Is progesterone safe to use with Keppra (levetiracetam) and lamotrigine?

Safety of Progesterone with Keppra (Levetiracetam) and Lamotrigine

Progesterone can be safely used with levetiracetam and lamotrigine as there are no significant drug interactions between these medications that would affect seizure control or contraceptive efficacy.

Drug Interaction Analysis

Levetiracetam (Keppra) and Progesterone

• Levetiracetam is considered a weight-neutral antiepileptic drug that does not induce hepatic enzymes 1
• No interactions have been documented between levetiracetam and hormonal contraceptives, including progesterone 2
• Levetiracetam does not affect the metabolism of hormonal contraceptives, making it a safe option for patients requiring both medications 2

Lamotrigine and Progesterone

• Unlike enzyme-inducing antiepileptic drugs (such as carbamazepine, phenytoin, and phenobarbital), lamotrigine does not reduce the effectiveness of progesterone-based contraceptives 2
• However, it's important to note that hormonal contraceptives can affect lamotrigine levels:
  • Some evidence indicates that concurrent use of hormonal contraceptives may decrease plasma concentrations of lamotrigine 3
  • This interaction may require monitoring and possible dose adjustment of lamotrigine, but does not make the combination unsafe 3

Clinical Considerations

Monitoring Recommendations

• If using progesterone with lamotrigine, monitor for:
  • Potential decrease in lamotrigine levels
  • Changes in seizure frequency
  • Consider lamotrigine level monitoring 1-2 weeks after starting or stopping progesterone therapy 4

Specific Patient Populations

• For women with catamenial epilepsy (seizures related to menstrual cycle):
  • Lamotrigine may actually be beneficial when used with progesterone
  • Research suggests lamotrigine may increase serum progesterone levels, which could have an anticonvulsant effect 5

Advantages of This Combination

• Both levetiracetam and lamotrigine are considered appropriate options for women of childbearing potential 6
• Normal dosing of progesterone-based contraceptives can be used with these non-enzyme-inducing antiepileptic drugs 2

Potential Pitfalls and Caveats

• While the combination is safe, be aware that:
  • Progesterone may decrease lamotrigine levels, potentially requiring dose adjustment
  • Any changes in hormonal therapy should be accompanied by monitoring of seizure frequency
  • Individual responses may vary, so clinical monitoring is essential

Algorithm for Management

1. Start with standard doses of all medications
2. Monitor lamotrigine levels 1-2 weeks after starting progesterone
3. Adjust lamotrigine dose if levels decrease significantly
4. Monitor seizure frequency throughout treatment
5. If breakthrough seizures occur, consider:
   • Checking lamotrigine levels
   • Increasing lamotrigine dose if levels are low
   • Evaluating other potential causes of seizure breakthrough

In conclusion, the combination of progesterone with levetiracetam and lamotrigine is safe and does not require special precautions beyond standard monitoring of seizure control and potential adjustment of lamotrigine dosing.