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Drug Interactions between Carnexiv and Nuvigil

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

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Interactions between your drugs

Moderate

carBAMazepine armodafinil

Applies to: Carnexiv (carbamazepine) and Nuvigil (armodafinil)

MONITOR: Coadministration of modafinil (the racemate) or armodafinil (the R-enantiomer) with carbamazepine may result in a reduction in the plasma concentrations and therapeutic effects of both drugs. The proposed mechanism involves increased clearance of each drug due to mutual induction of CYP450 3A4/5-mediated metabolism of each drug. Modafinil and armodafinil are both partially metabolized by the isoenzyme. According to one clinical study, coadministration of armodafinil 250 mg with carbamazepine 400 mg daily resulted in a 25% reduction in the mean systemic exposure of carbamazepine.

MANAGEMENT: Caution is advised if modafinil or armodafinil are used concomitantly with carbamazepine. Patients should be monitored for a reduction in the pharmacologic response to each drug. Dosage adjustments as well as clinical and laboratory monitoring of each drug should be considered whenever either drug is added to or withdrawn from therapy.

References

  1. (2001) "Product Information. Provigil (modafinil)." Cephalon, Inc
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. (2007) "Product Information. Nuvigil (armodafinil)." Cephalon Inc
  4. Cerner Multum, Inc. "Australian Product Information."
View all 4 references

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Drug and food interactions

Moderate

carBAMazepine food

Applies to: Carnexiv (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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Minor

armodafinil food

Applies to: Nuvigil (armodafinil)

Administration with food may delay the absorption of modafinil (the racemate) and armodafinil (the R-enantiomer) without significantly affecting their overall bioavailability. According to the product labeling, modafinil's absorption may be delayed by approximately one hour if taken with food. Similarly, the time to reach peak plasma concentration (Tmax) of armodafinil may be delayed by approximately 2 to 4 hours in the fed state.

References

  1. (2001) "Product Information. Provigil (modafinil)." Cephalon, Inc
  2. (2007) "Product Information. Nuvigil (armodafinil)." Cephalon Inc

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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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