What is the interaction between Aripiprazole (Abilify) and Lamotrigine (Lamictal)?

From the Guidelines

Abilify (aripiprazole) and Lamictal (lamotrigine) can be safely taken together and are sometimes prescribed as a combination therapy for certain mental health conditions, particularly bipolar disorder, as evidenced by recent studies 1.

Key Considerations

• This combination is useful for bipolar disorder, where Lamictal helps stabilize mood and prevent depressive episodes while Abilify works as an atypical antipsychotic to manage manic symptoms and provide additional mood stabilization.
• The medications work through different mechanisms - Lamictal affects sodium channels and glutamate release in the brain, while Abilify partially activates dopamine and serotonin receptors.
• Common dosages for adults include Abilify at 5-15 mg daily and Lamictal starting at 25 mg daily and gradually increasing to 100-200 mg daily, though exact dosing should be determined by your doctor.
• When taking these medications together, be aware of potential side effects including dizziness, headache, nausea, and drowsiness.
• It's essential to start Lamictal with a slow titration schedule to reduce the risk of serious rash, and regular monitoring by your healthcare provider is crucial to assess effectiveness and manage any side effects.

Evidence-Based Recommendations

• Recent studies have shown that antipsychotic polypharmacy, including the combination of Abilify and Lamictal, may be associated with reduced risk of psychiatric hospitalization and all-cause mortality 1.
• However, it's crucial to carefully evaluate the benefits and risks of this combination therapy for each individual patient, considering factors such as treatment-resistant schizophrenia, side effect profiles, and potential drug interactions.
• The American Psychiatric Association and other guidelines recommend monotherapy as the first-line treatment, but acknowledge that antipsychotic polypharmacy may be necessary in certain cases, such as treatment-resistant schizophrenia 1.

Important Considerations for Clinical Practice

• Regular monitoring and assessment of treatment effectiveness and side effects are essential when prescribing Abilify and Lamictal together.
• Healthcare providers should be aware of the potential for drug interactions and adjust dosages accordingly.
• Patients should be educated on the potential benefits and risks of this combination therapy and encouraged to report any side effects or concerns to their healthcare provider.

From the FDA Drug Label

7.2 Drugs Having No Clinically Important Interactions with Aripiprazole Based on pharmacokinetic studies, no dosage adjustment of aripiprazole is required when administered concomitantly with ... lamotrigine ... when co-administered with aripiprazole [see Clinical Pharmacology (12.3)].

The combination of Abilify (aripiprazole) and Lamictal (lamotrigine) does not require a dosage adjustment of aripiprazole, as there are no clinically important interactions between the two drugs 2.

From the Research

Abilify (Aripiprazole) with Lamictal (Lamotrigine)

• The combination of Abilify (Aripiprazole) and Lamictal (Lamotrigine) has been studied in the treatment of bipolar disorder 3.
• A study found that Aripiprazole plus Lamotrigine delayed the time to manic/mixed relapse, but the result was not statistically significant 3.
• The estimated relapse rates at Week 52 were 11% for Aripiprazole + Lamotrigine and 23% for placebo + Lamotrigine, yielding a number needed-to-treat of nine 3.
• Common adverse events included akathisia, insomnia, and anxiety 3.

Efficacy and Safety

• A review of Lamotrigine in the treatment of bipolar disorder found that it is effective in preventing depressive relapse, but has limited evidence for efficacy in acute mania or unipolar depression 4.
• A case report found that the combination of Aripiprazole, Lamotrigine, and antidepressants may increase the risk of akathisia, anxiety, and suicidal thoughts in patients with mood disorder 5.
• A review of the diagnosis and treatment of bipolar disorder found that Lamotrigine is a recommended treatment option for the maintenance phase in adult bipolar disorder, and Aripiprazole is recommended for the treatment of acute mania and prevention of manic relapse 6.

Combination Therapy

• A study found that the combination of Aripiprazole and Lamotrigine was more effective than placebo in preventing manic relapse, but not depressive relapse 7.
• The combination of Aripiprazole with Lamotrigine has been found to have a favorable safety and tolerability profile, with no unexpected adverse events 3.