Q:  Lamictal & Oral Contraceptives

I was dx'd two and a half years ago with BP II and am currently taking 200mg of Lamictal, 37.5 mg of Zoloft, and 25 mg of Seroquel. I want to go on the Pill, but have heard that hormonal contraceptives lower your Lamictal levels in your blood rather drastically. Is this true? Do you have any suggestions on how to start on the Pill (especially Yaz or Yasmin) without experiencing a huge drop in lamictal levels, because I know that can put you at risk for seizures and other bad side effects. Thanks!

Dear M' -- 
This is true, but whether it has any impact on the effectiveness of lamotrigine is not clear, and so far it seems as though the answer to that is "not a problem".  In part this is because the lamotrigine reduction occurs only during a part of the monthly cycle regulated by birth control pills.  If you would like a more complex explanation, as I think most people in your circumstance would want and should have, see my webpage on lamotrigine and oral contraceptives, and which incorporates everything I could get from the manufacturer on this phenomenon.

One could argue that someone about to start an oral contraceptive, who is doing well on lamotrigine, might want to get a lamotrigine level before adding the birth control pill.  Then, if things seem to be worse somehow, you could try to dial the lamotrigine back to its level prior to oral contraceptive. On the other hand, if things were worse somehow, you could just turn up the lamotrigine presuming that a decrease in level might have been the basis for the change -- so why get the lab testing, why not just be prepared to turn up the dose?  Either approach is justifiable.

Dr. Phelps