Lamotrigine with Lopinavir Interaction Details
Brand Names Associated with Lamotrigine
- Lamictal®
- Lamictal® CD
- Lamictal® ODT
- Lamictal® XR
- Lamotrigine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Decreased lamotrigine exposure
Interaction Summary
Lamotrigine is metabolized by glucuronic acid conjugation, lopinavir/ritonavir is known to induce glucuronidation and decrease lamotrigine exposure by 50%. Consider use of an alternative anticonvulsant; however, if these agents are coadministered, adjust lamotrigine doses accordingly and monitor for therapeutic concentrations . When initiating or discontinuing concomitant therapy a gradual escalating or tapering schedule for lamotrigine is dependent on the adjunctive therapy and indication of use .
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Consider an alternative anticonvulsant; however, If these agents are coadministered, adjust lamotrigine doses accordingly and monitor for therapeutic concentrations. When concurrent use is required in patients with epilepsy older than 12 years, start lamotrigine at 50 mg once daily for 2 weeks, followed by 50 mg twice daily for the third and fourth weeks, increasing by 100 mg/day every 1 to 2 weeks to a total daily dose of 300 mg to 500 mg in 2 divided doses. For patients with epilepsy aged 2 to 12 years, start lamotrigine at 0.6 mg/kg/day in 2 divided doses for 2 weeks, followed by 1.2 mg/kg/day in 2 divided doses for the third and fourth weeks, increasing by 1.2 mg/kg/day increments to 5 to 15 mg/kg/day (max of 400 mg/day) maintenance dose in 2 divided doses. When concurrent use is required in bipolar patients, start lamotrigine at 50 mg/day for 2 weeks, followed by divided doses of 100 mg/day at weeks 3 and 4, 200 mg/day at week 5, 300 mg/day at week 6, and up to 400 mg/day at week 7. When discontinuing therapy the gradual tapering schedule for lamotrigine is dependent on the adjunctive therapy and indication of use .
Mechanism Of Interaction
Induction of lamotrigine glucuronidation by lopinavir/ritonavir
Literature Reports
A) Lopinavir/ritonavir (400 mg/100 mg twice daily) decreased the AUC, Cmax, and elimination half-life of lamotrigine by approximately 50% to 55.4% in 18 healthy subjects .
Lamotrigine Overview
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Lamotrigine extended-release (long-acting) tablets are used with other medications to treat certain types of seizures in patients who have epilepsy. All types of lamotrigine tablets (tablets, orally disintegrating tablets, and chewable tablets) other than the extended-release tablets are used alone or with other medications to treat seizures in people who have epilepsy or Lennox-Gastaut syndrome (a disorder that causes seizures and often causes developmental delays). All types of lamotrigine tablets other than the extended-release tablets are also used to increase the time between episodes of depression, mania (frenzied or abnormally excited mood), and other abnormal moods in patients with bipolar I disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Lamotrigine has not been shown to be effective when people experience the actual episodes of depression or mania, so other medications must be used to help people recover from these episodes. Lamotrigine is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
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Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.