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Q: Which of the Following is Responsible for High Lamotrigine Levels?

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Q: Which of the Following is Responsible for High Lamotrigine Levels?

Post  Admin on Sun Jun 17, 2012 3:54 pm

Q: Which of the Following is Responsible for High Lamotrigine Levels?

(a) Oral Contraceptives
(b) Carbamazepine
(c) Phenobarbital
(d) St. John's Wort
(e) Valproate


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Re: Q: Which of the Following is Responsible for High Lamotrigine Levels?

Post  P450 on Mon Jun 18, 2012 8:11 pm

E. Valproate - inhibits UGT1A4, which shifts lamotrigine's metabolism to a cyp pathway, creating a toxic lamotrigine metabolite, and causing higher rates of stevens johnson syndrome.

A. OCP's inhibit 2C19 and would not significantly increase increase lamotrigine levels
B, C, D. All induce various CYP enzymes.

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Re: Q: Which of the Following is Responsible for High Lamotrigine Levels?

Post  Admin on Mon Jun 18, 2012 8:24 pm

Correct.

Today, I saw this patient on Lamotrigine (for Seizure ds), who was started on Valproate- now c/o rash.

Causes of High Lamotrigine:
- Valproate
- Sertraline

Causes of Low Lamotrigine:
- OCP
- Pregnancy
- Phenytoin
- Phenobarbital
- CBZ
- Rifampin
- Primidone

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