From the Guidelines
Lamictal (lamotrigine) and Cymbalta (duloxetine) can be taken together, but this combination should only be used under a doctor's supervision, as it may increase the risk of serotonin syndrome and other side effects, and require dosage adjustments 1. When considering this combination, it's essential to weigh the potential benefits against the risks, particularly in terms of morbidity, mortality, and quality of life. The combination of lamotrigine and duloxetine may be beneficial for patients with treatment-resistant depression or bipolar disorder with depression, as it may provide a more comprehensive treatment approach. However, it's crucial to monitor patients closely for potential side effects, including dizziness, drowsiness, headache, and increased risk of serotonin syndrome.
Some key considerations when taking these medications together include:
- Informing your doctor about all medications you're taking, including over-the-counter drugs and supplements, as they may interact with this combination
- Regular follow-up appointments to monitor effectiveness and side effects
- Never adjusting dosages or stopping either medication without consulting your healthcare provider first
- Being aware of the potential for increased risk of serotonin syndrome, which can be life-threatening if not recognized and treated promptly
It's also important to note that the evidence supporting medication combinations, including lamotrigine and duloxetine, is limited, and more research is needed to fully understand the benefits and risks of this combination 1. However, in clinical practice, this combination may be used under close supervision, with careful monitoring of side effects and adjustment of dosages as needed.
From the Research
Combination of Lamictal and Cymbalta
- The combination of Lamictal (lamotrigine) and Cymbalta (duloxetine) has not been directly studied in the provided evidence.
- However, studies have shown that lamotrigine can cause serotonin syndrome, a potentially life-threatening condition, when combined with other serotonergic agents 2, 3.
- Duloxetine, a serotonin-norepinephrine reuptake inhibitor, also has serotonergic properties and can increase the risk of serotonin syndrome when combined with other serotonergic agents.
- A study on serotonin syndrome induced by a combination of agents that enhance serotonin activity found that the simultaneous use of two or more serotonergic drugs can lead to severe serotonin syndrome 4, 5.
- Another study found that patients who co-ingested another serotonin agent with lamotrigine had a higher incidence of developing serotonin toxicity 6.
Serotonin Syndrome Risk
- The risk of serotonin syndrome when combining lamotrigine and duloxetine is not well-established, but it is likely increased due to the serotonergic properties of both drugs.
- Patients taking both lamotrigine and duloxetine should be closely monitored for signs of serotonin syndrome, such as mental status changes, autonomic hyperactivity, and neuromuscular abnormalities 5, 3.
- If serotonin syndrome is suspected, immediate medical attention is necessary, and the offending agents should be discontinued 2, 6.