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Oral contraceptives reduce lamotrigine plasma levels

From the Danish Epilepsy Hospital (Dr. Sabers), and Department of Clinical Pharmacology (Dr. Christensen), University of Aarhus, Denmark; and Departments of Clinical Pharmacology (Dr. Öhman) and Neurology (Dr. Tomson), Karolinska Hospital, Stockholm, Sweden.

Address correspondence and reprint requests to Dr. A. Sabers, Department of Neurology, Glostrup University Hospital, Nordre Ringvej, DK-2600 Glostrup, Denmark; e-mail: anns{at}glostruphosp.kbhamt.dk

The mean steady-state plasma concentration of lamotrigine (LTG) was 13 µmol/L in 22 women taking LTG in combination oral contraceptives (OC) compared with 28 µmol/L among 30 women on LTG who did not take OC (p < 0.0001). The LTG dose/body weight/plasma concentration was 2.1 L/kg/day in women on OC compared with 0.8 L/kg/day in women without OC (p < 0.0001), indicating that LTG plasma levels are reduced by >50% during OC co-medication. It is advisable to monitor LTG plasma levels in conjunction with initiation or withdrawal of OC in women on LTG therapy.

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