DRUG INTERACTION: Lamotrigine + Antiretrovirals

Q: Which of the following antiretroviral is NOT likely to decrease lamotrigine plasma concentrations?

 


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REDUCED LAMOTRIGINE LEVELS

  • Atazanavir/Ritonavir: may decrease lamotrigine plasma concentrations due to UGT1A4 induction.

  • Efavirenz: induces UGT1A4 and therefore could potentially decrease lamotrigine exposure. 

  • Ritonavir: induces oxidation by CYP2C9 and glucuronidation and as a result is expected to decrease the plasma concentrations of lamotrigine. 

  • Lopinavir: Lamotrigine exposure markedly decreased (~50%) when coadministered with lopinavir, probably by induction of glucuronidation.

  • Saquinavir/Ritonavir: could potentially decrease lamotrigine exposure possibly due to induction of glucuronidation. 

 

INCREASED LAMOTRIGINE LEVELS

  • Saquinavir: ?? according to maudsley prescribing guidelines, but accoridng to epocrates: no drug interaction; and according to online hiv-drug interactions: potential risk of reduction in lamotrigine.

 

NO INTERACTIONS WITH LAMOTRIGINE

  • Abacavir

  • Didanosine (ddI)

  • Lamivudine (3TC)

  • Nevirapine

  • Stavudine (d4T)

  • Zidovudine (AZT/ZDV)

 

 


Source:
    1. Current Psychiatry. 2018 May;17(5):35-36,41-44,46.

 

  1. Psychosomatics. 2010 Nov-Dec;51(6):480-8. 
  2. AIDS Rev. 2012 Apr-Jun;14(2):101-11.
  3. Maudsley prescribing guidelines.
  4. hiv-druginteractions online calculator.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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