Clinically Significant Interactions with Mood Stabilisers

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Abstract

Mood stabilisers are associated with a wide range of clinically significant drug-drug interactions. The glucuronidation of lamotrigine is inhibited by valproate and induced by oral contraceptives, carbamazepine and phenytoin. Lamotrigine induces the glucuronidation of quetiapine. Valproate is an inhibitor of CYP2C9 and glucuronosyltransferase enzymes and increases plasma levels of some benzodiazepines, tricyclic antidepressants and lamotrigine. Valproate’s metabolism is inhibited by aspirin and erythromycin and induced by carbapenem antibiotics. Carbamazepine is involved in innumerable interactions largely because of its potent ability to induce the activity of CYP3A4 and, to a lesser degree, CYP1A2 enzymes. Carbamazepine thus lowers plasma levels of many drugs including many analgesics, antipsychotics, benzodiazepines, antidepressants and antimicrobial agents. The metabolism of carbamazepine is inhibited by diltiazem, verapamil, danazol, isoniazid and ticlodipine. Lithium is largely renally excreted, a process that is inhibited by NSAIDs, thiazide and loop diuretics, ACE inhibitors and some calcium channel blockers. Lithium may give rise to neurotoxicity when combined with antipsychotics or antidepressants.

Keywords

Pharmacokinetics Metabolism Valproate Valprioc acid Divalproex Lamotrigine Carbamazepine Lithium 
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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Pharmacy DepartmentMaudsley HospitalDenmark Hill, LondonUK
  2. 2.Pharmacy DepartmentSouth London and Maudsley NHS Foundation Trust, Maudsley HospitalDenmark Hill, LondonUK

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