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Drug Interactions between carbamazepine and Seroquel XR

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

carBAMazepine QUEtiapine

Applies to: carbamazepine and Seroquel XR (quetiapine)

ADJUST DOSE: Coadministration with potent inducers of CYP450 3A4 such as carbamazepine may significantly decrease the plasma concentrations of quetiapine, which is primarily metabolized by the isoenzyme. In addition, quetiapine may increase the plasma levels and the risk of adverse effects of carbamazepine and its active epoxide metabolite. In 18 psychiatric patients receiving quetiapine 300 mg twice daily, addition of the potent CYP450 3A4 inducer carbamazepine (200 mg three times daily) decreased mean quetiapine peak plasma concentration (Cmax) and systemic exposure (AUC) by 80% and 87%, respectively, and increased oral clearance (Cl/F) by 7.5-fold compared to quetiapine administered alone.

MANAGEMENT: Increased dosages of quetiapine may be required during chronic treatment (greater than 7 to 14 days) with potent CYP450 3A4 inducers such as carbamazepine. The U.S. labeling recommends an increase of up to 5-fold of the original dosage. Further adjustments should be made based on clinical response and tolerance. The safety of dosages above 800 mg/day has not been established in clinical trials. Continued treatment at higher dosages should only be considered following careful consideration of risks and benefits. When carbamazepine is discontinued, the dosage of quetiapine should be reduced to the original level within 7 to 14 days. In addition, patients should be monitored for adverse effects associated with carbamazepine (e.g., dizziness, drowsiness, ataxia, diplopia). Some authorities suggest monitoring carbamazepine levels and adjusting the dosage accordingly when coadministered with quetiapine.

References

  1. (2002) "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals
  2. (2001) "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals
  3. (1997) "Quetiapine for schizophrenia." Med Lett Drugs Ther, 39, p. 117-8
  4. Wong YWJ, Yeh C, Thyrum PT (2001) "The effects of concomitant phenytoin administration on the steady-state pharmacokinetics of quetiapine." J Clin Psychopharmacol, 21, p. 89-93
  5. Grimm SW, Richtand NM, Winter HR, Stams KR, Reele SB (2006) "Effects of cytochrome P450 3A modulators ketoconazole and carbamazepine on quetiapine pharmacokinetics." Br J Clin Pharmacol, 61, p. 58-69
  6. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  7. Cerner Multum, Inc. "Australian Product Information."
View all 7 references

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Drug and food interactions

Moderate

carBAMazepine food

Applies to: carbamazepine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of carbamazepine. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

In a small, randomized, crossover study, the administration of carbamazepine with grapefruit juice (compared to water) increased plasma drug concentrations by approximately 40%. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

MANAGEMENT: Patients receiving carbamazepine should be advised to avoid or limit consumption of alcohol. Given the drug's narrow therapeutic index, patients receiving carbamazepine therapy should preferably avoid the regular consumption of grapefruits and grapefruit juice to prevent any undue fluctuations in plasma drug levels. Patients should be advised to report signs of carbamazepine toxicity (nausea, visual disturbances, dizziness, or ataxia) to their physicians.

References

  1. (2002) "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals
  2. Garg SK, Kumar N, Bhargava VK, Prabhakar SK (1998) "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther, 64, p. 286-8
  3. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77

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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.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown 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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