From the Guidelines
Visanne may potentially decrease lamotrigine levels, and therefore, lamotrigine dosage adjustments may be necessary when used concurrently with Visanne. The interaction between Visanne (dienogest) and lamotrigine is not well-documented, but progestogens like dienogest can affect lamotrigine metabolism 1. Lamotrigine is primarily metabolized through glucuronidation in the liver, and hormonal medications can induce these enzymes, potentially lowering lamotrigine blood levels and reducing its effectiveness in controlling seizures or mood disorders. Some key points to consider when using Visanne and lamotrigine together include:
- Monitoring for changes in seizure frequency or mood stability
- Potential need for lamotrigine dosage adjustments when starting or stopping Visanne
- Regular blood level monitoring of lamotrigine to ensure therapeutic levels are maintained It is essential to consult with a healthcare provider to discuss the potential risks and benefits of using Visanne and lamotrigine concurrently, as well as to determine the best course of action for individual patients 1.
From the Research
Effect of Visanne on Lamotrigine
- Visanne, which contains dienogest, is a progestin that can affect the levels of certain medications, including lamotrigine 2.
- A study found that drospirenone and levonorgestrel, but not gestoden, reduced lamotrigine serum concentrations when co-administered in women with epilepsy 2.
- However, dienogest, the progestin in Visanne, was not specifically studied in this context, but its effects on lamotrigine levels can be inferred to be similar to other progestins 2.
- The reduction in lamotrigine serum concentrations may increase the risk of seizures, and therefore, monitoring of lamotrigine levels is recommended when Visanne is initiated or discontinued 2.
Mechanism of Interaction
- The exact mechanism of the interaction between Visanne and lamotrigine is not fully understood, but it is thought to be related to the induction of hepatic enzymes by progestins, which can increase the metabolism of lamotrigine 2.
- Lamotrigine is primarily metabolized by glucuronic acid conjugation, and progestins may induce this pathway, leading to increased clearance of lamotrigine 3.
Clinical Implications
- Women with epilepsy who are taking lamotrigine and are initiated on Visanne should be monitored closely for changes in seizure frequency or severity 2.
- The dosage of lamotrigine may need to be adjusted to maintain therapeutic levels when Visanne is co-administered 2.
- Healthcare providers should be aware of the potential interaction between Visanne and lamotrigine and take steps to minimize the risk of seizures or other adverse effects 2.