Lamictal XR (lamotrigine) Disease Interactions
There are 8 disease interactions with Lamictal XR (lamotrigine):
Anticonvulsants (Includes Lamictal XR) ↔ depression
Severe Potential Hazard, Moderate plausibility. Applies to: Depression
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.
Lamotrigine (Includes Lamictal XR) ↔ rash
Severe Potential Hazard, Moderate plausibility. Applies to: Dermatitis - Drug-Induced
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 Lamotrigine therapy should be withdrawn promptly at the first sign of a rash.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.
- Chaffin JJ, Davis SM "Suspected lamotrigine-induced toxic epidermal necrolysis." Ann Pharmacother 31 (1997): 720-3
- Wadelius M, Karlsson T, Wadelius C "Lamotrigine and toxic epidermal necrolysis." Lancet 348 (1996): 1041
- "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome, Research Triangle Park, NC.
- Sachs B, Ronnau AC, Ruzicka T, Gleichmann E, Schuppe HC "Lamotrigine and toxic epidermal necrolysis." Lancet 348 (1996): 1597
- Page RL, ONeil MG, Yarbrough DR, Conradi S "Fatal toxic epidermal necrolysis related to lamotrigine administration." Pharmacotherapy 18 (1998): 392-8
Antiepileptics (Includes Lamictal XR) ↔ suicidal tendency
Moderate Potential Hazard, Moderate plausibility. Applies to: Depression, Psychosis
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 across multiple indications in either monotherapy or adjunctive therapy for a median treatment duration of 12 weeks (up to a maximum of 24 weeks) showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. The estimated rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% for 16,029 placebo-treated patients, representing an increase of approximately one case for every 530 patients treated. There were four suicides in AED-treated patients and none in placebo-treated patients, although the number is too small to establish any causal relationship. The increased risk of suicidal thoughts or behavior was observed as early as one week after starting AEDs and persisted for the duration of treatment assessed. The risk did not vary substantially by age (5 to 100 years) in the clinical trials analyzed. Therapy with 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. For clinically significant or persistent symptoms, a dosage reduction or treatment withdrawal should be considered. If patients have symptoms of suicidal ideation or behavior, treatment should be discontinued.
Aromatic antiepileptic drugs (Includes Lamictal XR) ↔ arrhythmias
Moderate Potential Hazard, Moderate plausibility. Applies to: Cardiovascular Disease, Arrhythmias
Aromatic antiepileptic drugs (phenytoin, carbamazepine, oxcarbazepine, and lamotrigine) inhibit voltage- gated sodium channels and reduce membrane excitability in neurons and muscle and can be associated with cardiovascular effects. Individual agents have demonstrated AV heart block, including second and third-degree block following treatment. This occurred generally, but not solely in patients with underlying EKG abnormalities or risk factors for conduction abnormalities. Therapy with these agents should be considered and administered cautiously in patients with a history of cardiovascular disease and conduction abnormalities.
- Kenneback G, Bergfeldt L, Vallin H, et al "Electrophysiologic effects and clinical hazards of carbamazepine treatment for neurologic disorders in patients with abnormalities of thecardiac conduction system." Am Heart J 121 (1991): 1421-9
- Weig SG, Pollack P "Carbamazepine-induced heart block in a child with tuberous sclerosis and cardiac rhabdomyoma - implications for evaluation and follow-up." Ann Neurol 34 (1993): 617-9
- "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals, East Hanover, NJ.
- Steckler TL "Lithium- and carbamazepine-associated sinus node dysfunction: nine-year experience in a psychiatric hospital." J Clin Psychopharmacol 14 (1994): 336-9
- Boesen F, Andersen EB, Jensen EK, Ladefoged SD "Cardiac conduction disturbances during carbamazepine therapy." Acta Neurol Scand 68 (1983): 49-52
- Isojarvi JI, Airaksinen KE, Repo M, Pakarinen AJ, Salmela P, Myllyla VV "Carbamazepine, serum thyroid hormones and myocardial function in epileptic patients." J Neurol Neurosurg Psychiatry 56 (1993): 710-2
Lamotrigine (Includes Lamictal XR) ↔ blood dyscrasias
Moderate Potential Hazard, Moderate plausibility. Applies to: Bone Marrow Depression/Low Blood Counts
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.
Lamotrigine (Includes Lamictal XR) ↔ meningitis
Moderate Potential Hazard, Moderate plausibility. Applies to: Lupus Erythematosus, Autoimmune Disorder
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.
Lamotrigine (Includes Lamictal XR) ↔ renal/liver disease
Moderate Potential Hazard, Moderate plausibility. Applies to: Liver Disease, Renal Dysfunction
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.
- Peck AW "Clinical pharmacology of lamotrigine." Epilepsia 32 Suppl 2 (1991): s9-12
- 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
- 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
- "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome, Research Triangle Park, NC.
- Marcellin P, de Bony F, Garret C, et al. "Influence of cirrhosis on lamotrigine pharmacokinetics." Br J Clin Pharmacol 51 (2001): 410-4
- 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
- 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
Lamotrigine tablets for oral suspension (chewable dispersible tablets) (Includes Lamictal XR) ↔ PKU
Moderate Potential Hazard, Moderate plausibility. Applies to: Phenylketonuria
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).
Lamictal XR (lamotrigine) drug interactions
There are 233 drug interactions with Lamictal XR (lamotrigine)
Lamictal XR (lamotrigine) alcohol/food interactions
There is 1 alcohol/food interaction with Lamictal XR (lamotrigine)
More about Lamictal XR (lamotrigine)
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- Drug class: triazine anticonvulsants
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- FDA Approval History
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Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|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.|
|No interaction information available.|
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