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Lamotrigine and CHC — DFSRH MCQ

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HardPharmacology of hormonal contraceptionLamotrigine and CHCDFSRH

A 26-year-old woman on lamotrigine for epilepsy has been stable for 2 years and asks for the combined pill. She uses condoms inconsistently and has had no seizures recently. What is the most appropriate management?

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Correct answer: D — Liaise with epilepsy prescriber before starting CHC

The best answer is “Liaise with epilepsy prescriber before starting CHC”. Ethinylestradiol-containing contraception can reduce lamotrigine concentrations and may destabilise seizure control, so contraceptive choice and any dose adjustment require coordination with the epilepsy prescriber. The issue is not enzyme induction by lamotrigine. Ulipristal is emergency rather than regular contraception, and epilepsy does not itself contraindicate a copper IUD.

Reference: CoSRH/FSRH, Drug Interactions with Hormonal Contraception: https://www.cosrh.org/Common/Uploaded%20files/documents/drug-interactions-with-hormonal-contraception-5may2022.pdf