Lamotrigine Dental Interactions — ORE Part 1 MCQ
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Correct answer: E — Lamotrigine has minimal clinically significant interactions with amoxicillin, metronidazole, paracetamol, and ibuprofen
Answer E is correct. Lamotrigine has minimal clinically significant interactions with commonly prescribed dental medications. Unlike older aromatic antiepileptics (phenytoin, carbamazepine), lamotrigine is not an enzyme inducer and does not undergo major metabolism interactions with amoxicillin, metronidazole, paracetamol, or NSAIDs such as ibuprofen. These agents are safe to use in patients on lamotrigine therapy. Distractor B is false: no evidence supports severe interactions between lamotrigine and local anaesthetics. Distractor C is incorrect: gingival overgrowth is a characteristic adverse effect of phenytoin and other aromatic antiepileptics, not lamotrigine. Distractor D misrepresents the evidence: metronidazole has no documented pharmacokinetic interaction with lamotrigine and is not contraindicated. Distractor E is unsupported: fluoride toothpaste does not interact with lamotrigine.
Reference: Spina E, Perucca E. Drug interactions between antiepileptic drugs and psychotropic drugs. In: Gaspari F, Vignatelli L (eds). Drug Interactions in Psychopharmacology: Evidence and Mechanisms. Therapeutic Drug Monitoring Services, European guidelines. Consensus from Schwarz et al. (2005). Publicly available at: https://pubmed.ncbi.nlm.nih.gov/16012277/