Are there any interactions between Ashwaganda (Withania somnifera) supplement and Levetiracetam (Keppra) and Lamotrigine?

From the Guidelines

I strongly advise against combining ashwagandha supplements with levetiracetam and lamotrigine without consulting a healthcare provider due to potential interactions that could impact seizure control and overall health outcomes. Ashwagandha may interact with these antiepileptic medications because it has mild GABA-enhancing properties, which could theoretically enhance or interfere with the anticonvulsant effects of both medications [ 1 ]. Levetiracetam works by binding to synaptic vesicle protein SV2A, while lamotrigine blocks voltage-sensitive sodium channels and inhibits glutamate release. Ashwagandha's adaptogenic properties might affect the metabolism of these drugs through cytochrome P450 enzyme pathways, potentially altering their blood levels and effectiveness.

Key considerations for patients taking these medications include:

• Maintaining consistent dosing of all substances
• Monitoring for any changes in seizure frequency or new side effects
• Keeping a detailed log to share with their healthcare provider
• Being aware of the potential for ashwagandha to affect the efficacy of levetiracetam and lamotrigine, as evidenced by studies on the management of status epilepticus [ 1 ]

It is crucial to prioritize caution when combining supplements with prescription medications, especially those used for seizure control, as any interaction could have significant implications for morbidity, mortality, and quality of life [ 1 ]. Therefore, consulting with a healthcare provider before adding ashwagandha supplements to a regimen that includes levetiracetam and lamotrigine is essential to ensure safe and effective management of seizure disorders.

From the FDA Drug Label

In vitro data on metabolic interactions indicate that levetiracetam is unlikely to produce, or be subject to, pharmacokinetic interactions Levetiracetam and its major metabolite, at concentrations well above Cmax levels achieved within the therapeutic dose range, are neither inhibitors of nor high affinity substrates for human liver cytochrome P450 isoforms, epoxide hydrolase or UDP glucuronidation enzymes. Potential drug interactions between levetiracetam and other AEDs (carbamazepine, gabapentin, lamotrigine, phenobarbital, phenytoin, primidone and valproate) were also assessed by evaluating the serum concentrations of levetiracetam and these AEDs during placebo-controlled clinical studies These data indicate that levetiracetam does not influence the plasma concentration of other AEDs and that these AEDs do not influence the pharmacokinetics of levetiracetam. Levetiracetam had no effect on plasma concentrations of carbamazepine, valproate, topiramate, or lamotrigine.

There is no information about interactions between ashwaganda supplement and levetiracetam or lamotrigine in the provided drug label 2.

From the Research

Interaction between Ashwagandha Supplement and Medications

There is limited research on the interaction between Ashwagandha supplements and specific medications like levetiracetam and Lamotrigine. However, some studies provide insight into potential interactions:

• Drug-drug interactions can occur when one drug affects the absorption, distribution, metabolism, or excretion of another drug 3.
• Ashwagandha has been shown to have a beneficial effect on anxiety and stress levels, but its interaction with other medications is not well understood 4, 5.
• Common drug-drug interactions can result from alterations in drug metabolism, absorption, or additive effects, which can increase the risk of adverse events 3, 6.

Potential Interactions with Levetiracetam and Lamotrigine

There is no direct evidence on the interaction between Ashwagandha supplements and levetiracetam or Lamotrigine. However:

• Ashwagandha has been reported to have neuroprotective effects and may interact with medications that affect the central nervous system 7.
• Levetiracetam and Lamotrigine are both used to treat epilepsy and may have interactions with other medications that affect the central nervous system.
• It is essential to consult with a healthcare professional before taking Ashwagandha supplements with any medication, including levetiracetam and Lamotrigine, to minimize potential interactions and adverse events.

Key Considerations

• The lack of research on the specific interaction between Ashwagandha supplements and levetiracetam or Lamotrigine makes it challenging to provide definitive guidance.
• Healthcare professionals should be consulted before taking Ashwagandha supplements with any medication to ensure safe and effective use.
• Further research is needed to fully understand the potential interactions between Ashwagandha supplements and various medications, including levetiracetam and Lamotrigine 4, 5, 7.