Carbamazepine

Combined P-gp and strong CYP3A4 inducer that decreases apixaban exposure and increases risk of stroke and thromboembolic events. Avoid concomitant use.

Strong CYP3A4 inducer that decreases aripiprazole exposure. Avoid use for greater than 14 days.

Strong CYP3A4 inducer contraindicated with artemether and lumefantrine due to potential loss of antimalarial efficacy.

Strong UGT1A1 inducer that significantly decreases cabotegravir plasma concentrations. Coadministration is contraindicated.

Strong CYP3A4 inducer that decreases clozapine plasma concentration. Concomitant use is not recommended due to decreased clozapine effectiveness.

Co-administration decreases doravirine plasma concentrations. At least a 4-week cessation period is recommended prior to initiation of PIFELTRO.

Co-administration decreases doravirine plasma concentrations and is contraindicated. At least a 4-week cessation period is recommended prior to initiation of DELSTRIGO.

Strong CYP3A inducer expected to decrease elexacaftor, tezacaftor, and ivacaftor exposures, reducing TRIKAFTA efficacy.

Strong CYP3A4 inducer. Should not use Estradiol Valerate/Dienogest while taking or for 28 days after discontinuation due to risk of decreased contraceptive efficacy.

Strong CYP3A4 inducer substantially reduces exposure to irinotecan and SN-38. Do not administer unless no therapeutic alternatives exist.

Strong CYP3A4 inducer. Avoid concomitant use with istradefylline.

Strong CYP3A inducer. Avoid concomitant use with NINLARO (ixazomib).

Strong CYP3A inducer that decreases lemborexant exposure, which may reduce DAYVIGO efficacy. Concomitant use should be avoided.

Carbamazepine decreases lenacapavir concentration, resulting in loss of therapeutic effect and development of resistance.

Strong CYP3A4 inducer that decreases lurasidone exposure; concomitant use is contraindicated.

CYP3A inducer. Do not use with ranolazine extended-release tablets.

Coadministration is contraindicated due to decreased rilpivirine plasma concentrations and loss of virologic response.

Coadministration is contraindicated. Induces CYP3A, resulting in decreased rilpivirine plasma concentrations and loss of virologic response.

Combined P-gp and strong CYP3A inducer that decreases rivaroxaban exposure and may increase thromboembolic risk. Avoid concomitant use.

Strong CYP3A inducer that substantially reduces ticagrelor exposure and decreases efficacy.

CYP3A4 inducer that significantly reduces tramadol analgesic effect and increases seizure risk. Concomitant use is not recommended.

CYP450 inducer likely to result in significant reduction of voriconazole plasma exposure.

Strong CYP3A4 inducer substantially decreases aprepitant exposure, which may decrease efficacy. Avoid concomitant use.

Strong CYP3A4 inducer that decreases aripiprazole exposure. Avoid concomitant use because dosage cannot be modified.

Strong CYP3A4/5 inducer reduces axitinib plasma exposure. Co-administration should be avoided.

CYP3A4 inducer decreases hydrocodone plasma concentration, resulting in decreased efficacy and risk of withdrawal syndrome. Stopping inducer may cause serious respiratory depression.

CYP3A4 inducer decreases buprenorphine plasma concentration, potentially resulting in decreased efficacy or withdrawal syndrome. Upon discontinuation, buprenorphine levels increase with risk of serious respiratory depression.

CYP3A4 inducer decreases codeine levels and morphine formation, reducing efficacy or causing withdrawal. Discontinuation may increase morphine levels and cause respiratory depression.

CYP3A4 inducer decreases codeine levels and morphine formation, resulting in decreased efficacy or withdrawal syndrome. Upon discontinuation, may cause serious respiratory depression.

Carbamazepine induces clonazepam metabolism, causing approximately 38% decrease in plasma clonazepam levels.

Strong CYP3A inducer may decrease cobimetinib exposure by >80% and reduce efficacy. Avoid concurrent use.

CYP3A4 inducer can result in lower codeine and morphine levels, decreasing efficacy or causing withdrawal syndrome. Avoid concomitant use.

CYP3A4 inducer that decreases codeine and morphine levels, resulting in reduced efficacy or withdrawal syndrome in dependent patients.

Moderate CYP3A4 inducer may reduce deflazacort efficacy. Avoid concomitant use.

Concomitant administration results in elevated plasma carbamazepine levels, resulting in toxicity in some cases.

Enzyme-inducing drug that can double valproate clearance. Increased monitoring of valproate and carbamazepine concentrations and dosage adjustment indicated.

Can double the clearance of valproate, resulting in lower valproate concentrations and potential loss of therapeutic effect.

CYP3A4 inducer decreases erlotinib exposure. Increase erlotinib dosage if co-administration is unavoidable.

CYP3A4 inducer decreases erlotinib exposure. Increase erlotinib dosage if co-administration is unavoidable.

Erythromycin increases serum carbamazepine levels with subsequent development of carbamazepine toxicity signs.

Strong CYP 3A4 inducer that significantly decreases exemestane exposure. Dose increase to 50 mg recommended.

Felbamate decreases steady-state carbamazepine plasma concentrations by 31% while increasing carbamazepine epoxide concentrations by 57%, potentially reducing carbamazepine efficacy.

Anticonvulsant that considerably reduces felodipine plasma concentrations; alternative antihypertensive therapy should be considered.

CYP3A4 inducer that decreases fentanyl plasma concentration, resulting in decreased efficacy and withdrawal syndrome. Discontinuation may cause serious respiratory depression.

CYP3A4 inducer that decreases fentanyl plasma concentration, resulting in decreased efficacy, withdrawal syndrome, and upon discontinuation, potential serious respiratory depression.

CYP3A4 inducer; concomitant use can decrease plasma concentration of fentanyl, resulting in decreased efficacy or withdrawal syndrome. Stopping inducer may increase fentanyl levels causing serious respiratory depression.

Fluoxetine may elevate carbamazepine levels and cause clinical anticonvulsant toxicity.

Fluoxetine may elevate carbamazepine levels and cause clinical anticonvulsant toxicity.

Elevated carbamazepine levels and symptoms of toxicity with co-administration.

Enzyme-inducing anticonvulsant that decreases folate availability through increased hepatic metabolism and inhibition of intestinal folate-processing.

Significantly decreases temsavir plasma concentrations, which may lead to loss of virologic response.

May significantly decrease plasma concentrations of glecaprevir and pibrentasvir, leading to reduced therapeutic effect. Coadministration is not recommended.

CYP3A4 inducer that decreases hydrocodone plasma concentration, resulting in decreased efficacy or withdrawal syndrome. Discontinuation may cause serious respiratory depression.

CYP3A4 inducer that decreases hydrocodone plasma concentration, resulting in decreased efficacy and potential withdrawal syndrome. Upon discontinuation, may cause serious respiratory depression.

CYP3A4 inducer that can decrease hydrocodone plasma concentration, resulting in decreased efficacy or withdrawal syndrome.

CYP3A4 inducer that decreases hydrocodone plasma concentration, resulting in decreased opioid efficacy or withdrawal syndrome. Discontinuation may cause serious respiratory depression.

CYP3A4 inducer that can decrease plasma concentration of hydrocodone, resulting in decreased efficacy or withdrawal syndrome.

Enzyme-inducing anti-epileptic drug that decreases imatinib AUC by 73%, significantly reducing imatinib exposure.

Carbamazepine increases risk of hyponatremia when used with irbesartan and hydrochlorothiazide.

Isoniazid slows metabolism and increases serum levels of carbamazepine, requiring monitoring for toxicity signs and dosage adjustment.

Potent CYP3A4 enzyme inducer that may decrease itraconazole bioavailability and efficacy. Avoid use 2 weeks before and during itraconazole treatment.

Strong CYP3A inducer. Co-administration not recommended.

Potent CYP3A4 enzyme inducer that may decrease ketoconazole bioavailability and reduce antifungal efficacy. Coadministration not recommended.

Carbamazepine decreases lamotrigine concentrations by approximately 40%, requiring dose adjustment.

Strong CYP3A4 inducer decreases lapatinib systemic exposure. Consider gradual dose increase of lapatinib.

Increases metabolism of contraceptive steroids, reducing contraceptive effectiveness and potentially resulting in unintended pregnancy or unscheduled bleeding.

Concomitant use may increase risk of adverse reactions with carbamazepine.

Epoxide hydrolase inhibitor; increases carbamazepine-10,11-epoxide plasma concentrations. Dosage adjustment and plasma level monitoring required.

Strong CYP3A4 inducer may reduce plasma macimorelin concentrations and lead to false positive test results. Discontinue prior to use.

Strong CYP3A4 inducer that decreases maribavir concentrations. A dose adjustment of LIVTENCITY to 800 mg twice daily is recommended when coadministered.

Strong CYP3A inducer may decrease medroxyprogesterone acetate concentrations and reduce contraceptive efficacy. Avoid concomitant use or use backup contraception.

CYP inducer that decreases methadone plasma concentration, resulting in decreased efficacy or withdrawal symptoms.

CYP3A4 and CYP2C19 inducer that decreases methadone plasma concentration, reducing efficacy and causing withdrawal symptoms, with risk of serious respiratory depression and death upon discontinuation.

Strong CYP3A inducer causing significant decrease in plasma naldemedine concentrations, which may reduce efficacy.

Strong CYP3A4 inducer that significantly decreases plasma naloxegol concentrations and may decrease efficacy; use is not recommended.

Strong CYP3A inducer reduces the bioavailability and efficacy of nifedipine; careful consideration needed if co-administered.

P-gp and CYP3A4 inducer that may decrease nintedanib exposure. Should be avoided due to risk of reduced efficacy.

May reduce contraceptive effectiveness and result in unintended pregnancy or breakthrough bleeding by increasing metabolism of contraceptive steroids.

Carbamazepine increases metabolism of ethinyl estradiol and/or norethindrone, which could result in reduced contraceptive effectiveness.

Carbamazepine increases metabolism of ethinyl estradiol and/or norethindrone, potentially reducing contraceptive effectiveness.

May decrease plasma concentrations of COCs and potentially diminish effectiveness or increase breakthrough bleeding.

Potential for elevated carbamazepine levels and clinical anticonvulsant toxicity.

Strong CYP3A4/CYP2B6 inducer may decrease osilodrostat concentration and reduce efficacy. Dose increase may be needed; monitor cortisol.

CYP3A4 inducer that decreases oxycodone plasma concentration, resulting in decreased efficacy or withdrawal syndrome; discontinuation may cause serious respiratory depression.

CYP3A4 inducer that decreases plasma concentration of oxycodone, resulting in decreased efficacy or withdrawal syndrome; discontinuation may cause respiratory depression.

CYP450 inducer may increase clearance of oxycodone, leading to decreased plasma concentrations and potential lack of efficacy or abstinence syndrome.

CYP3A4 inducer that decreases oxycodone plasma concentration, resulting in decreased efficacy or withdrawal syndrome. Upon discontinuation, oxycodone levels increase risking serious respiratory depression.

CYP3A4 inducer that decreases oxycodone plasma concentration, resulting in decreased efficacy and withdrawal syndrome risk. Stopping carbamazepine increases oxycodone levels and serious respiratory depression risk.

CYP3A4 inducer that decreases oxycodone plasma concentration, resulting in decreased efficacy or withdrawal syndrome. Upon discontinuation, increased oxycodone levels may cause serious respiratory depression.

Strong CYP3A inducer. Avoid concomitant use with palbociclib.

Strong CYP3A4/P-gp inducer that may decrease paliperidone exposure. Avoid during 3-month dosing interval if possible; consider paliperidone extended-release tablets if necessary.

Concomitant use decreased perampanel plasma levels by 50-67%. Dose adjustment of FYCOMPA necessary; close monitoring required when introduced or withdrawn.

CYP 3A4 inducer enhances metabolism of prednisolone, requiring increased dosage of corticosteroid.

CYP3A4 inducer reduces codeine levels and morphine formation, decreasing efficacy or causing withdrawal syndrome. Avoid use; if necessary, monitor for reduced efficacy.

CYP3A4 inducer can result in lower codeine and morphine levels, causing decreased efficacy or withdrawal syndrome.

CYP3A4 inducer decreases quetiapine exposure; dose adjustment of quetiapine necessary.

Potent CYP3A4 inducer that decreases quetiapine exposure; dose adjustment necessary.

Strong CYP3A4 inducer that decreases regorafenib plasma concentrations and may lead to decreased efficacy.

Strong CYP3A inducer may significantly reduce riociguat exposure. Data are not available to guide dosing.

Chronic use causes resistance to rocuronium effects with diminished neuromuscular block magnitude or shortened duration.

Strong CYP450 enzyme inducer that decreases roflumilast systemic exposure and may reduce therapeutic effectiveness. Use not recommended.

Strong CYP3A4 inducer that decreases midostaurin concentrations and may reduce efficacy. Avoid coadministration.

P-gp inducer and moderate to strong CYP inducer that may significantly decrease plasma concentrations of sofosbuvir, velpatasvir, and/or voxilaprevir, leading to reduced therapeutic effect.

CYP3A4 inducer that decreases sufentanil plasma concentration, resulting in decreased efficacy or withdrawal syndrome. Upon discontinuation, can cause increased sufentanil levels and serious respiratory depression.

CYP3A4 inducer that decreases sufentanil plasma concentration, resulting in decreased efficacy or withdrawal syndrome. Discontinuation may cause increased sufentanil levels and serious respiratory depression.

Strong CYP3A inducer; substantially decreases suvorexant exposure and may reduce efficacy.

May decrease tacrolimus whole blood trough concentrations and increase risk of rejection. Increase tacrolimus dose and monitor concentrations.

Strong CYP3A inducer may decrease tacrolimus concentrations and increase risk of rejection. Increase tacrolimus dose and monitor concentrations.

Use of carbamazepine with temsirolimus should be avoided due to significant reduction in temsirolimus concentrations. If coadministration is necessary, dose adjustment is required.

Strong CYP3A inducer. Co-administration not recommended due to reduced SYMDEKO efficacy.

Concomitant administration results in clinically significant decrease in plasma concentrations of topiramate. Dosage adjustment may be needed.

Strong CYP3A4 inducer that decreases toremifene steady-state concentration and should be avoided.

CYP3A4 inducer that reduces trazodone and active metabolite plasma concentrations by 76% and 60%, respectively; dose increase may be necessary.

Hepatic enzyme inducer that increases corticosteroid clearance, reducing their effect.

CYP3A4 and epoxide hydrolase inhibitor; increases carbamazepine-10,11-epoxide plasma concentrations. Dosage adjustment and plasma level monitoring required.

Epoxide hydrolase inhibitor; increases carbamazepine-10,11-epoxide plasma concentrations. Dosage adjustment and plasma level monitoring required.

May lead to symptomatic hyponatremia when administered concurrently with hydrochlorothiazide.

P-gp and moderate to strong CYP inducer that may decrease concentrations of sofosbuvir and/or velpatasvir, leading to reduced therapeutic effect. Use not recommended.

Strong CYP3A4 inducer that decreases vemurafenib plasma concentrations and may result in decreased efficacy. Avoid coadministration; replace with alternative drugs when possible.

CYP2C9 inducer that decreases warfarin exposure and INR; requires close INR monitoring.

CYP2C9 inducer that decreases warfarin effect and INR; requires closer INR monitoring.

Induces hepatic microsomal enzymes, increasing potential for acetaminophen hepatotoxicity.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

Increases the degree of heart block produced by adenosine, potentially resulting in higher degrees of AV node block.

P-glycoprotein inducer that decreases afatinib exposure. Increase GILOTRIF dose by 10 mg per day as tolerated.

P-gp inducer that decreases tenofovir alafenamide absorption and plasma concentrations. Dose adjustment to two tablets once daily is recommended.

CYP3A inducer. Can increase alprazolam metabolism and decrease plasma levels. Caution recommended during coadministration.

CYP3A inducer can increase alprazolam metabolism and decrease plasma levels. Caution is recommended during coadministration.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

Strong CYP3A4 inducer that decreases aripiprazole exposure. Consider increasing aripiprazole dosage when used concomitantly.

CYP3A4 inhibitors that may increase plasma levels of carbamazepine; dose reduction may be necessary.

Hepatic enzyme induction may enhance corticosteroid metabolism, requiring increased corticosteroid dosage.

Inhibitor of human microsomal epoxide hydrolase that may increase carbamazepine-10,11 epoxide plasma concentrations. Dosage adjustment and/or plasma level monitoring recommended.

Brivaracetam may increase exposure to carbamazepine-epoxide (active metabolite); carbamazepine dose reduction should be considered if tolerability issues arise.

CYP2B6 inducer that may decrease bupropion exposure; dose increase may be necessary but should not exceed maximum recommended dose.

May induce metabolism of bupropion and decrease bupropion exposure; dose increase may be necessary.

CYP2B6 inducer that may decrease bupropion exposure. Dose increase may be necessary but should not exceed maximum recommended dose.

CYP2B6 inducer that may decrease bupropion exposure. Dose increase of bupropion may be necessary but should not exceed maximum recommended dose.

CYP2B6 inducer that may decrease bupropion exposure. Dose increase may be necessary but should not exceed maximum recommended dose.

Strong CYP3A4 inducer. Avoid chronic co-administration or increase COMETRIQ dosage if unavoidable.

May reduce the effects of calcitriol by increasing vitamin D catabolism.

Carbamazepine is a hepatic CYP enzyme inducer expected to reduce caspofungin acetate plasma concentrations. Increased caspofungin dosing should be considered.

Elevated carbamazepine levels have been reported in postmarketing experience when cefixime is administered concomitantly. Drug monitoring may be of assistance in detecting alterations in carbamazepine plasma concentrations.

XCOPRI decreases carbamazepine plasma concentrations, potentially reducing efficacy; dosage increase recommended.

Mixing carbamazepine suspension with chlorpromazine solution results in formation of an orange rubbery precipitate. Should not be administered simultaneously.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

May shorten duration of neuromuscular blockade and increase infusion rate requirements. Use peripheral nerve stimulator and monitor.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

Macrolide CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inducer may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.

CYP3A4 and UGT inducer may reduce estrogen and bazedoxifene concentrations, decreasing therapeutic effects and increasing endometrial hyperplasia risk.

Anticonvulsant that decreases cyclosporine concentrations. Dosage adjustment required.

CYP3A4 inhibitor that increases plasma levels of carbamazepine; dose adjustment and/or plasma level monitoring may be necessary.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inhibitor that increases carbamazepine plasma levels; close monitoring and dosage adjustment may be required.

CYP3A4 inhibitor that increases plasma levels of carbamazepine; dose adjustment and/or plasma level monitoring may be necessary.

Carbamazepine induces CYP3A4 enzyme activity, enhancing corticosteroid metabolism and requiring dose increases.

Concomitant use may increase risk of water intoxication with hyponatremia; requires more frequent serum sodium monitoring.

May increase risk of water intoxication with hyponatremia. Monitor serum sodium more frequently.

Similar association with reduced efficacy and breakthrough bleeding suggested, though less marked than with rifampin.

CYP 3A4 inducers may enhance metabolism of dexamethasone, requiring dosage increase.

Carbamazepine induces CYP 3A4 enzyme activity, enhancing dexamethasone metabolism and requiring dosage increase.

Carbamazepine induces CYP 3A4 and enhances dexamethasone metabolism, requiring dosage increase.

CYP3A4 inducer that increases diazepam elimination, potentially decreasing efficacy.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

High doses of folic acid may decrease serum levels of this anticonvulsant drug.

Carbamazepine decreases doxepin exposure, which could lead to reduced treatment effect. Monitor doxepin plasma concentrations and consider increasing dosage.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

CYP3A4 inducer that decreases carbamazepine plasma levels; monitoring and dosage adjustment may be necessary.

Carbamazepine shortens the half-life of doxycycline, thereby lowering doxycycline concentration in the body.

Carbamazepine decreases the half-life of doxycycline.

May decrease systemic concentrations of hormonal contraceptives and diminish effectiveness or increase breakthrough bleeding.

Induces CYP3A4 enzyme, may decrease effectiveness of COCs or increase breakthrough bleeding.

May decrease the effectiveness of hormonal contraceptives or increase breakthrough bleeding through CYP3A4 enzyme induction.

Enzyme inducer that may decrease effectiveness of COCs or increase breakthrough bleeding. Use back-up contraception.

Can double the clearance of valproate, potentially decreasing valproate concentrations. Monitor valproate levels when introduced or withdrawn.

Decreases TAF concentration. Consider alternative anticonvulsant.

Macrolide CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

Carbamazepine may increase clearance of escitalopram due to enzyme-inducing properties. Monitor effectiveness of escitalopram.

Carbamazepine may increase clearance of escitalopram due to its enzyme-inducing properties. Consider possibility of increased clearance if coadministered.

May need dose adjustment for eslicarbazepine acetate or carbamazepine. Carbamazepine can induce enzymes that metabolize eslicarbazepine acetate and cause decreased plasma concentrations.

Potent CYP3A inducer; expected to decrease estazolam concentrations and reduce efficacy.

CYP3A4 inducer that may reduce plasma concentrations of estradiol, possibly decreasing therapeutic effects and altering uterine bleeding profile.

CYP3A4 inducer may decrease estradiol acetate plasma concentration, resulting in decreased therapeutic effects and/or changes in uterine bleeding profile.

CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.

CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.

CYP3A4 inducer may reduce plasma concentrations of estrogens and progestins, possibly decreasing therapeutic effects and altering uterine bleeding profile.

CYP3A4 inducer that may reduce estradiol plasma concentrations, possibly decreasing therapeutic effects and altering uterine bleeding profile.

CYP3A4 inducer that may reduce estradiol plasma concentrations, possibly decreasing therapeutic effects and/or altering uterine bleeding profile.

CYP3A4 inducer that may reduce plasma concentrations of estradiol valerate, possibly decreasing therapeutic effects and altering uterine bleeding profile.

CYP3A4 inducer that may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and altering uterine bleeding profile.

CYP3A4 inducer may reduce plasma concentrations of estrogens, possibly decreasing therapeutic effects and altering uterine bleeding profile.

May decrease plasma concentrations of etonogestrel and diminish contraceptive effectiveness or increase breakthrough bleeding.

CYP3A4 enzyme inducer that may decrease plasma concentrations of etonogestrel and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

Induces CYP3A4, may decrease plasma concentrations of CHCs and potentially diminish effectiveness or increase breakthrough bleeding.

CYP3A4 inducer. No dosing adjustments recommended in the presence of this drug.

Enzyme inducer; limited data indicate only 30% increase in flecainide elimination rate.

CYP3A4 inducer; concomitant use may decrease flibanserin exposure and therapeutic effect.

Azole CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

May decrease phenytoin serum levels; dose adjustment may be required.

CYP3A4 inducer that decreases ganaxolone exposure and efficacy; ZTALMY dosage may need to be increased but should not exceed maximum daily dosage.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inducer that can decrease hydrocodone plasma concentration, resulting in decreased efficacy or withdrawal syndrome.

CYP3A4 inducer may decrease serum hydrocortisone concentrations and increase risk of adrenal crisis; may require dose increase.

Carbamazepine induces hepatic enzyme activity, enhancing corticosteroid metabolism and may require dosage increase.

Carbamazepine induces cytochrome P450 3A4 enzyme activity, enhancing corticosteroid metabolism and requiring increased corticosteroid dosage.

CYP3A4 inhibitor that increases carbamazepine plasma levels; close monitoring and dosage adjustment may be required.

CYP3A4 inducer may increase metabolism of ifosfamide to active metabolites and increase formation of neurotoxic/nephrotoxic chloroacetaldehyde. Monitor for toxicities and consider dose adjustment.

Hepatic enzyme inducer may increase corticosteroid metabolism and reduce efficacy.

Addition of carbamazepine decreases lamotrigine concentration approximately 40%. May increase carbamazepine epoxide levels.

Carbamazepine decreases lamotrigine concentration approximately 40%. May increase carbamazepine epoxide levels.

Carbamazepine induces CYP3A4 and may decrease plasma concentrations of COCs, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

Carbamazepine induces CYP3A4 enzymes, potentially decreasing contraceptive effectiveness and increasing breakthrough bleeding.

May alter T4 and T3 serum transport or metabolism, affecting levothyroxine efficacy.

May cause protein binding site displacement of thyroid hormones, reducing serum protein binding. Total and free T4 may be reduced 20-40%, but most patients remain clinically euthyroid. Closely monitor thyroid hormone parameters.

Concomitant use may increase risk of adverse reactions of carbamazepine.

Concomitant use may increase risk of adverse reactions of carbamazepine. Monitor patients closely for adverse reactions.

CYP3A4 inhibitor that increases carbamazepine plasma levels; close monitoring and dosage adjustment may be required.

Hepatic enzyme inducer may increase corticosteroid clearance.

Mefloquine may reduce seizure control by lowering plasma levels of anticonvulsant. Monitor blood levels and adjust dosage appropriately.

Carbamazepine induces CYP3A4, potentially increasing the rate of elimination of donepezil.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

Hepatic enzyme inducer may enhance metabolism of corticosteroids, requiring dosage increase of the corticosteroid.

Carbamazepine induces cytochrome P450 3A4 and may enhance corticosteroid metabolism, requiring dosage increase.

Carbamazepine induces CYP3A4 enzyme activity, enhancing corticosteroid metabolism and may require dosage increase.

Hepatic enzyme inducer that enhances corticosteroid metabolism and may require increased corticosteroid dosage.

CYP3A4 substrate whose plasma levels may increase with concomitant metronidazole use. Monitor plasma concentrations.

CYP3A4 inducer that markedly decreases midazolam C max and AUC, reducing its efficacy.

CYP3A4 inducer anticonvulsant that may lower mifepristone serum concentrations and reduce efficacy. Verify treatment success through follow-up assessment.

Strong CYP3A inducer decreases mirtazapine plasma concentration. May require dose increase.

CYP2B6 inducer that may reduce CONTRAVE efficacy by reducing bupropion exposure. Avoid concomitant use.

CYP3A4 inhibitor that increases plasma levels of carbamazepine; dose adjustment and/or plasma level monitoring may be necessary.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

Enzyme inducer that may decrease plasma concentrations of CHCs and potentially diminish effectiveness or increase breakthrough bleeding.

Enzyme inducer that may decrease plasma concentrations of norethindrone and ethinyl estradiol, potentially diminishing contraceptive effectiveness or increasing breakthrough bleeding.

May decrease plasma concentrations and efficacy of contraceptive; may increase breakthrough bleeding.

Potent CYP1A2 inducer causing approximately 50% increase in olanzapine clearance; higher doses may cause greater increase.

Carbamazepine causes approximately 50% increase in olanzapine clearance due to CYP1A2 induction.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

Potent CYP3A4 inducer significantly increases ondansetron clearance and decreases blood concentrations. Monitor for reduced ondansetron efficacy.

Potent CYP3A4 inducer significantly increases ondansetron clearance and decreases blood concentrations. Monitor for reduced ondansetron efficacy.

Potent CYP3A4 inducer significantly increases ondansetron clearance and decreases blood concentrations. Monitor for potential decreased ondansetron efficacy.

Carbamazepine decreases plasma levels of MHD (active metabolite) by 25-49%. Monitoring of MHD levels and oxcarbazepine dose adjustment may be necessary.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inducer; caution should be exercised when administering paclitaxel concomitantly.

Strong CYP3A4/P-gp inducer may increase paliperidone clearance; dose increase may be necessary. Dose decrease needed upon discontinuation.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

Concomitant administration decreased topiramate plasma concentrations by 40% in epilepsy patients, reducing topiramate efficacy.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

May decrease phenytoin serum levels; monitoring of phenytoin levels recommended.

CYP 3A4 enzyme inducer enhances metabolism of corticosteroids, requiring increased prednisone dosage.

Impairs folate absorption and increases metabolism of circulating folate.

High doses of folic acid may result in decreased serum levels of carbamazepine.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

May increase elimination of progesterone through induction of hepatic cytochrome P450-3A4 system.

CYP3A4 inhibitor that increases carbamazepine plasma levels; close monitoring and dosage adjustment may be required.

CYP3A4 inhibitors that increase carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inhibitor that increases plasma levels of carbamazepine; dose adjustment and/or plasma level monitoring may be necessary.

CYP3A4 inducer that may decrease quinine plasma concentrations and reduce efficacy.

CYP3A4 inhibitor that increases plasma levels of carbamazepine; dose adjustment and/or plasma level monitoring may be necessary.

Strong inducer of drug metabolizing enzymes that may decrease raltegravir levels. Coadministration not recommended.

Weak/moderate CYP3A4/P-gp inducer that may decrease sirolimus concentrations. Monitor and adjust dosage as needed.

CYP3A4 and CYP2C8 inducer. Repaglinide dose increases and increased glucose monitoring may be required.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

Enzyme inducer that decreases plasma concentrations of risperidone. Increase risperidone dose up to double the patient's usual dose and titrate slowly.

Chronic carbamazepine therapy may cause resistance to rocuronium effects, resulting in shorter neuromuscular block duration and higher infusion rates needed.

Carbamazepine decreases rufinamide concentration by 19-26% and rufinamide decreases carbamazepine by 7-13%.

Metabolic enzyme inducer that may decrease systemic concentrations of estrogen and/or progestin, potentially diminishing contraceptive effectiveness.

DIACOMIT may inhibit P-glycoprotein transport of carbamazepine; consider dose reduction if adverse reactions occur. Carbamazepine may also induce DIACOMIT metabolism.

CYP3A4 inhibitor that increases carbamazepine plasma levels; close monitoring and dosage adjustment may be required.

CYP3A4 inducer that decreases carbamazepine plasma levels. Carbamazepine levels and/or dosage adjustment may be necessary.

Mixing carbamazepine suspension with liquid thioridazine results in formation of an orange rubbery precipitate. Should not be administered simultaneously.

Significantly increases clearance of thiothixene, potentially reducing its effectiveness. Patients should be monitored for signs of reduced thiothixene efficacy.

Mixing carbamazepine suspension with chlorpromazine solution results in orange rubbery precipitate formation. Simultaneous administration should be avoided.

Carbamazepine increases tiagabine clearance by 60%, which may require dose adjustments to maintain therapeutic efficacy.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

CYP 3A4 inducer enhances metabolism of corticosteroids and may require dosage increase.

Macrolide CYP3A4 inhibitor that increases carbamazepine plasma levels; close monitoring and dosage adjustment may be required.

CYP3A4 inducer decreases plasma concentrations of ulipristal acetate and may decrease its effectiveness as emergency contraception.

Carbamazepine is an enzyme-inducing drug that can increase valproate clearance and may double it. Monitoring of valproate and carbamazepine concentrations and dosage adjustment are indicated.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

Verapamil may increase carbamazepine concentrations, producing side effects such as diplopia, headache, ataxia, or dizziness.

Strong CYP3A4 inducer that decreases vilazodone exposure; consider increasing dose by 2-fold up to 80 mg daily.

Strong CYP inducer decreases plasma concentrations of vortioxetine. Consider increasing TRINTELLIX dose; maximum dose not to exceed 3 times original dose.

Zafirlukast may interact with carbamazepine as it is metabolized by CYP2C9. Care should be exercised when coadministered.

CYP3A4 inhibitor that increases plasma levels of carbamazepine; dose adjustment and/or plasma level monitoring may be necessary.

Carbamazepine induces CYP3A4, decreasing ziprasidone AUC by approximately 35%, potentially reducing ziprasidone efficacy.

Carbamazepine induces CYP3A4, decreasing ziprasidone AUC by approximately 35%, with potentially greater effects at higher carbamazepine doses.

Carbamazepine induces CYP3A4, decreasing ziprasidone AUC by approximately 35%, with potentially greater effects at higher carbamazepine doses.

Enzyme-inducing AED that increases zonisamide metabolism and clearance, decreasing its half-life to 27-38 hours.

Azithromycin had a modest effect on carbamazepine pharmacokinetics. No dosage adjustment recommended.

Steady-state carbamazepine and carbamazepine 10,11 epoxide concentrations were not affected by concomitant gabapentin, and gabapentin pharmacokinetics were unaltered.

Carbamazepine 400 mg/day had no influence on lacosamide 400 mg/day pharmacokinetics, and lacosamide had no influence on carbamazepine pharmacokinetics.

Levetiracetam does not influence carbamazepine plasma concentration. Carbamazepine as an enzyme-inducing AED increased levetiracetam clearance by ~22% in pediatric patients.

CYP3A inducer not expected to have significant effect on prasugrel active metabolite pharmacokinetics.

In addition, carbamazepine causes, or would be expected to cause, decreased levels of the following drugs, for which monitoring of concentrations or dosage adjustment may be necessary: acetaminophen, albendazole, alprazolam, aprepitant, buprenorphone, bupropion, citalopram, clonazepam, clozapine, corticosteroids (e.g., prednisolone, dexamethasone), cyclosporine, dicumarol, dihydropyridine calcium channel blockers (e.g., felodipine), doxycycline, ethosuximide, everolimus, haloperidol, imatinib, itraconazole, lamotrigine, levothyroxine, methadone, methsuximide, mianserin, midazolam, olanzapine, oral and other hormonal contraceptives, oxcarbazepine, paliperidone, phensuximide, phenytoin, praziquantel, protease inhibitors, risperidone, sertraline, sirolimus, tadalafil, theophylline, tiagabine, topiramate, tramadol, trazodone, tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline), valproate, warfarin, ziprasidone, zonisamide.

Other Drug Interactions Cyclophosphamide is an inactive prodrug and is converted to its active metabolite in part by CYP3A. The rate of metabolism and the leukopenic activity of cyclophosphamide are reportedly increased by chronic coadministration of CYP3A4 inducers. There is a potential for increased cyclophosphamide toxicity when coadministered with carbamazepine.

In addition, carbamazepine causes, or would be expected to cause, decreased levels of the following drugs, for which monitoring of concentrations or dosage adjustment may be necessary: acetaminophen, albendazole, alprazolam, aprepitant, buprenorphone, bupropion, citalopram, clonazepam, clozapine, corticosteroids (e.g., prednisolone, dexamethasone), cyclosporine, dicumarol, dihydropyridine calcium channel blockers (e.g., felodipine), doxycycline, ethosuximide, everolimus, haloperidol, imatinib, itraconazole, lamotrigine, levothyroxine, methadone, methsuximide, mianserin, midazolam, olanzapine, oral and other hormonal contraceptives, oxcarbazepine, paliperidone, phensuximide, phenytoin, praziquantel, protease inhibitors, risperidone, sertraline, sirolimus, tadalafil, theophylline, tiagabine, topiramate, tramadol, trazodone, tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline), valproate, warfarin, ziprasidone, zonisamide.

Reciprocal interactions may occur through cytochrome P450 system effects, though not studied.

prednisolone, dexamethasone), cyclosporin, dabigatran( 6 ), delavirdine, desipramine, diazepam, dicumarol, dihydropyridine calcium channel blockers (e.g., felodipine), doxycycline, edoxaban( 6 ), eslicarbazepine, ethosuximide, everolimus, felbamate, haloperidol, imatinib, itraconazole, lamotrigine, levothyroxine, lorazepam, methadone, methsuximide, midazolam, mirtazapine, nefazodone, nortriptyline, olanzapine, oral and other hormonal contraceptives( 2 ), oxcarbazepine, paliperidone, phenytoin( 3 ), praziquantel, protease inhibitors, quetiapine, risperidone, rivaroxaban( 6 ), sertraline, sirolimus, tadalafil, theophylline, tiagabine, topiramate, tramadol, triazolam, trazodone( 4 ), tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline), valproate, warfarin (5) , ziprasidone, and zonisamide.

In addition, carbamazepine causes, or would be expected to cause, decreased levels of the following drugs, for which monitoring of concentrations or dosage adjustment may be necessary: acetaminophen, albendazole, alprazolam, aprepitant, buprenorphone, bupropion, citalopram, clonazepam, clozapine, corticosteroids (e.g., prednisolone, dexamethasone), cyclosporine, dicumarol, dihydropyridine calcium channel blockers (e.g., felodipine), doxycycline, ethosuximide, everolimus, haloperidol, imatinib, itraconazole, lamotrigine, levothyroxine, methadone, methsuximide, mianserin, midazolam, olanzapine, oral and other hormonal contraceptives, oxcarbazepine, paliperidone, phensuximide, phenytoin, praziquantel, protease inhibitors, risperidone, sertraline, sirolimus, tadalafil, theophylline, tiagabine, topiramate, tramadol, trazodone, tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline), valproate, warfarin, ziprasidone, zonisamide.

In addition, carbamazepine causes, or would be expected to cause, decreased levels of the following drugs, for which monitoring of concentrations or dosage adjustment may be necessary: acetaminophen, albendazole, alprazolam, aprepitant, buprenorphone, bupropion, citalopram, clonazepam, clozapine, corticosteroids (e.g., prednisolone, dexamethasone), cyclosporine, dicumarol, dihydropyridine calcium channel blockers (e.g., felodipine), doxycycline, ethosuximide, everolimus, haloperidol, imatinib, itraconazole, lamotrigine, levothyroxine, methadone, methsuximide, mianserin, midazolam, olanzapine, oral and other hormonal contraceptives, oxcarbazepine, paliperidone, phensuximide, phenytoin, praziquantel, protease inhibitors, risperidone, sertraline, sirolimus, tadalafil, theophylline, tiagabine, topiramate, tramadol, trazodone, tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline), valproate, warfarin, ziprasidone, zonisamide.

In addition, carbamazepine causes, or would be expected to cause, decreased levels of the following drugs, for which monitoring of concentrations or dosage adjustment may be necessary: acetaminophen, albendazole, alprazolam, aprepitant, buprenorphone, bupropion, citalopram, clonazepam, clozapine, corticosteroids (e.g., prednisolone, dexamethasone), cyclosporine, dicumarol, dihydropyridine calcium channel blockers (e.g., felodipine), doxycycline, ethosuximide, everolimus, haloperidol, imatinib, itraconazole, lamotrigine, levothyroxine, methadone, methsuximide, mianserin, midazolam, olanzapine, oral and other hormonal contraceptives, oxcarbazepine, paliperidone, phensuximide, phenytoin, praziquantel, protease inhibitors, risperidone, sertraline, sirolimus, tadalafil, theophylline, tiagabine, topiramate, tramadol, trazodone, tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline), valproate, warfarin, ziprasidone, zonisamide.

prednisolone, dexamethasone), cyclosporin, dabigatran( 6 ), delavirdine, desipramine, diazepam, dicumarol, dihydropyridine calcium channel blockers (e.g., felodipine), doxycycline, edoxaban( 6 ), eslicarbazepine, ethosuximide, everolimus, felbamate, haloperidol, imatinib, itraconazole, lamotrigine, levothyroxine, lorazepam, methadone, methsuximide, midazolam, mirtazapine, nefazodone, nortriptyline, olanzapine, oral and other hormonal contraceptives( 2 ), oxcarbazepine, paliperidone, phenytoin( 3 ), praziquantel, protease inhibitors, quetiapine, risperidone, rivaroxaban( 6 ), sertraline, sirolimus, tadalafil, theophylline, tiagabine, topiramate, tramadol, triazolam, trazodone( 4 ), tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline), valproate, warfarin (5) , ziprasidone, and zonisamide.