Skip to Content

Tegretol (carbamazepine) Disease Interactions

There are 13 disease interactions with Tegretol (carbamazepine):

Major

Anticonvulsants (Includes Tegretol) ↔ Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Depression

Antiepileptic drugs can increase depression and suicidal thoughts or behaviors in patients receiving these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts and unusual changes in mood or behavior. Caregivers and family should be alert for the emergence or worsening of symptoms. Behaviors of concern should be reported immediately to the healthcare providers.

Major

Anticonvulsants (Includes Tegretol) ↔ Liver Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Most anticonvulsants are 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 anticonvulsants should be administered cautiously in patients with mild and moderate liver impairment. Therapy with these drugs is mostly not recommended in patients with severe liver impairment. Caution is also advised when treating patients with a history of liver disease, since the use of some anticonvulsants has been associated with hepatotoxicity. Baseline and periodic evaluation of liver function is recommended. Therapy should be discontinued and not readministered if evidence of liver damage is observed and felt to be drug-related.

References

  1. Swinburn BA, Croxson MS, Miller MV, Crawford KB "Carbamazepine induced granulomatous hepatitis." N Z Med J Mar (1986): 167
  2. Ponte CD "Carbamazepine-induced thrombocytopenia, rash, and hepatic dysfunction." Drug Intell Clin Pharm 17 (1983): 642-4
  3. Horowitz S, Patwardhan R, Marcus E "Hepatotoxic reactions associated with carbamazepine therapy." Epilepsia 29 (1988): 149-54
View all 22 references
Major

Anticonvulsants (Includes Tegretol) ↔ Renal Dysfunction

Severe Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Most anticonvulsants are primarily excreted by the kidney. The plasma clearance may be decreased and the half-life prolonged in patients with impaired renal function. Therapy with anticonvulsants should be administered cautiously in patients with significant renal dysfunction. In most cases it is recommended to adjust the dosage in patients with CrCl <50 mL/min to half the usual starting dose and then increase slowly to achieve the desired clinical response. The renal function should be monitored regularly in patients receiving therapy.

References

  1. "Product Information. Trileptal (oxcarbazepine)" Novartis Pharmaceuticals, East Hanover, NJ.
Major

Carbamazepine (Includes Tegretol) ↔ Blood Dyscrasias

Severe Potential Hazard, Moderate plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

The use of carbamazepine has been associated with hematologic toxicities such as leukopenia, neutropenia, thrombocytopenia and, rarely, aplastic anemia and agranulocytosis. Carbamazepine should not be used in patients with history of 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.

References

  1. Tohen M, Castillo J, Cole JO, et al "Thrombocytopenia associated with carbamazepine: a case series." J Clin Psychiatry 52 (1991): 496-8
  2. Stroink AR, Skillrud DM, Kiely JM, Sundt TM Jr "Carbamazepine-induced hemolytic anemia." Acta Haematol 72 (1984): 346-8
  3. Terao T "Transient thrombocytopenia while continuing carbamazepine." Am J Psychiatry 150 (1993): 1750-1
View all 14 references
Major

Carbamazepine (Includes Tegretol) ↔ History Of Porphyria

Severe Potential Hazard, Moderate plausibility

Applies to: Porphyria

The use of carbamazepine should be avoided in patients with a history of hepatic porphyria (e.g., acute intermittent porphyria, variegate porphyria, porphyria cutanea tarda). Acute attacks have been reported in such patients receiving carbamazepine therapy.

Moderate

Anticonvulsants (Includes Tegretol) ↔ Hyponatremia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyponatremia, Hypothyroidism, Adrenal Insufficiency, Congestive Heart Failure, SIADH

Some anticonvulsants can cause clinically significant hyponatremia (Na < 125 mmol/L). Therapy with these drugs should be administered cautiously in patients with conditions predisposing to hyponatremia, such as SIADH, use of diuretics or drugs associated with inappropriate antidiuretic hormone secretion, adrenal insufficiency, hypothyroidism, primary polydipsia, and edema (e.g., due to liver cirrhosis, congestive heart failure, or nephrotic syndrome). Serum sodium levels should be monitored during maintenance therapy, and patients should be monitored for signs and symptoms possibly indicating hyponatremia such as nausea, malaise, headache, lethargy, confusion, obtundation, and increase in seizure frequency or severity. If hyponatremia occurs, conservative measures such as fluid restriction, a reduction in dosage, or discontinuation of therapy will usually suffice.

References

  1. Steinhoff BJ, Stoll KD, Stodieck SR, Paulus W "Hyponatremic coma under oxcarbazepine therapy." Epilepsy Res 11 (1992): 67-70
  2. Van Amelsvoort T, Bakshi R, Devaux CB, Schwabe S "Hyponatremia associated with carbamazepine and oxcarbazepine therapy: a review." Epilepsia 35 (1994): 181-8
  3. Nielsen OA, Johannessen AC, Bardrum B "Oxcarbazepine-induced hyponatremia, a cross-sectional study." Epilepsy Res 2 (1988): 269-71
View all 7 references
Moderate

Antiepileptics (Includes Tegretol) ↔ Suicidal Tendency

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis, Depression

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.

Moderate

Carbamazepine (Includes Tegretol) ↔ Anticholinergic Effects

Moderate Potential Hazard, Moderate plausibility

Applies to: Glaucoma/Intraocular Hypertension, Urinary Retention

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.

References

  1. Hockings N, Pall A, Moody J, et al "The effects of age on carbamazepine pharmacokinetics and adverse effects." Br J Clin Pharmacol 22 (1986): 725-8
  2. Tormey WP "Mechanisms of carbamazepine-induced antidiuresis." J Neurol Neurosurg Psychiatry 56 (1993): 567
  3. "Product Information. Tegretol (carbamazepine)." Basel Pharmaceuticals, Summit, NJ.
Moderate

Carbamazepine (Includes Tegretol) ↔ Cardiovascular Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Cardiovascular Disease, Arrhythmias

Carbamazepine is structurally related to the tricyclic antidepressants (TCAs) and may demonstrate some of the same cardiovascular effects. AV heart block, including second and third degree block have been reported following carbamazepine treatment. This occurred generally, but not solely in patients with underlying EKG abnormalities or risk factors for conduction abnormalities. Therapy with carbamazepine should be considered and administered cautiously in patients with a history of cardiovascular disease and conduction abnormalities.

References

  1. "Product Information. Tegretol (carbamazepine)." Basel Pharmaceuticals, Summit, NJ.
  2. Kenneback G, Bergfeldt L, Vallin H, et al "Electrophysiologic effects and clinical hazards of carbamazepine treatment for neurologic disorders in patients with abnormalities of thecardiac conduction system." Am Heart J 121 (1991): 1421-9
  3. Steckler TL "Lithium- and carbamazepine-associated sinus node dysfunction: nine-year experience in a psychiatric hospital." J Clin Psychopharmacol 14 (1994): 336-9
View all 6 references
Moderate

Carbamazepine (Includes Tegretol) ↔ Fructose Intolerance

Moderate Potential Hazard, Moderate plausibility

Applies to: Fructose Intolerance

Carbamazepine in chewable tablets and suspension contains sorbitol and should not be administered to patients with rare hereditary problems of fructose intolerance.

Moderate

Carbamazepine (Includes Tegretol) ↔ Psychosis

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis

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.

References

  1. Pellock JM "Carbamazepine side effects in children and adults." Epilepsia 28 (1987): s64-70
  2. Hockings N, Pall A, Moody J, et al "The effects of age on carbamazepine pharmacokinetics and adverse effects." Br J Clin Pharmacol 22 (1986): 725-8
  3. "Product Information. Tegretol (carbamazepine)." Basel Pharmaceuticals, Summit, NJ.
View all 4 references
Moderate

Carbamazepine (Includes Tegretol) ↔ Seizures

Moderate Potential Hazard, Moderate plausibility

Applies to: Seizures

Carbamazepine should be used with caution in patients with mixed seizure disorder that includes atypical absence seizures, as in these patients it has been associated with increased frequency of generalized convulsions.

Moderate

Carbamazepine (Includes Tegretol) ↔ Thyroid Function Tests

Moderate Potential Hazard, Moderate plausibility

Applies to: Thyroid Disease

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.

References

  1. Delzompo M, Bocchetta A, Loviselli A, Martino E, Post RM, Ketter TA "Thyroid function during carbamazepine." Biol Psychiatry 36 (1994): 135-6
  2. Isojarvi JI, Airaksinen KE, Repo M, Pakarinen AJ, Salmela P, Myllyla VV "Carbamazepine, serum thyroid hormones and myocardial function in epileptic patients." J Neurol Neurosurg Psychiatry 56 (1993): 710-2
  3. Strandjord RE, AAnderud S, Myking OL, Johannessen SI "Influence of carbamazepine on serum thyroxine and triiodothyronine in patients with epilepsy." Acta Neurol Scand 63 (1981): 111-21
View all 4 references

You should also know about...

Tegretol (carbamazepine) drug Interactions

There are 1069 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.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

Hide