Drug Interactions between carbamazepine and mefloquine
This report displays the potential drug interactions for the following 2 drugs:
- carbamazepine
- mefloquine
Interactions between your drugs
carBAMazepine mefloquine
Applies to: carbamazepine and mefloquine
Consumer information for this interaction is not currently available.
GENERALLY AVOID: Mefloquine may increase the risk of seizures and decrease the effectiveness of anticonvulsant drugs in patients with epilepsy. The use of mefloquine alone and in combination with other related antimalarial agents (e.g., quinine, quinidine, chloroquine) has been associated with convulsions in some patients. Coadministration of mefloquine with certain anticonvulsant medications may also result in reduced seizure control by lowering the plasma levels of the anticonvulsant. In one case report, a patient with a seizure disorder previously well controlled on valproic acid and carbamazepine experienced several seizure episodes after taking mefloquine (250 mg weekly) for malaria prophylaxis. A subsequent kinetics study performed on the patient revealed a significant reduction in sodium valproate half-life (5.65 hours vs. reported normal of 8 to 20 hours) and no change in carbamazepine half-life. The author suggested that mefloquine be administered to epileptic patients with caution, particularly if being treated with sodium valproate. Additional clinical data with other antiepileptics are unavailable.
MANAGEMENT: According to the product labeling, mefloquine may precipitate convulsions in patients with a history of seizure disorder and should not be used for malaria prophylaxis in such patients. If mefloquine administration is required for curative treatment of malaria, anticonvulsant blood levels should be closely monitored and the anticonvulsant dosage adjusted accordingly as needed. Patients should be advised to notify their physician if they experience a loss of seizure control.
MONITOR CLOSELY: Coadministration with potent inducers of CYP450 3A4 may significantly decrease the plasma concentrations of mefloquine, which is primarily metabolized by the isoenzyme. In seven healthy, nonsmoking male volunteers, administration of a single 500 mg oral dose of mefloquine on day 7 of treatment with the potent CYP450 3A4 inducer rifampin (600 mg orally once daily on days 1 through 7, followed by 600 mg twice weekly on days 8 through 56) decreased mean mefloquine peak plasma concentration (Cmax) and systemic exposure (AUC) by 19% and 68%, respectively, compared to mefloquine administered alone. The mean elimination half-life of mefloquine was also decreased by 63% (from 305 to 113 hours) in the presence of rifampin, while mean apparent oral clearance increased by 281%.
MANAGEMENT: The possibility of diminished antimalarial efficacy should be considered when mefloquine is used in combination with potent CYP450 3A4 inducers. Alternative agents with minimal or less enzyme induction potential are recommended when possible to avoid the risk of therapeutic failure, particularly in the treatment of acute malaria infections.
References
- Singh K, Shanks GD, Wilde H "Seizures after mefloquine." Ann Intern Med 114 (1991): 994
- Weinke T, Trautmann M, Held T, et al. "Neuropsychiatric side effects after the use of mefloquine." Am J Trop Med Hyg 45 (1991): 86-91
- Bem JL, Kerr L, Stuerchler D "Mefloquine prophylaxis: an overview of spontaneous reports of severe psychiatric reactions and convulsions." J Trop Med Hyg 95 (1992): 167-79
- Jallon P "Use of mefloquine in epileptic patients." J Neurol Neurosurg Psychiatry 51 (1988): 732
- "Product Information. Mefloquine Hydrochloride (mefloquine)." Hikma USA (formerly West-Ward Pharmaceutical Corporation) (2021):
- Ries S, Pohlmanneden B "Seizures during malaria prophylaxis with mefloquine." Dtsch Med Wochenschr 118 (1993): 1911-2
- Ruff TA, Sherwen SJ, Donnan GA "Seizure associated with mefloquine for malaria prophylaxis." Med J Aust 161 (1994): 453
- Pous E, Gascon J, Obach J, Corachan M "Mefloquine-induced grand mal seizure during malaria chemoprophylaxis in a non-epileptic subject." Trans R Soc Trop Med Hyg 89 (1995): 434
- Potasman I, Juven Y, Weller B, Schwartz E "Does mefloquine prophylaxis affect electroencephalographic patterns?" Am J Med 112 (2002): 147-9
- Jimenez-Huete A, Gil-Nagel A, Franch O "Multifocal myoclonus associated with mefloquine chemoprophylaxis." Clin Neuropharmacol 25 (2002): 243
- Ridtitid W, Wongnawa M, Mahatthanatrakul W, Chaipol P, Sunbhanich M "Effect of rifampin on plasma concentrations of mefloquine in healthy volunteers." J Pharm Pharmacol 52 (2000): 1265-9
- "Product Information. Lariam (mefloquine)." Pharmaco Australia Ltd (2022):
- "Product Information. Mefloquine (mefloquine)." AA Pharma Inc (2017):
- "Product Information. Lariam (mefloquine)." Neon Healthcare Ltd (2022):
Drug and food interactions
carBAMazepine food
Applies to: carbamazepine
You should preferably avoid the regular consumption of grapefruits and grapefruit juice while taking carBAMazepine. This can cause carBAMazepine levels to increase. You should report signs of carBAMazepine side effects such as nausea, visual disturbances, dizziness, or muscle weakness to your doctor. You should avoid or limit the use of alcohol while being treated with carBAMazepine. Alcohol can increase the nervous system side effects of carBAMazepine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. Talk to your doctor or pharmacist if you have any questions or concerns.
mefloquine food
Applies to: mefloquine
Food can enhance the levels of mefloquine in your body. Take mefloquine immediately after a meal. This will make it easier for your body to absorb the medication. Take each dose with a full glass, at least 8 ounces (240 mL) of water. For children or those who have difficulty swallowing, mefloquine can be crushed and mixed with water or sugar water. Talk to your healthcare provider if swallowing the tablets is difficult.
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
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. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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