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Drug Interactions between carbamazepine and Cleocin HCl

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

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Interactions between your drugs

Moderate

clindamycin carBAMazepine

Applies to: Cleocin HCl (clindamycin) and carbamazepine

MONITOR: Coadministration with strong CYP450 3A4 inducers may decrease plasma concentrations and antimicrobial effects of clindamycin, which is metabolized predominantly by the isoenzyme. In a pharmacokinetic analysis among patients (n=34) with staphylococcal osteoarticular infection receiving treatment with clindamycin (600 mg 3 times a day) and either rifampin (a strong CYP450 3A4 inducer; 600 mg twice a day) or levofloxacin (500 mg twice a day), clindamycin mean trough concentrations and Cmax values for patients treated with levofloxacin were 4.7 and 10.2 mcg/mL, respectively, compared to 0.79 and 3.48 mcg/mL, respectively, for patients treated with rifampin. However, while these findings confirm rifampin is an effective inducer of clindamycin, this combination has been used clinically with some success. The extent of the interaction or clinical use with other 3A4 inducers has not been established.

MANAGEMENT: Monitor closely for diminished therapeutic response to clindamycin during coadministration with strong CYP450 3A4 inducers. Dosage adjustments as well as clinical and laboratory monitoring should be considered whenever a strong CYP450 3A4 inducer is added to or withdrawn from therapy with clindamycin. An alternative agent with no or minimal CYP450 3A4-inducing activity may also be considered.

References (2)
  1. (2002) "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn
  2. Bernard A, Kermarrec G, Parize P, et al. (2015) "Dramatic reduction of clindamycin serum concentration in staphylococcal osteoarticular infection patients treated with the oral clindamycin-rifampicin combination." J Infect, 71, p. 200-6

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 (3)
  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

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

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