This panel provides information on interacting drugs and their ADRs along with references
| Interacting drug |
Toxicity |
Interaction Type |
Mechanism |
Reference |
|---|
| Allopurinol (315-30-0) | Raise Serum Carbamazepine Levels | Synergistic | allopurinol can act as a liver enzyme inhibitor, which reduces the metabolism and clearance of carbamazepin | The effect of atovaquone on etoposide pharmacokinetics in children with acute lymphoblastic leukemia
|
| Cimetidine (51481-61-9) | Ataxia | Additives | Not fully understood. It is thought that cimetidine can inhibit the activity of the liver enzymes concerned with the metabolism of carbamazepine (such as the cytochrome P450 isoenzyme CYP3A4), resulting in its reduced clearance from the body | Effects of cimetidine on carbamazepine auto- and hetero-induction in man
|
| Danazol (17230-88-5) | Carbamazepine Toxicity | Synergistic | Danazol inhibits the metabolism (by the epoxide-trans-diol pathway) of carbamazepine by the liver | Carbamazepine-danazol drug interaction: its mechanism examined by a stable isotope technique
|
| Erythromycin (114-07-8) | Diplopia | Synergistic | Erythromycin slow the rate of metabolism of the carbamazepine by the cytochrome P450 isoenzyme CYP3A4 | Inhibition by erythromycin of the conversion of carbamazepine to its active 10,11-epoxide metabolite
|
| Felbamate (25451-15-4) | Reduce Serum Carbamazepine Levels | Synergistic | uncertain | In vivo CYP3A4 heteroactivation is a possible mechanism for the drug interaction between felbamate and carbamazepine
|
| Fluconazole (86386-73-4) | Raise Serum Carbamazepine Levels | Synergistic | Fluconaazole antifungals inhibit the cytochrome P450 isoenzyme CYP3A4, which is concerned with the metabolism of carbamazepine | Fluconazole-carbamazepine interaction
|
| Fluoxetine (54910-89-3) | Tinnitus | Synergistic | The evidence suggests that fluoxetine inhibit the metabolism of carbamazepine by the liver (presumably by inhibiting the cytochrome P450 isoenzyme CYP3A4) so that its loss from the body is reduced, leading to a rise in its serum levels | Increased carbamazepine plasma concentrations after fluoxetine coadministration
|
| Furosemide (54-31-9) | Hyponatraemia | Synergistic | uncertain | Carbamazepine, diuretics, and hyponatremia: a possible interaction
|
| Gemfibrozil (25812-30-0) | Ataxia | Synergistic | uncertain | Therapeutic drug monitoring—antiepileptic drugs
|
| Influenza Vaccine Usp (CASNA550) | Raise Serum Carbamazepine Levels | Additives | vaccine inhibits the liver enzymes concerned with the metabolism of carbamazepine | Carbamazepine toxicity after influenza vaccination
|
| Isoniazid (54-85-3) | Aggression | Synergistic | It seems probable that isoniazid inhibits the activity of the cytochrome P450 isoenzyme CYP3A4, which is concerned with the metabolism of carbamazepine, causing it to accumulate in the body. | Carbamazepine intoxication caused by interaction with isoniazid
|
| Lamotrigine (84057-84-1) | Diplopia | Synergistic | lamotrigine increases the carbamazepine-10,11-epoxide serum levels. Carbamazepine may induce the lucuronidation of
lamotrigine | Carbamazepine toxicity with lamotrigine: pharmacokinetic or pharmacodynamic interaction?
|
| Loxapine (1977-10-2#) | Neurotoxicity | Antagonistic | the toxicity appeared to be due to elevated carbamazepine-10,11-epoxide levels (the metabolite of carbamazepine) | Potential interaction between carbamazepine and loxapine: case report and retrospective review
|
| Metronidazole (443-48-1) | Diplopia | Synergistic | uncertain | Possible interaction between metronidazole and carbamazepine
|
| Nefazodone (83366-66-9) | Raise Serum Carbamazepine Levels | Synergistic | Both drugs are metabolised by the cytochrome P450 isoenzyme CYP3A4. Nefazodone is known to inhibit CYP3A4, whereas carbamazepine is a potent inducer of CYP3A4. Hence concurrent use reduces carbamazepine metabolism | Nefazodone-induced carbamazepine toxicity
|
| Omeprazole (73590-58-6) | Reduction In Carbamazepine Serum Levels | Synergistic | Omeprazole may inhibit the oxidative metabolism of single doses of carbamazepine. However, when carbamazepine is taken continuously it induces its own metabolism by the cytochrome P450 isoenzyme CYP3A4, thereby possibly opposing the effects of this interaction | Effect of Multiple Dose Omeprazole on the Pharmacokinetics of Carbamazepine
|
| Oxybutynin (5633-20-5) | Nystagmus | Synergistic | due to the inhibition by oxybutynin of the cytochrome P450 isoenzyme CYP3A4-mediated metabolism of carbamazepine | Carbamazepine toxicity following Oxybutynin and Dantrolene administration: a case report
|
| Phenobarbital (50-06-6) | Clearance Decreased | Antagonistic | Phenobarbital and carbamazepine are both enzyme inducers, and increase each others metabolism. Phenobarbital may also induce the metabolism of carbamazepine-10,11-epoxide | Effect of phenobarbital on the pharmacokinetics of carbamazepine-10,11-epoxide, an active metabolite of carbamazepine
|
| Primidone (125-33-7) | Reduce The Effects Of Carbamazepine | Antagonistic | When the primidone was stopped in the single case cited, the clearance of the carbamazepine decreased by about 60%. This is consistent with the known enzyme-inducing effects ofprimidone (converted in the body to phenobarbital), which can increase the metabolism of other drugs by the liver | Primidone-carbamazepine interaction: clinical consequences
|
| Propoxyphene (469-62-5) | Dizziness | Synergistic | Uncertain. It is suggested that dextropropoxyphene inhibits the metabolism of carbamazepine by the liver, leading to its accumulation in the body. | Influence of dextropropoxyphene on steady state serum levels and protein binding of three anti-epileptic drugs in man
|
| Remacemide (111686-79-4) | Raise Serum Carbamazepine Levels | Synergistic | Not fully understood, but in vitro studies indicate that remacemide inhibits the cytochrome P450 isoenzyme CYP3A4 | Adjustment of carbamazepine dose to offset the effects of the interaction with remacemide hydrochloride in a double-blind, multicentre, add-on drug trial (CR2237) in refractory epileps
|
| St JohnÆs wort (84082-80-4) | Increased The Clearance Of Carbamazepine | Antagonistic | St John’s wort is not sufficiently potent an inducer to further induce carbamazepine metabolism when autoinduction has occurred,
1 and therefore a small interaction is seen with single doses but no interaction is seen with multiple doses | Lack of effect of St John's Wort on carbamazepine pharmacokinetics in healthy volunteers
|
| Terbinafine (91161-71-6) | Necrolysis | Synergistic | not understood | Toxic epidermal necrolysis induced by terbinafine in a patient on long-term anti-epileptics
|
| Ticlopidine (55142-85-3) | Ataxia | Synergistic | uncertain | Ticlopidine-carbamazepine interaction in a coronary stent patient
|
| Valnoctamide (4171-13-5) | Nystagmus | Synergistic | Valnoctamide inhibits the enzyme epoxide hydrolase, which is concerned with the metabolism and elimination of carbamazepine and its active epoxide metabolite | Impairment of carbamazepine-10, 11-epoxide elimination by valnoctamide, a valpromide isomer, in healthy subjects
|
| Valproic Acid (99-66-1) | Nystagmus | Antagonistic | carbamazepine metabolism appear to be inhibited by both valproate and its amide derivative, valpromide.The levels of the metabolite carbamazepine-,10,11-epoxide increase during concurrent use,
probably by inhibition of its metabolism to carbamazepine-10,11-trans-diol, by epoxide hydrolase | Effect of valpromide on the pharmacokinetics of carbamazepine-10, 11-epoxide
|
| verapamil (52-53-9) | Carbamazepine Toxicity | Synergistic | verapamil inhibit the metabolism of carbamazepine by the cytochrome P450 isoenzyme CYP3A4, thereby reducing its loss from the body and increasing serum levels | Verapamil-carbamazepine neurotoxicity
|
| Viloxazine (46817-91-8) | Ataxia | Synergistic | Uncertain. some suggests that viloxazine inhibits the metabolism of carbamazepine, thereby reducing its clearance and raising its serum levels. | Effect of viloxazine on serum carbamazepine levels in epileptic patients
|
| Phenytoin (57-41-0) | Neurotoxicity | Synergistic | Not understood,carbamazepine can inhibit the cytochrome P450 isoenzyme CYP2C19, which is one of the enzymes involved in phenytoin metabolism.19 Carbamazepine might therefore cause increases in phenytoin levels by this mechanism. | Carbamazepine and oxcarbazepine decrease phenytoin metabolism through inhibition of CYP2C19
|
| Topiramate (97240-79-4) | Topiramate was Excreted Unchanged In The Urine In The Presence Of Carbamazepine | Antagonistic | Carbamazepine appears to induce the metabolism of topiramate | Pharmacokinetic and metabolic investigation of topiramate disposition in healthy subjects in the absence and in the presence of enzyme induction by carbamazepine
|