Understanding Lamotrigine and Oral Contraceptives

Introduction:

Philadelphia Integrative Psychiatry, dedicated to holistic patient care, takes a keen interest in the study by Maroney, PharmD, BCPP, on the interactions between lamotrigine and oral contraceptives. This research is crucial for patients like Ms. Alen’s, a 20-year-old with Bipolar II Disorder, who use lamotrigine alongside oral contraceptives.

Lamotrigine, often prescribed for epilepsy and bipolar disorder, shows a high absorption rate and is mainly metabolized through glucuronic acid conjugation. However, when combined with oral contraceptives containing ethinyl estradiol and progestin, a bidirectional interaction occurs. This interaction significantly decreases lamotrigine's plasma concentration, posing risks like seizure recurrence or inadequate mood stabilization.

Such interactions necessitate a tailored approach to medication management. For instance, starting oral contraceptives may call for doubling the lamotrigine dose, with careful weekly increments and regular blood level monitoring. Conversely, discontinuing contraceptives requires reducing the lamotrigine dose, typically by no more than 25% per week.

Extended or continuous cycle contraceptive regimens are recommended to minimize fluctuations in lamotrigine levels. Progestin-only pills, on the other hand, may increase lamotrigine exposure. It's also important to consider alternative contraception methods, as the efficacy of contraceptives might be reduced, especially with higher lamotrigine doses.

In Ms. Alen’s case, the interaction likely contributed to a resurgence of depressive symptoms. A gradual increase in her lamotrigine dosage is planned, with close monitoring for any serious side effects, such as rash and counseling on the potential for unintended pregnancy given her current medication combination.

For more insights into lamotrigine, including dosing, side effects and the risk of Stevens-Johnson Syndrome, visit our detailed blog: Lamotrigine.

Embark on your journey to wellness with Philadelphia Integrative Psychiatry, where we prioritize comprehensive, individualized care. Visit www.phillyintegrative.com or call 610-999-6414 to schedule a consultation. Together, we can navigate a path to better health, focusing on the whole person, not just the diagnosis.