Is it safe to take Lamotrigine and Levetiracetam together?

Safety of Taking Lamotrigine and Levetiracetam Together

Yes, it is safe to take lamotrigine and levetiracetam together, as they are both non-enzyme-inducing antiepileptic drugs that do not have significant pharmacokinetic interactions with each other. 1, 2

Pharmacological Interaction Profile

Levetiracetam and lamotrigine have favorable interaction profiles when used together:

• Levetiracetam does not affect the plasma concentration of lamotrigine 2
• Lamotrigine does not influence the pharmacokinetics of levetiracetam 2
• Neither drug significantly affects cytochrome P450 enzymes 2
• Both are classified as non-enzyme-inducing antiepileptic drugs (non-EIAEDs) 1

Clinical Evidence Supporting Combined Use

Studies examining the combination of lamotrigine and levetiracetam have shown:

• No significant pharmacokinetic interactions between these medications 2
• Driving performance studies show no clinically meaningful impairment with continued administration of either drug 1
• Some evidence suggests a potential beneficial pharmacodynamic interaction between levetiracetam and lamotrigine 3
• Post-hoc analysis of pooled Phase III trials showed that brivaracetam (similar to levetiracetam) with concomitant lamotrigine was generally well tolerated 4

Monitoring Considerations

While the combination is safe, certain monitoring parameters should be observed:

• Watch for common side effects of both medications:

  • Somnolence, dizziness, and fatigue are the most frequently reported adverse events for both drugs 1
  • Lamotrigine requires slow titration to minimize risk of serious rash 5

• No dose adjustments are typically needed when these medications are used together 2

• If valproate is added to this combination, lamotrigine levels will significantly increase due to inhibition of glucuronidation, requiring lamotrigine dose reduction 5

Advantages of This Combination

This combination offers several benefits:

• Both are non-enzyme-inducing antiepileptic drugs, making them preferable for patients on multiple medications, especially those receiving chemotherapy 1
• Neither drug significantly affects the metabolism of the other, reducing the risk of drug interactions 2
• The combination may be particularly useful for patients with focal epilepsy 1, 3

Potential Concerns

While generally safe, be aware of:

• Initial titration periods may have different side effect profiles (lamotrigine requires slower titration) 5
• Individual patient responses may vary, so monitoring for efficacy and side effects remains important
• Driving ability may be temporarily affected during initial titration, particularly with higher doses 1

In conclusion, lamotrigine and levetiracetam can be safely administered together without significant pharmacokinetic interactions or need for dose adjustments, making this a practical combination therapy option for seizure management.