Lamotrigine and Escitalopram Can Be Safely Prescribed Together
Yes, Lamictal (lamotrigine) and Lexapro (escitalopram) can be safely prescribed together, though monitoring for potential interactions is recommended.
Mechanism and Safety Profile
Lamotrigine and escitalopram work through different mechanisms:
- Lamotrigine (Lamictal): An anticonvulsant and mood stabilizer that works by inhibiting voltage-sensitive sodium channels and reducing glutamate release
- Escitalopram (Lexapro): A selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels in the brain
The combination is commonly used in clinical practice, particularly for patients with:
- Bipolar depression with comorbid anxiety
- Treatment-resistant depression
- Mixed mood states requiring both mood stabilization and antidepressant effects
Evidence for Safety
According to clinical guidelines, there is no significant pharmacokinetic interaction between lamotrigine and SSRIs like escitalopram 1. Unlike some drug combinations that require dosage adjustments, this combination doesn't typically require special dosing considerations.
The American Academy of Child and Adolescent Psychiatry guidelines note that lamotrigine has a relatively favorable drug interaction profile compared to other anticonvulsants 1. While the guidelines caution about combining multiple serotonergic agents in general, they don't specifically contraindicate the lamotrigine-escitalopram combination.
Monitoring Recommendations
While generally safe, monitoring is still important:
Watch for serotonin syndrome: Though rare with this specific combination, be alert for symptoms including:
- Mental status changes (agitation, confusion)
- Neuromuscular abnormalities (tremor, hyperreflexia)
- Autonomic instability (tachycardia, hypertension)
Monitor mood stability: Especially in bipolar patients, as antidepressants can potentially trigger manic episodes
Follow-up timing: The American College of Physicians recommends follow-up within 1-2 weeks of treatment initiation to monitor for emergence of suicidal thoughts and signs of serotonin syndrome 2
Precautions
There is one case report of serotonin toxicity following overdose with this combination 3, but this occurred in the context of intentional overdose rather than therapeutic dosing. At normal therapeutic doses, the risk appears minimal.
Dosing Considerations
- Start with standard doses of each medication
- Titrate each medication according to its individual guidelines
- No special dosage adjustments are typically needed when using these medications together
Conclusion
The combination of lamotrigine and escitalopram is generally considered safe and effective for appropriate patients. While monitoring for potential adverse effects is recommended, as with any medication regimen, there are no specific contraindications or major drug interactions that would prevent their concurrent use.