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Drug Interactions between Dalalone and Epitol

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

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Interactions between your drugs

Moderate

carBAMazepine dexAMETHasone

Applies to: Epitol (carbamazepine) and Dalalone (dexamethasone)

MONITOR: Carbamazepine may decrease the plasma concentrations and systemic effects of both endogenous and exogenous corticosteroids. The mechanism is accelerated corticosteroid metabolism due to induction of the CYP450 3A4 enzymatic pathway by carbamazepine.

MANAGEMENT: Patients treated concomitantly with carbamazepine may require higher dosages of corticosteroids or adrenocorticotropic agents. Pharmacologic response to these agents should be monitored more closely whenever carbamazepine is added to or withdrawn from therapy in patients stabilized on their existing corticosteroid or adrenocorticotropic regimen, and the dosage(s) adjusted as necessary.

References

  1. Olivesi A "Modified elimination of prednisolone in epileptic patients on carbamazepine monotherapy, and in women using low-dose oral contraceptives." Biomed Pharmacother 40 (1986): 301-8
  2. Keitner GI, Fruzzetti AE, Miller IW, Norman WH, Brown WA "The effect of anticonvulsants on the dexamethasone suppression test." Can J Psychiatry 34 (1989): 441-3
  3. Privitera MR, Greden JF, Gardner RW, Ritchie JC, Calrroll BJ "Interference by carbamazepine with the dexamethasone suppresion test." Biol Psychiatry 17 (1982): 611-20
  4. Spina E, Pisani F, Perucca E "Clinically significant pharmacokinetic drug interactions with carbamazepine - an update." Clin Pharmacokinet 31 (1996): 198-214
  5. Levy RH "Cytochrome P450 isozymes and antiepileptic drug interactions." Epilepsia 36 Suppl 5 (1995): s8-13
View all 5 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. "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals PROD (2002):
  2. Garg SK, Kumar N, Bhargava VK, Prabhakar SK "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther 64 (1998): 286-8
  3. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther 68 (2000): 468-77

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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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