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1 Estrogen‐induced glucuronidation is responsible for the drop in lamotrigine levels during active COC use. A pill‐free week may be safe during prophylactic treatment, as opposed to pill‐free weeks during treatment in epilepsy. The age of onset of her first mood symptoms was at the age of 19, with mainly depressive and anxiety symptoms. Since valproic acid is no longer recommended as a first‐line mood stabilizer in fertile women, LTG is often used in these patients.

Patient does not provide medical advice, diagnosis or treatment.Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. Lamotrigine may interact with the Pill, patch and vaginal ring, making them work less well. The second test was done on day 6 or 7 of the pill‐free week, since the LTG‐concentration increases daily with a peak level on day 6 or 7. Registered in England and Wales. After a skin reaction during escalation, protocols advise against restarting lamotrigine, with a potential loss of a level 1 treatment option.

The mean ratios of lamotrigine C max and AUC(0,24 h) for the comparison of lamotrigine + combined oral contraceptive : lamotrigine alone were 0.61 (a 39% decrease) and 0.48 (a 52% decrease), respectively, with the 90% CIs of these ratios being outside of the acceptance range (0.75–1.33) .

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Slow‐dose escalation is crucial to reduce the risk of Stevens‐Johnsons syndrome within the first 8 weeks. Some evidence exists for a plasma concentration‐response association, with a therapeutic range between 1‐6 µg/mL.We present two euthymic patients who completed daily mood monitoring (LifeChart method). Her history mentions one manic episode without psychotic symptoms, for which she was admitted in 2015 when living abroad. The third test was done in the first week of the COC strip.A 31‐year‐old consultant was treated for bipolar I disorder at our outpatient clinic since 2016. The first test was done in the last week of the COC strip. She recently immigrated to the Netherlands, and was already treated successfully with a combination of quetiapine 200 mg once a day, lamotrigine 200 mg twice a day, and fluoxetine 30 mg once a day. However, estrogens interact with LTG and potentially lower the plasma concentration up to 60%.

Since the start of cariprazine she reported symptoms of restless legs, an inability to sit still and mild anxiety. Before and after this episode, she mainly suffered from depression, which was now adequately treated with cariprazine 3 mg once a day, fluoxetine 10 mg once a day, and zolpidem 10 mg for the night, when needed. Sodium valproate does not affect oestrogen metabolism. I've taken this and tolerated it for 50 years. I have read and accept the Wiley Online Library Terms and Conditions of UseEthinyl estradiol, not progestogens, reduces lamotrigine serum concentrationsHormone replacement therapy with estrogens may reduce lamotrigine serum concentrations: A matched case–control studyRetrospective Analysis of Therapeutic Drug Monitoring Data for Treatment of Bipolar Disorder with LamotrigineLamotrigine plasma levels reduced by oral contraceptivesOpinion following an Article 30 referral for Lamictal and associated names International Non‐Proprietary Name (INN): lamotrigine: background informationLamotrigine, bipolar disorder, and the pill‐free week, Cariprazine/ethinylestradiol/levonorgestrel/lamotrigine, When discussing her mood during her pill‐free week, she did not recognize a pattern of mood instability linked to this week. For birth control, these women often use combined oral anticonceptives (COC) containing ethinyl estradiol and progestins.


For anticonception, she used a combined ethinylestradiol/levonorgestrel (30 μg/150 μg) pill.