Psychopharmacology and Psychiatry Updates Lamotrigine: Pearls for Prescribing
Feb 5, 2025
Discover the ins and outs of prescribing lamotrigine, especially its surprising interaction with birth control pills that can halve its effectiveness in just a week. Learn about its mechanisms, including sodium channel blockade, and the importance of a careful titration schedule. The conversation also dives into how estrogen affects lamotrigine levels and necessary dosage adjustments during pregnancy. Equip yourself with essential knowledge for safe prescribing practices while managing bipolar disorder!
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Lamotrigine Mechanism Insights
- Lamotrigine primarily works by blocking sodium channels to inhibit excitatory neurotransmission.
- It has minimal effects on common psychiatric drug targets like histaminergic or adrenergic receptors.
Lamotrigine Titration Advice
- Start lamotrigine at 25 mg daily and increase by 25 mg every two weeks for outpatients.
- Adjust titration when patients are on valproic acid, carbamazepine, or oral contraceptives to avoid side effects and interactions.
Manage Lamotrigine with Birth Control
- Estrogen-containing oral contraceptives halve lamotrigine levels within one week.
- Monitor psychiatric symptoms and adjust lamotrigine doses when patients start or stop birth control.