Moderate
Probable
Description
Sertraline may increase lamotrigine plasma concentrations by inhibiting its glucuronidation, potentially causing lamotrigine toxicity.
Mechanism
Sertraline inhibits UGT enzymes responsible for lamotrigine glucuronidation, particularly UGT1A4, resulting in reduced lamotrigine clearance.
Clinical Significance
Lamotrigine levels may increase significantly; symptoms of lamotrigine toxicity (diplopia, dizziness, ataxia) may develop.
Management
Monitor lamotrigine levels and for toxicity symptoms when sertraline is added; lamotrigine dose reduction may be required.