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Drug Interactions between Clozaril and Lamictal

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

cloZAPine lamoTRIgine

Applies to: Clozaril (clozapine) and Lamictal (lamotrigine)

MONITOR: A case report suggests that lamotrigine may increase the plasma concentrations of clozapine. The mechanism of interaction and a causal relationship have not been established. In the report, a 35-year-old man who had been stabilized on clozapine 400 mg/day for three years developed dizziness and sedation in association with a threefold increase in clozapine plasma concentration after two weeks of taking lamotrigine 100 mg/day. The dosage of lamotrigine was tapered over the next two weeks, and plasma clozapine levels returned to therapeutic levels.

MANAGEMENT: Pharmacologic response and plasma clozapine levels should be monitored more closely whenever lamotrigine is added to or withdrawn from therapy, and the clozapine dosage adjusted as necessary.

References

  1. Kossen M, Selten JP, Kahn RS "Elevated clozapine plasma level with lamotrigine." Am J Psychiatry 158 (2001): 1930

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Drug and food interactions

Moderate

cloZAPine food

Applies to: Clozaril (clozapine)

GENERALLY AVOID: 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.

MANAGEMENT: 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.

References

  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):
View all 4 references

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Moderate

lamoTRIgine food

Applies to: Lamictal (lamotrigine)

GENERALLY AVOID: 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.

MANAGEMENT: 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.

References

  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):
View all 4 references

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Minor

cloZAPine food

Applies to: Clozaril (clozapine)

Caffeine may increase clozapine serum concentrations and exacerbate psychotic symptoms. The mechanism is unknown but may be related to competition for the same metabolic pathway. No specific intervention is necessary; however, if an interaction is suspected it is recommended that caffeine intake be avoided.

References

  1. Carrillo JA, Jerling M, Bertilsson L "Interaction between caffeine and clozapine - comment." J Clin Psychopharmacol 15 (1995): 376-7
  2. Odom-White A, de Leon J "Clozapine levels and caffeine." J Clin Psychiatry 57 (1996): 175-6
  3. Vainer JL, Chouinard G "Interaction between caffeine and clozapine." J Clin Psychopharmacol 14 (1994): 284
  4. Hagg S, Spiset O, Mjorndal T, Dalqvist R "Effect of caffeine on clozapine pharmacokinetics in healthy volunteers." Br J Clin Pharmacol 49 (2000): 59-63
View all 4 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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