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Drug Interactions between carbamazepine and rifabutin

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

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Interactions between your drugs

Moderate

carBAMazepine rifabutin

Applies to: carbamazepine and rifabutin

MONITOR: Coadministration with inducers of CYP450 3A4 may decrease the plasma concentrations and pharmacologic effects of carbamazepine, which is primarily metabolized by the isoenzyme. The interaction has been reported with known CYP450 3A4 inducers such as phenobarbital, phenytoin, and primidone.

MANAGEMENT: Pharmacologic effects and serum concentrations of carbamazepine should be monitored more closely whenever a CYP450 3A4 inducer is added to or withdrawn from therapy, and the carbamazepine dosage adjusted as necessary.

References (8)
  1. Eichelbaum M, Kothe KW, Hoffmann F, von Unruh GE (1979) "Kinetics and metabolism of carbamazepine during combined antiepileptic drug therapy." Clin Pharmacol Ther, 26, p. 366-71
  2. Zielinski JJ, Haidukewych D (1987) "Dual effects of carbamazepine-phenytoin interaction." Ther Drug Monit, 9, p. 21-3
  3. Ramsay RE, McManus DQ, Guterman A, et al. (1990) "Carbamazepine metabolism in humans: effect of concurrent anticonvulsant therapy." Ther Drug Monit, 12, p. 235-41
  4. Spina E, Martines C, Fazio A, Trio R, Pisani F, Tomson T (1991) "Effect of phenobarbital on the pharmacokinetics of carbamazepine-10, 11-epoxide, an active metabolite of carbamazepine." Ther Drug Monit, 13, p. 109-12
  5. (2002) "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals
  6. Tomson T, Spina E, Wedlund JE (1987) "Minor additive inducing effects of phenobarbital on carbamazepine clearance in patients on combined carbamazepine-phenytoin therapy." Ther Drug Monit, 9, p. 117-9
  7. Benetello P, Furlanut M (1987) "Primidone-carbamazepine interaction: clinical consequences." Int J Clin Pharmacol Res, 7, p. 165-8
  8. Liu H, Delgado MR (1995) "Interactions of phenobarbital and phenytoin with carbamazepine and its metabolites' concentrations, concentration ratios, and level dose ratios in epileptic children." Epilepsia, 36, p. 249-54

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.

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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