Lamotrigine interaction — DFSRH MCQ

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HardCombined hormonal contraceptionLamotrigine interactionDFSRH

A 24-year-old woman with epilepsy controlled on lamotrigine asks for the combined pill. She has no seizures for three years and wants predictable bleeding. What would you advise this patient?

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Correct answer: B — Discuss non-oestrogen methods and liaise about lamotrigine levels

The best answer is “Discuss non-oestrogen methods and liaise about lamotrigine levels”. CHC can lower lamotrigine levels and levels can rise during hormone-free intervals, so non-oestrogen The patch is still combined hormonal contraception and does not avoid the interaction. A clinical pearl is to think pharmacokinetics as well as UKMEC safety. Combined hormonal contraception must be assessed by applying oestrogen-related arterial and venous risk, the exact timing of incorrect use, drug interactions and the need for emergency contraception. A non-oestrogen method may be acceptable even when CHC is not. Missed-use advice depends on whether the hormone-free interval was extended, rather than simply on the number of tablets mentioned.

Reference: CoSRH/FSRH, Combined Hormonal Contraception (January 2019, amended October 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-combined-hormonal-contraception-october-2023.pdf