Drug Interactions between carbamazepine and risperidone
This report displays the potential drug interactions for the following 2 drugs:
- carbamazepine
- risperidone
Interactions between your drugs
carBAMazepine risperiDONE
Applies to: carbamazepine and risperidone
ADJUST DOSE: Coadministration with potent inducers of CYP450 3A4 and/or P-glycoprotein (P-gp) may decrease the plasma concentrations of risperidone and its active metabolite, 9-hydroxyrisperidone. Both risperidone and 9-hydroxyrisperidone are substrates of the CYP450 3A4 isoenzyme and P-gp efflux transporter. Since 9-hydroxyrisperidone has similar pharmacological activity as the parent drug, the clinical effect of risperidone results from the combined plasma concentrations of both entities. When oral risperidone 3 mg twice daily was coadministered with the potent CYP450 3A4 and P-gp inducer carbamazepine at an average dosage of 573 mg/day (+/-168 mg/day) in study patients, steady-state peak plasma concentration (Cmax) and systemic exposure (AUC) values for the total active moiety (risperidone plus 9-hydroxyrisperidone) decreased by 45% and 49%, respectively. Plasma concentrations of carbamazepine did not appear to be affected. Rifampin, another potent 3A4 and P-gp inducer, decreased the Cmax and AUC of the total active moiety by 41% and 45%, respectively, following a single 1 mg oral dose of risperidone. The interaction was suspected in a case report of two patients treated with risperidone who developed parkinsonian symptoms several weeks following the discontinuation of carbamazepine. The symptoms resolved completely in both cases within a week after risperidone dosage was reduced.
MANAGEMENT: When risperidone is administered orally, the prescribing information recommends increasing (up to double) the usual dosage gradually (e.g., over 1 to 2 weeks) following the addition of a potent CYP450 3A4/P-gp inducer. For extended-release injectable formulations of risperidone, patients should be closely monitored for the first 4 to 8 weeks after starting treatment with a potent CYP450 3A4/P-gp inducer. A dosage increase or supplemental oral risperidone therapy may be required in some cases. Changes in efficacy and safety should be carefully monitored with any dosage adjustment. Upon discontinuation of the inducer, risperidone dosage should be reassessed and readjusted accordingly for the anticipated increase in plasma concentrations of risperidone and 9-hydroxyrisperidone. The prescribing information for individual risperidone products should be consulted for specific recommendations regarding concomitant use with potent CYP450 3A4 inducers.
References
- (2001) "Product Information. Risperdal (risperidone)." Janssen Pharmaceuticals
- Spina E, Avenoso A, Facciola G, Salemi M, Scordo MG, Giacobello T, Madia AG, Perucca E (2000) "Plasma concentrations of risperidone and 9-hydroxyrisperidone: Effect of comedication with carbamazepine or valproate." Ther Drug Monit, 22, p. 481-5
- Spina E, Scordo MG, Avenoso A, Perucca E (2001) "Adverse drug interaction between risperidone and carbamazepine in a patient with chronic schizophrenia and deficient CYP2D6 activity." J Clin Psychopharmacol, 21, p. 108-9
- (2022) "Product Information. RisperDAL (risperiDONE)." Janssen Pharmaceuticals
- (2022) "Product Information. Perseris (risperiDONE)." Indivior Inc.
- (2021) "Product Information. RisperDAL Consta (risperiDONE)." Janssen Pharmaceuticals
- (2022) "Product Information. Teva-Risperidone (risperidone)." Teva Canada Limited
- (2021) "Product Information. Perseris (risperidone)." HLS Therapeutics Inc
- (2020) "Product Information. Risperdal Consta (risperidone)." Janssen Inc
- (2022) "Product Information. Rixadone (riSPERIDONe)." Alphapharm Pty Ltd
- (2020) "Product Information. Risperdal Consta (riSPERIDONe)." Janssen-Cilag Pty Ltd
- (2023) "Product Information. Risperidone (risperidone)." Krka UK Ltd
- (2022) "Product Information. Okedi (risperidone)." ROVI Biotech Ltd
- (2022) "Product Information. Risperdal Consta (risperidone)." Janssen-Cilag Ltd
Drug and food interactions
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
- (2002) "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals
- 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
- 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
risperiDONE food
Applies to: risperidone
GENERALLY AVOID: Risperidone oral solution is not compatible with either tea or cola. In addition, alcohol may potentiate some of the pharmacologic effects of risperidone. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
MANAGEMENT: Risperidone oral solution should not be mixed with tea or cola. It may be taken with water, coffee, orange juice, or lowfat milk. Patients should also be advised to avoid consumption of alcohol.
References
- (2001) "Product Information. Risperdal (risperidone)." Janssen Pharmaceuticals
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
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