Drug Interactions between Aptiom and Carozide

MONITOR: Coadministration with other medications that can lower serum sodium levels such as diuretics, selective serotonin reuptake inhibitors (SSRIs), and serotonin-noradrenaline reuptake inhibitors (SNRIs) may potentiate the risk of hyponatremia associated with eslicarbazepine. In controlled clinical trials, 1% and 1.5% of patients treated with eslicarbazepine acetate 800 mg/day and 1200 mg/day, respectively, had at least one serum sodium value less than 125 mEq/L, compared to none of the patients receiving placebo. Additionally, 5.1% of eslicarbazepine-treated patients experienced decreases greater than 10 mEq/L, versus 0.7% of placebo-treated patients. These effects were dose-related and generally appeared within the first 8 weeks of treatment, with onset as early as after 3 days. Serious, life-threatening complications have included seizures, dehydration from severe nausea and vomiting, severe gait instability, and injury. Hospitalization and discontinuation of eslicarbazepine therapy were required in some cases. Concurrent hypochloremia was also present in patients with hyponatremia.

MANAGEMENT: Routine monitoring of serum sodium and chloride levels should be considered during maintenance treatment with eslicarbazepine acetate and concomitant use of other medications known to decrease serum sodium levels. Patients should be advised to seek medical attention if they experience potential signs and symptoms of hyponatremia such as nausea, vomiting, headache, malaise, lethargy, irritability, difficulty concentrating, memory impairment, confusion, weakness, muscle spasm, and unsteadiness (which may lead to falls). More severe and/or acute cases may include hallucination, syncope, seizure, coma, respiratory arrest, and death. Depending on the severity of hyponatremia, dosage reduction or discontinuation of eslicarbazepine acetate and other medications may be required, and appropriate medical intervention instituted as necessary.

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