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Carbamazepine - Interactions and Warnings

Possible clinical interaction between topiramate (TPM) and carbamazepine modified release (CBZ-MR) in patients taking maximum tolerated doses of carbamazepine. Data are presented on 25 patients who contacted the epilepsy nurse specialist telephone helpline for advice after starting treatment with TPM and complained of symptoms of antiepileptic drug intoxication.
- Seizure 2002 Oct;11(7):464 -- Interaction of topiramate with carbamazepine: two case reports and a review of clinical experience. -- Mack C, Kuc S, Mulcrone S, Pilley A, Grunewald R.

Fluconazole is a known inhibitor of the cytochrome P450 enzyme system, this suggests an inhibition of carbamazepine metabolism.
- South Med J 2002 Sep;95(9):1099-100 -- Fluconazole-carbamazepine interaction. -- Finch CK, Green CA, Self TH.

These findings are interpreted as an inhibition of intestinal folic acid absorption caused by the antiepileptic therapy.
- Acta Neurol Scand 1984 Apr;69(4):226-31 -- The effects of carbamazepine and valproate on folate metabolism in man.

Findings show that all anticonvulsant drugs interfere with folate metabolism.
- Q J Med 1987 Nov;65(247):911-9 -- A comparative study of the relative effects of anticonvulsant drugs and dietary folate on the red cell folate status of patients with epilepsy. -- Goggin T, Gough H, Bissessar A, Crowley M, Baker M, Callaghan N.

Vitamin K deficiency may occur in pregnant women and the child after birth for women taking hepatic enzyme-inducing anti-epileptic drugs.
- Curr Treat Options Neurol 2002 Jan;4(1):31-40 -- Epilepsy in Pregnant Women. -- Bruno MK, Harden CL.

Carbamazepine is likely to interact with hormones.
- Epilepsia 1991;32 Suppl 6:S60-7 -- Effects of antiepileptic drugs on hormones. -- Ramsay RE, Slater JD.

Less well recognized is the possibility that influenza vaccination may significantly increase carbamazepine blood levels. Our experience suggests that carbamazepine toxicity can result from influenza vaccination.
- Pediatr Neurol 2002 Jan;26(1):61-3 -- Carbamazepine toxicity after influenza vaccination. -- Robertson WC Jr.

Concurrent ingestion of the herbal tea prepared from Cassia auriculata flowers with carbamazepine may influence the bioavailability of the drug and hence its therapeutic potential.
- Drug Metabol Drug Interact. 2003;19(3):177-87. -- Possible interaction of herbal tea and carbamazepine. -- Thabrew MI, Munasinghe TM, Chackrewarthi S, Senarath S. rent changes in toxicity.

last update: November 2008

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