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Drug Interactions between Epitol and vigabatrin

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

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Interactions between your drugs

Minor

carBAMazepine vigabatrin

Applies to: Epitol (carbamazepine) and vigabatrin

Coadministration of vigabatrin with carbamazepine may have no effect, or it may modestly increase or decrease the plasma concentrations of carbamazepine. The mechanism of interaction is unknown. Several studies have reported that carbamazepine levels were not significantly altered by the addition of vigabatrin. In contrast, in a study involving 59 patients receiving carbamazepine, following the addition of vigabatrin, 3 patients exhibited no change in carbamazepine levels, 34 experienced an increase in carbamazepine levels and 22 had a decrease in carbamazepine levels. In another study, 69% of patients exhibited an increase in carbamazepine levels of at least 10% with a mean increase of approximately 24%. In yet another study involving 15 patients with refractory partial epilepsy, the addition of vigabatrin (1500 to 4000 mg/day for at least 3 months) to existing carbamazepine monotherapy (800 to 1200 mg/day orally for 3 to 12 months) decreased the mean steady-state plasma trough concentration (Cmin) and plasma concentration-to-dose ratio of carbamazepine by 18% and 24%, respectively, compared to baseline. The mean carbamazepine plasma clearance increased by 35%. These changes are unlikely to be of therapeutic significance in most patients, and dose adjustments are not routinely required. Based on population pharmacokinetics, carbamazepine appears to have no effect on the plasma concentrations of vigabatrin.

References

  1. Tassinari CA, Michelucci R, Ambrosetto G, Salvi F (1987) "Double-blind study of vigabatrin in the treatment of drug-resistant epilepsy." Arch Neurol, 44, p. 907-10
  2. Browne TR, Mattson RH, Penry JK, Smith DB, Treiman DM, Wilder BJ, Ben-Menachem E, Napoliello MJ, Sherry KM, Szabo GK (1987) "Vigabatrin for refractory complex partial seizures: multicenter single-blind study with long-term follow-up." Neurology, 37, p. 184-9
  3. Jedrzejczak J, Dlawichowska E, Owczarek K, Majkowski J (2000) "Effect of vigabatrin addition on carbamazepine blood serum levels in patients with epilepsy." Epilepsy Res, 39, p. 115-20
  4. Sanchez-Alcaraz A, Quintana MB, Lopez E, Rodriguez I, Llopis P (2002) "Effect of vigabatrin on the pharmacokinetics of carbamazepine." J Clin Pharm Ther, 27, p. 427-30
  5. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  6. (2009) "Product Information. Sabril (vigabatrin)." Lundbeck Inc
View all 6 references

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Drug and food interactions

Moderate

carBAMazepine food

Applies to: Epitol (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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Moderate

vigabatrin food

Applies to: vigabatrin

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

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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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.

See also

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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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