Well, well . . . you learn something everyday . . .
I had a question posed to me about whether there are interactions between Lamictal and birth control pills. Lamictal, as you may know, is the only medication approved by the FDA for use in Bipolar Depression. It is a great medicine and is widely used because of how well it works and how well it is tolerated. Many of the women who take it are of child-bearing age and many of those use hormonal birth control methods. It is important that birth control pills, when taken, are effective–women are counting on them to work. This is especially true when taking medications for psychiatric issues so that you avoid exposing the baby to psychiatric medicine unnecessarily. So, the question was a good one . . . and I was not sure of the answer at first. So . . . a little bit of research was in order!
While there are no absolutes in this business, it does seem that there is no clinically significant change in birth control pill blood levels and effectiveness when combined with Lamictal. The studies are limited, of course, but this is certainly encouraging. In the studies that were done, the women who were taking the combination did not show any clinical or hormonal signs of ovulation (supression of ovulation is the point of birth control pills). There is, however, a very slight effect of birth control pills on Lamictal concentrations (this is news to me!). Co-administration of Lamictal with birth control pills will result in slightly lower blood levels of Lamictal. During the one week placebo pill period of birth control pills, blood levels of Lamictal will actually go up. Slightly. There can be some potential clinical relevance to this. If you increase the dose of Lamictal at the same time that the patient is entering the blank-pill section of her birth control pills, she will be receiving a larger increase in the Lamictal than was intended. Since the most concerning side effect of the Lamictal (rash) is correlated with giving too much too fast, it may be prudent to avoid Lamictal increases during that last week of the pills.
You learn something every day!
–Dan Hartman, MD
Hello Dr. Hartman,
I’m 24, I have Bipolar I w/ rapid cycling and have been taking Lamictal for about 6 months. I’m only up to 150mg and so far it doesn’t seem to have made much difference. I know I need to increase my dosage but my doctor will not prescribe me until I’m on a “sure-fire” contraceptive. I’ve been reading that Lamictal can cause cleft pallet and other serious birth defects so I take this matter very seriously. In the past, low hormone birth control pills and the patch made me extremely nauseous and irritable, Depovera made my depression worsen, and I’ve been advised against UTIs because I’ve never been pregnant. What’s left? Am I doomed to a life of celibacy?
I don’t think you wanted a urinary tract infection, but you may have meant an IUD –intra uterine device. The Mirena has hormones (just progestin so, no estrogeen interference); the copper one does not.
There may be reasons specific to you, like the shape of your uterus why you couldn’t get one, but not having had a child is not a sufficient reason though many doctors believe that it is. It could make the insertion a bit harder and require a more skilled practitioner, but there are tricks that they can use. If you don’t have good luck with your regular ob/gyn go back to your PCP or consider visiting a Planned Parenthood Clinic. There’s also a lot of information on the livejournal site IUD divas.
I take lamictal, and I just got a Paragard (copper IUD) inserted, for a whole bunch of reasons, and I quite like it. I’ve never been pregnant.
Angela–
Lets be real here. There is no such thing as a “sure-fire” contraceptive. And if you want to be sexually active, then you need to be responsible and take precautions. Use condoms, spermicides etc. As for the Lamictal, if you are safe enough for 150 mg then you are safe enough for 200 . . . or 300 . . . or 400. There is no evidence that the risk for a fetus goes up with increasing dose. It is either a risk or it is not. Given what you wrote, I would say that hormone therapy is psychiatrically contraindicated. It is mandatory that you get an adequate trial of the Lamictal with all due haste. Talk to your doctor in a clear fashion. Hopefully he/she will listen to you. Take a look at my June 2, 2007 blarticle about talking to your doctor. Good Luck
–DH MD
I am 20 and have just recently been diagnosed with Bipolar Type II. Right away my doctor prescribed me lamictal, in addition to my welbutrin…then added lithium. It all just seems too much. I have been taking birth control for years now and I am afraid that all this “medicine” is interfering with my weight. Although it says that Lamital does not promote weight gain, I fear that the combination of all these drugs is working against me in my efforts to loose weight. Any help?
Amber–this is a good subject. I wrote a blarticle about this that will be published on Jan 9th or 10th.
–DHMD
I am 20 and I would like to go on birth control. im taking 150 mg of lamictal for my epilepsy and was wondering if birth control meds will affect my siezures, or if the Lamictal will affect the birth control at all. Do you know what type of birth control (brand) works best when combined with Lamictal? And do I need to use a higher dose of birth control so that it is more effective?