacology of lamotrigine." Epilepsia 32 Suppl 2 (1991): s9-12
  3. Posner J, Cohen AF, Land G, Winton C, Peck AW "The pharmacokinetics of lamotrigine (BW430C) in healthy subjects with unconjugated hyperbilirubinaemia (Gilbert's syndrome)." Br J Clin Pharmacol 28 (1989): 117-20
  4. Mikati MA, Schachter SC, Schomer DL, Keally M, Osborne-Shafer P, Seaman CA, Sheridan PH, Ashworth M, Kupferberg H, Valakas A, et al. "Long-term tolerability, pharmacokinetic and preliminary efficacy study of lamotrigine in patients with resistant partial seizures." Clin Neuropharmacol 12 (1989): 312-21
  5. Fillastre JP, Taburet AM, Fialaire A, Etienne I, Bidault R, Singlas E "Pharmacokinetics of lamotrigine in patients with renal impairment: influence of haemodialysis." Drugs Exp Clin Res 19 (1993): 25-32
  6. "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome (2001):
  7. Marcellin P, de Bony F, Garret C, et al. "Influence of cirrhosis on lamotrigine pharmacokinetics." Br J Clin Pharmacol 51 (2001): 410-4

• Meningitis

  Moderate

  Therapy with lamotrigine increases the risk of aseptic meningitis. Symptoms upon presentation included headache, fever, nausea, vomiting, and nuchal rigidity and usually occurred after treatment initiation. In most cases, symptoms resolved after discontinuation of treatment but returned quickly and more severely with reexposure. Some of the patients who developed aseptic meningitis had underlying diagnoses of systemic lupus erythematosus and other autoimmune diseases.

  1 source

  1. "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome (2001):

• Phenylketonurias

  Moderate

  Lamotrigine tablets for oral suspension (chewable dispersible tablets) contain phenylalanine. The phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

  No sources recorded