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7 Interactions found for:

Lamictal and Cymbalta
Interactions Summary
  • 3 Major
  • 3 Moderate
  • 1 Minor
  • Lamictal
  • Cymbalta

Drug Interactions

Moderate
Lamictal + Cymbalta

The following applies to the ingredients: Lamotrigine (found in Lamictal) and Duloxetine (found in Cymbalta)

Treatment with DULoxetine may occasionally cause blood sodium levels to get too low, a condition known as hyponatremia, and using it with lamoTRIgine can increase that risk. In addition, DULoxetine can cause seizures in susceptible patients, which may reduce the effectiveness of medications that are used to control seizures such as lamoTRIgine. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. You should seek medical attention if you experience nausea, vomiting, headache, lethargy, irritability, difficulty concentrating, memory impairment, confusion, muscle spasm, weakness or unsteadiness, as these may be symptoms of hyponatremia. More severe cases may lead to hallucination, fainting, seizure, coma, and even death. Also let your doctor know if you develop seizures or experience an increase in seizures during treatment with DULoxetine. Additionally, because these medications may cause dizziness, drowsiness, and impairment in judgment, reaction speed and motor coordination, you should avoid driving or operating hazardous machinery until you know how they affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Drug and Food Interactions

Moderate
Lamictal + Food

The following applies to the ingredients: Lamotrigine (found in Lamictal)

Alcohol can increase the nervous system side effects of lamoTRIgine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with lamoTRIgine. Do not use more than the recommended dose of lamoTRIgine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Moderate
Cymbalta + Food

The following applies to the ingredients: Duloxetine (found in Cymbalta)

DULoxetine may cause liver damage, and taking it with alcohol may increase that risk. You should avoid or limit the use of alcohol while being treated with DULoxetine. Call your doctor immediately if you have fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, dark colored urine, or yellowing of the skin or the whites of your eyes, as these may be symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Drug and Pregnancy Interactions

The following applies to the ingredients: Lamotrigine (found in Lamictal)

Professional Content

Benefit should outweigh risk

AU TGA pregnancy category: D
US FDA pregnancy category: Not assigned

Risk Summary: Several prospective pregnancy exposure registries and epidemiological studies have not detected an increased frequency of major congenital malformations or a consistent pattern of malformations among women exposed to lamotrigine compared with the general population; animal studies have shown developmental toxicities at doses administered clinically.

Comments:
-Women with epilepsy who are planning to become pregnant should receive pre-pregnancy counseling; folate supplementation should be considered before conception and for the first 12 weeks of pregnancy.
-Abrupt discontinuation of anti-epileptic therapy during pregnancy is not advised as this may lead to breakthrough seizures in mother and fetus.
-Physiologic changes during pregnancy may affect drug concentrations and/or therapeutic effect; dose adjustments may be necessary to maintain clinical response.
-Women should be advised to notify their healthcare provider if they plan to start or stop oral contraceptive use or other female hormonal preparations as this may significantly affect lamotrigine drug concentrations.
-A pregnancy registry is available to provide information on the effects of in utero exposure; pregnant patients should be encouraged to enroll: North American AED Pregnancy Registry: US toll free number: 1-888-233-2334; Website: http://www.aedpregnancyregistry.org/

Animal studies have shown developmental toxicity at doses estimated to be lower than those used clinically. Pregnant rats administered 3 doses (5, 10 or 20 mg/kg) during the latter part of gestation had increased offspring mortality (including stillbirths) at all doses. The lowest effect dose for peri/postnatal developmental toxicity was less than the human dose of 400 mg/day on mg/m2 basis. Maternal toxicity was observed at the 2 highest doses. Studies in rats have shown a decrease in folic acid during pregnancy, and since this drug is a weak inhibitor of dihydrofolate reductase, there is a theoretical risk of malformation due to folate deficiency. Anti-epileptic drugs should generally be continued during pregnancy with the goal of monotherapy at the lowest effective dose, however, the risk to the mother and fetus of uncontrolled epilepsy should be considered when deciding on treatment options. Data from several international pregnancy registries have not shown an increased risk for malformations overall. The frequency of major congenital malformations was similar to estimates from the general population. The North American Antiepileptic Drug Pregnancy (NAAED) Registry has reported an increased risk of isolated oral clefts, although this finding has not been observed in other large international pregnancy registries. Several meta-analyses have not reported an increased risk of major congenital malformations following lamotrigine exposure in pregnancy compared with healthy and disease-matched controls. No patterns of specific malformation types were observed. As with other antiepileptic drugs, decreased lamotrigine concentrations have been reported during pregnancy with a return to pre-pregnancy concentrations after delivery. Appropriate clinical management should include monitoring drug concentrations and adjusting doses as indicated. There are no adequate and well-controlled studies in pregnant women.

AU TGA pregnancy category D: Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome, Research Triangle Park, NC.
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online. Available from: URL: http://www.appco.com.au/appguide/default.asp." ([2006]):
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  5. "Product Information. LaMICtal XR (lamoTRIgine)." GlaxoSmithKline, Research Triangle Park, NC.

The following applies to the ingredients: Duloxetine (found in Cymbalta)

Professional Content

This drug should not be used during pregnancy unless the benefit outweighs the risk to the fetus.

AU TGA pregnancy category: B3
US FDA pregnancy category: Not assigned.

Risk summary: Observational study data have not produced clear drug-associated risks regarding adverse events or major birth defects.

Comments:
-A pregnancy exposure registry is available.
-Neonates exposed to this drug late in the third trimester may require respiratory support, tube feeding, and/or prolonged hospitalization.
-Exposed neonates should be monitored after delivery for direct toxic effects of this drug, drug discontinuation syndrome, and serotonin syndrome.
-Women who discontinued antidepressant use during pregnancy were more likely to experience a relapse of major depression than women who continued antidepressant use.

Animal studies have revealed increased perinatal toxicity and fetotoxicity at doses potentially correlated with maternal toxicity. There are no controlled data in human pregnancy.

Some neonates exposed to SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), or SSRIs (Selective Serotonin Reuptake Inhibitors) late in the third trimester had clinical findings including respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. This clinical picture is consistent with either direct toxic effect of SSRIs and SNRIs, drug discontinuation syndrome, or serotonin syndrome.

A less than 2-fold increase in postpartum hemorrhage was determined by observational data in patients exposed to the drug within 1 month before birth.

A study of women with a history of major depression who were euthymic at the beginning of pregnancy, showed women who discontinued antidepressant medication during pregnancy were more likely to experience a relapse of major depression than women who continued antidepressant medication.

To monitor maternal-fetal outcomes of pregnant women exposed to antidepressant therapy, a National Pregnancy Registry for Antidepressants has been established. Healthcare providers are encouraged to prospectively register patients. For additional information: https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/

Healthcare providers are encouraged to register patients receiving Cymbalta by calling the Cymbalta Pregnancy Registry at 1-866-814-6975 or by visiting www.cymbaltapregnancyregistry.com.

AU TGA pregnancy category B3: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.

References

  1. "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company, Indianapolis, IN.
  2. Cerner Multum, Inc. "Australian Product Information." O 0
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

Drug and Breastfeeding Interactions

The following applies to the ingredients: Duloxetine (found in Cymbalta)

Professional Content

Use is not recommended and a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.

Excreted into human milk: Yes

Comments:
-Some experts state that a more thoroughly studied alternative agent (e.g., nortriptyline, paroxetine, sertraline) may be preferred while breastfeeding premature or neonates.
-The American Academy of Pediatrics classifies other antidepressants as agents for which the effect on nursing infants is unknown but may be of concern.
-Exposed infants should be monitored for developmental milestones, feeding, sedation, weight gain, especially in younger infants who are exclusively breastfed and/or when breastfed infants are exposed to multiple antipsychotropic agents.

The estimated neonatal dose is approximately 0.1% to 0.3% of the maternal dose.

References

  1. National Library of Medicine (US) "Drugs and Lactation Database (LactMed) Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK501922/" (2006):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. "Product Information. Cymbalta (duloxetine)." Lilly, Eli and Company, Indianapolis, IN.
  5. United States National Library of Medicine "Toxnet. Toxicology Data Network. Available from: URL: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT." ([cited 2013 -]):
  6. Briggs GG, Freeman RK. "Drugs in Pregnancy and Lactation. 10th ed." Philadelphia, PA: Wolters Kluwer Health (2015):

The following applies to the ingredients: Lamotrigine (found in Lamictal)

Professional Content

Benefit should outweigh risk

Excreted into human milk: Yes

Comments:
-Adverse reactions have occasionally been reported in breastfed babies, but long-term exposure does not appear to affect infant growth and development.
-Breastfed infants should be carefully monitored for side effects; serum levels may be measured to rule out toxicity.
-If infant rash occurs, breastfeeding should be discontinued until cause can be established.

Drug concentrations in human milk may be as high as 50% of the maternal serum levels. Neonates are at risk for high plasma levels due to plasma protein binding being relatively low and decreased ability to clear drug (immaturity of glucuronidation capacity). Additionally, similar to other antiepileptic drugs, the maternal dose should generally be reduced after delivery to the pre-pregnancy dosage, and failure to reduce dose may lead to higher milk concentrations. Apnea, rash, drowsiness, and poor sucking have been reported in breastfed infants. If an adverse event occurs, a serum level can be measured to rule out toxicity. Consider monitoring platelet counts and liver function. Breastfeeding should be discontinued in infants with lamotrigine toxicity

References

  1. Pharmaceutical Society of Australia "APPGuide online. Australian prescription products guide online. Available from: URL: http://www.appco.com.au/appguide/default.asp." ([2006]):
  2. "Product Information. LaMICtal XR (lamoTRIgine)." GlaxoSmithKline, Research Triangle Park, NC.
  3. "Product Information. Lamictal (lamotrigine)." Glaxo Wellcome, Research Triangle Park, NC.
  4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  5. United States National Library of Medicine "Toxnet. Toxicology Data Network. Available from: URL: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT." ([cited 2013 -]):

Therapeutic Duplication Warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

Switch to: Professional Interactions

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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