Tegretol (carbamazepine) Disease Interactions
There are 7 disease interactions with Tegretol (carbamazepine):
- Blood Dyscrasias
- Cardiovascular Disease
- Liver Disease
- Suicidal Tendency
- Anticholinergic Effects
- Thyroid Function Tests
The use of carbamazepine has been associated with hematologic toxicities such as leukopenia, neutropenia, thrombocytopenia and, rarely, aplastic anemia and agranulocytosis. Therapy with carbamazepine should be administered with extreme caution in patients with preexisting blood dyscrasias and/or bone marrow depression. Complete blood counts, including platelets and possibly reticulocytes and serum iron, should be performed prior to initiating therapy and regularly during therapy. Patients who exhibit decreases in blood counts at any time during treatment should be monitored more closely. Marked depression of blood counts may be indication for permanent withdrawal of carbamazepine therapy.
Carbamazepine is structurally related to the tricyclic antidepressants (TCAs) and may demonstrate some of the same cardiovascular effects. Specifically, carbamazepine has occasionally caused congestive heart failure, edema, aggravation of hypertension, hypotension, syncope and collapse, aggravation of coronary artery disease, arrhythmias, AV block, thrombophlebitis, and thromboembolism. Myocardial infarction has been associated with TCAs. Therapy with carbamazepine should be considered and administered cautiously in patients with a history of cardiovascular disease or cardiac damage.
Carbamazepine is primarily metabolized by the liver. Metabolic activity may be decreased in patients with liver disease, resulting in elevated drug levels and increased risk of toxicity. Therapy with carbamazepine should be administered cautiously in patients with impaired hepatic function. Caution is also advised when treating patients with a history of liver disease, since the use of anticonvulsants, including carbamazepine, has been associated with hepatotoxicity. Baseline and periodic evaluation of liver function is recommended. Carbamazepine therapy should be discontinued and not readministered if evidence of liver damage is observed and felt to be drug-related.
Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs across multiple indications in either monotherapy or adjunctive therapy for a median treatment duration of 12 weeks (up to a maximum of 24 weeks) showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. The estimated rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% for 16,029 placebo-treated patients, representing an increase of approximately one case for every 530 patients treated. There were four suicides in AED-treated patients and none in placebo-treated patients, although the number is too small to establish any causal relationship. The increased risk of suicidal thoughts or behavior was observed as early as one week after starting AEDs and persisted for the duration of treatment assessed. The risk did not vary substantially by age (5 to 100 years) in the clinical trials analyzed. Therapy with AEDs should be administered cautiously in patients with depression or other psychiatric disorders. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. For clinically significant or persistent symptoms, a dosage reduction or treatment withdrawal should be considered. If patients have symptoms of suicidal ideation or behavior, treatment should be discontinued.
Carbamazepine is structurally related to the tricyclic antidepressants and has shown mild anticholinergic activity. Therapy with carbamazepine should be administered cautiously in patients with conditions that may be exacerbated by anticholinergic activity, such as urinary retention or obstruction and elevated intraocular pressure, especially angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma.
Carbamazepine is structurally related to the tricyclic antidepressants (TCAs). The possibility of activation of a latent psychosis or exacerbation of psychotic symptoms, especially in elderly patients, should be borne in mind.
Decreased values for thyroid function tests have been observed with carbamazepine administration. One study reported decreased serum levels of T4, FT4, and T3. In that study, TSH concentrations were not significantly altered. Clinicians should be cognizant of these effects when prescribing or administering carbamazepine therapy to patients with thyroid disorders.
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Tegretol (carbamazepine) drug Interactions
There are 983 drug interactions with Tegretol (carbamazepine)
Tegretol (carbamazepine) alcohol/food Interactions
There are 2 alcohol/food interactions with Tegretol (carbamazepine)
Drug Interaction Classification
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
|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.|
Do not stop taking any medications without consulting your healthcare provider.
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