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Drug Interactions between carbamazepine and oxcarbazepine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

carBAMazepine OXcarbazepine

Applies to: carbamazepine and oxcarbazepine

MONITOR: Coadministration with potent CYP450 inducers may decrease the plasma concentrations of the pharmacologically active 10-monohydroxy metabolite of oxcarbazepine known as MHD. Administration of oxcarbazepine 900 mg/day in combination with carbamazepine 400 to 2000 mg/day has resulted in an average reduction of MHD plasma concentrations by approximately 40%. Phenytoin 250 to 500 mg/day and phenobarbital 100 to 150 mg/day have reduced the plasma concentrations of MHD on average by approximately 30% and 25%, respectively, when oxcarbazepine was coadministered at 600 to 1800 mg/day. Since MHD is responsible for much of the pharmacologic effects of oxcarbazepine, the potential for altered anticonvulsant activity should be considered. Oxcarbazepine had no significant effect on the pharmacokinetics of carbamazepine and phenobarbital, but increased the plasma concentrations of phenytoin by 40% when administered at dosages greater than 1200 mg/day.

MANAGEMENT: The possibility of diminished therapeutic effects of oxcarbazepine should be considered when used in combination with potent CYP450 inducers such as carbamazepine, phenobarbital, phenytoin, primidone (which is metabolized to phenobarbital), rifampin, and St. John's wort. Close clinical and laboratory monitoring is recommended whenever a CYP450 inducer is added to or withdrawn from oxcarbazepine therapy, and the dosage adjusted as necessary.

References (1)
  1. (2001) "Product Information. Trileptal (oxcarbazepine)." Novartis Pharmaceuticals

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Drug and food interactions

Moderate

carBAMazepine food

Applies to: carbamazepine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of carbamazepine. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

In a small, randomized, crossover study, the administration of carbamazepine with grapefruit juice (compared to water) increased plasma drug concentrations by approximately 40%. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

MANAGEMENT: Patients receiving carbamazepine should be advised to avoid or limit consumption of alcohol. Given the drug's narrow therapeutic index, patients receiving carbamazepine therapy should preferably avoid the regular consumption of grapefruits and grapefruit juice to prevent any undue fluctuations in plasma drug levels. Patients should be advised to report signs of carbamazepine toxicity (nausea, visual disturbances, dizziness, or ataxia) to their physicians.

References (3)
  1. (2002) "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals
  2. Garg SK, Kumar N, Bhargava VK, Prabhakar SK (1998) "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther, 64, p. 286-8
  3. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77

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Moderate

OXcarbazepine food

Applies to: oxcarbazepine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References (4)
  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc

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Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Dibenzazepine anticonvulsant agents

Therapeutic duplication

The recommended maximum number of medicines in the 'dibenzazepine anticonvulsant agents' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'dibenzazepine anticonvulsant agents' category:

  • carbamazepine
  • oxcarbazepine

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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