Lamictal & Oral Contraceptives

[nicolee]

I've heard and read conflicting information on the interaction between Lamical and BC pills. It's well documented that the pill can mess with the lamictal levels, but that's not what I'm worried about. I can't seem to find any information that says whether or not Lamictal can decrease the effectiveness of the bc pill. I've called 3 different pharmacies, googled it, talked to my doctors and I can't seem to get an definitive answer. Do any of you know where I could find this information or know if there is a chance that the Lamictal could decrease the effectiveness of the birth control pill?

[Izzythekitty]

I have been on lamictal and pc pills. I am not sure if they decrease the effectiveness of the pill but I do believe for me that lamictac interferes with my hormones somehow. Two weeks before my period I start throwing up for about 10 days everyday. I assume it is hormones because it is the same time every month. I have never had any problems with birthcontrol on the pill. I will check it out and if I find anything post it.

[Izzythekitty]

I have been on lamictal and pc pills. I am not sure if they decrease the effectiveness of the pill but I do believe for me that lamictac interferes with my hormones somehow. Two weeks before my period I start throwing up for about 10 days everyday. I assume it is hormones because it is the same time every month. I have never had any problems with birthcontrol on the pill. I will check it out and if I find anything post it.

here is a site that lists meds that can interact with lamictal

http://www.drugs.com/drug-interactions/lamictal_d03809.html

[kellmate]

I've heard and read conflicting information on the interaction between Lamical and BC pills. It's well documented that the pill can mess with the lamictal levels, but that's not what I'm worried about. I can't seem to find any information that says whether or not Lamictal can decrease the effectiveness of the bc pill. I've called 3 different pharmacies, googled it, talked to my doctors and I can't seem to get an definitive answer. Do any of you know where I could find this information or know if there is a chance that the Lamictal could decrease the effectiveness of the birth control pill?

I talked to both my pdoc and gynecologist and they said the pill can effect lamictal, but not the other way around. I'm on yaz and they both agreed that was the best bc pill to be on. However, I'm getting an IUD in May(for free, everyone in college should call their local planned parenthood and see if they have the college program that allows college students to get it for free!) so that I don't have to worry about any interactions at all.

[beetle]

I ran a drug interaction check between Seasonale (the bc I take) and lamictal and this is what I get:

ethinyl estradiol (Ingredient of Seasonale) and Lamictal (lamotrigine) (Moderate Drug-Drug)

MONITOR: Coadministration with estrogens or progestins may decrease the plasma concentrations and pharmacologic effects of lamotrigine due to induction of lamotrigine glucuronidation. One group of investigators cited seven suspected cases of this interaction in women treated with oral contraceptives that contained either ethinyl estradiol in combination with desogestrel or norethindrone or norethindrone alone. The contraceptives reduced plasma levels of lamotrigine by 41% to 64%, and a deterioration in seizure control was observed several days to two months after initiation of contraceptive use, necessitating an increase in lamotrigine dosage or discontinuation of the contraceptive. In some cases, contraceptive discontinuation led to lamotrigine toxicity that required dosage reduction. A pharmacokinetic study also reported similar reductions in lamotrigine plasma levels in patients on combination oral contraceptives, with lamotrigine clearance 2.5 times greater than in controls. The interaction is further supported by the fact that changes in hormone levels are known to influence the pharmacokinetics of glucuronidated drugs in humans, and elimination of lamotrigine is significantly increased during pregnancy. However, a population pharmacokinetics study in patients newly diagnosed with epilepsy and receiving oral lamotrigine monotherapy for up to 48 weeks found no significant effect of oral contraceptive use or dose on the oral clearance of lamotrigine. Lamotrigine also has been shown to have little or no effect on the pharmacokinetics of contraceptive hormones, although measurement of serum FSH, LH, and estradiol has indicated some loss of suppression of the hypothalamic-pituitary-ovarian axis. The clinical significance is unknown. Measurement of serum progesterone indicated no hormonal evidence of ovulation.

MANAGEMENT: Pharmacologic response and plasma lamotrigine levels should be monitored more closely whenever estrogen- and/or progestin-containing drugs are added to or withdrawn from therapy, and the lamotrigine dosage adjusted as necessary. Patients should be advised to contact their physician if they experience loss of seizure control or symptoms of lamotrigine toxicity such as ataxia, nystagmus, increased seizures, irregular heartbeat, and changes in mental status. In patients receiving oral contraceptives, gradual transient increases in lamotrigine levels will occur during the pill-free week for women not also taking an enzyme-inducing drug (e.g., carbamazepine, phenytoin, phenobarbital, primidone, rifampin). The increase in lamotrigine levels will be greater if the dose of lamotrigine is increased in the few days before or during the pill-free week. Although diminished contraceptive efficacy has not been reported, the possibility should be considered. Patients should be instructed to promptly report changes in their menstrual pattern.

And:

levonorgestrel (Ingredient of Seasonale) and Lamictal (lamotrigine) (Moderate Drug-Drug)

MONITOR: Coadministration with estrogens or progestins may decrease the plasma concentrations and pharmacologic effects of lamotrigine due to induction of lamotrigine glucuronidation. One group of investigators cited seven suspected cases of this interaction in women treated with oral contraceptives that contained either ethinyl estradiol in combination with desogestrel or norethindrone or norethindrone alone. The contraceptives reduced plasma levels of lamotrigine by 41% to 64%, and a deterioration in seizure control was observed several days to two months after initiation of contraceptive use, necessitating an increase in lamotrigine dosage or discontinuation of the contraceptive. In some cases, contraceptive discontinuation led to lamotrigine toxicity that required dosage reduction. A pharmacokinetic study also reported similar reductions in lamotrigine plasma levels in patients on combination oral contraceptives, with lamotrigine clearance 2.5 times greater than in controls. The interaction is further supported by the fact that changes in hormone levels are known to influence the pharmacokinetics of glucuronidated drugs in humans, and elimination of lamotrigine is significantly increased during pregnancy. However, a population pharmacokinetics study in patients newly diagnosed with epilepsy and receiving oral lamotrigine monotherapy for up to 48 weeks found no significant effect of oral contraceptive use or dose on the oral clearance of lamotrigine. Lamotrigine also has been shown to have little or no effect on the pharmacokinetics of contraceptive hormones, although measurement of serum FSH, LH, and estradiol has indicated some loss of suppression of the hypothalamic-pituitary-ovarian axis. The clinical significance is unknown. Measurement of serum progesterone indicated no hormonal evidence of ovulation.

MANAGEMENT: Pharmacologic response and plasma lamotrigine levels should be monitored more closely whenever estrogen- and/or progestin-containing drugs are added to or withdrawn from therapy, and the lamotrigine dosage adjusted as necessary. Patients should be advised to contact their physician if they experience loss of seizure control or symptoms of lamotrigine toxicity such as ataxia, nystagmus, increased seizures, irregular heartbeat, and changes in mental status. In patients receiving oral contraceptives, gradual transient increases in lamotrigine levels will occur during the pill-free week for women not also taking an enzyme-inducing drug (e.g., carbamazepine, phenytoin, phenobarbital, primidone, rifampin). The increase in lamotrigine levels will be greater if the dose of lamotrigine is increased in the few days before or during the pill-free week. Although diminished contraceptive efficacy has not been reported, the possibility should be considered. Patients should be instructed to promptly report changes in their menstrual pattern.

So, it's sounds like the bigger concern is the effect of bc on lamictal. But that last sentence would indicate that if one wanted to be extra careful they should consider the possibility that lamictal may effect bc.

BTW, the drug checker I used is here:

http://www.drugs.com/drug_interactions.html

I was on lamictal for a bit. When I went to pick up my Rx the pharmacy tech said, and loudly I might add, that the lamictal might effect my bc so I should probably use a backup method of bc.

Maybe related, maybe not but.... I have now been taking trileptal (also an AC) and have just started having trouble with my period. Basically I take Seasonale so I should only have a period once every three months. I don't use it for bc, just to regulate my period. Well I missed a pill and have been spotting ever since. This didn't happen if I missed a pill before going on trileptal. So, I wonder if trileptal is effecting my hormone levels just enough that missing one pill sent me into spotting. I do hope it ends soon.

When I run a drug check between Seasonale and trileptal I get this. I'll only post the result for one out of the two hormonal ingredients in Seasonale, the interaction is the same for both.

ethinyl estradiol (Ingredient of Seasonale) and Trileptal (oxcarbazepine) (Moderate Drug-Drug)

ADDITIONAL CONTRACEPTION RECOMMENDED: Coadministration with certain anticonvulsants such as carbamazepine, oxcarbazepine, phenobarbital, phenytoin, and primidone may reduce the efficacy of contraceptive hormones. There have been numerous case reports of menstrual abnormalities (e.g., breakthrough bleeding, amenorrhea, irregular menses) and unintended pregnancy occurring in women who received oral contraceptives with anticonvulsants. The incidence of menstrual irregularities associated with this combination has been reported to be as high as 65% in some studies. The interaction stems from accelerated clearance of contraceptive hormones as well as decreased plasma concentrations of unbound (active) hormones due to induction of hepatic CYP450 enzymatic activity and hormone-binding globulin capacity by some anticonvulsants. Pharmacokinetic studies have found that normally recommended dosages of carbamazepine, phenobarbital, oxcarbazepine, and phenytoin can individually reduce the systemic exposure (AUC) of ethinyl estradiol and levonorgestrel by a third or more.

MANAGEMENT: Women using hormonal contraceptives should be advised of the risk of breakthrough bleeding and unintended pregnancy during concomitant therapy with enzyme-inducing anticonvulsants. Alternative or additional methods of birth control should be used during and for at least two weeks after short-term and 4 weeks after long-term (greater than 4 weeks) anticonvulsant therapy. If a combination oral contraceptive pill is used, a regimen containing at least 50 mcg of ethinyl estradiol per day or equivalent should be selected. Although breakthrough bleeding is not necessarily indicative of low ethinyl estradiol serum levels or increased risk of ovulation, some clinicians suggest that women who experience breakthrough bleeding during enzyme-inducing therapy may be prescribed an increased dose of ethinyl estradiol above 50 mcg daily by combining more than one formulation of contraceptive pill if necessary. For levonorgestrel emergency contraception in patients receiving enzyme-inducing therapy, a regimen consisting of a 1.5 mg dose as soon as possible (within 72 hours of unprotected intercourse) followed by a 0.75 mg or 1.5 mg dose twelve hours later has been recommended by some clinicians. An alternative is a single 2.25 mg dose as soon as possible following unprotected intercourse. However, there are no data on efficacy, compliance, or side effects with any of these regimens. No precautions or recommendations are available for women using hormone-releasing intrauterine systems, but a significant interaction with these systems is thought to be unlikely due to their local action. Injectable progestin-only contraceptives are also thought to be unaffected by enzyme-inducing drugs.

This is a very different warning than the one given for lamictal and Seasonale. But I think that last bit of caution in the lamictal/Seasonale warning is because, ACs in general can mess with bc. But lamictal supposedly works so much differently than other ACs that it might not be a problem.

So, I guess the final answer to your question is...Maybe

[nalgas]

Maybe related, maybe not but.... I have now been taking trileptal (also an AC) and have just started having trouble with my period. Basically I take Seasonale so I should only have a period once every three months. I don't use it for bc, just to regulate my period. Well I missed a pill and have been spotting ever since. This didn't happen if I missed a pill before going on trileptal. So, I wonder if trileptal is effecting my hormone levels just enough that missing one pill sent me into spotting. I do hope it ends soon.

Trileptal (and Tegretol and Topamax) can definitely do that. It raises the levels of the liver enzymes that metabolize hormones like that, and the result of that is lower levels of the hormones. That's the same reason that it interacts with a bunch of other stuff, too.

[beetle]

Maybe related, maybe not but.... I have now been taking trileptal (also an AC) and have just started having trouble with my period. Basically I take Seasonale so I should only have a period once every three months. I don't use it for bc, just to regulate my period. Well I missed a pill and have been spotting ever since. This didn't happen if I missed a pill before going on trileptal. So, I wonder if trileptal is effecting my hormone levels just enough that missing one pill sent me into spotting. I do hope it ends soon.

Trileptal (and Tegretol and Topamax) can definitely do that. It raises the levels of the liver enzymes that metabolize hormones like that, and the result of that is lower levels of the hormones. That's the same reason that it interacts with a bunch of other stuff, too.

*sigh* I expected as much. Just another reason to love my meds. whoopie!

[nicolee]

Thanks for the responses. I don't have insurance so an IUD or tubal ligation is out of my reach right now. I never want kids, so I'd prefer to be sterilized, but until I get a job with insurance it won't happen. I'd rather be safe than sorry, so I guess I'll be using a back up method of bc.