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Drug Interactions between divalproex sodium and primidone

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

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Interactions between your drugs

Moderate

primidone divalproex sodium

Applies to: primidone and divalproex sodium

MONITOR: Valproate may increase the plasma levels of primidone's major metabolite, phenobarbital. The mechanism may be related to decreased CYP450 hepatic metabolism of the barbiturate.

MANAGEMENT: Patients started on combination therapy should be closely monitored for clinical and laboratory evidence of toxicity. They should be advised to notify their physician if they experience excessive sedation or lethargy.

References (6)
  1. Windorfer A, Sauer W, Gadeke R (1975) "Elevation of diphenylhydantoin and primidone serum concentration by addition of dipropylacetate, a new anticonvulsant drug." Acta Paediatr Scand, 64, p. 771-2
  2. Gram L, Wulff K, Rasmussen KE, et al. (1977) "Valproate sodium: a controlled clinical trial including monitoring of drug levels." Epilepsia, 18, p. 141-8
  3. Patel IH, Levy RH, Cutler RE (1980) "Phenobarbital-valproic acid interaction." Clin Pharmacol Ther, 27, p. 515-21
  4. Bruni J, Wilder BJ, Perchalski RJ, Hammond EJ, Villarreal HJ (1980) "Valproic acid and plasma levels of phenobarbital." Neurology, 30, p. 94-7
  5. Wilder BJ, Willmore LJ, Bruni J, Villarreal HJ (1978) "Valproic acid: interaction with other anticonvulsant drugs." Neurology, 28, p. 892-6
  6. Bourgeois BF (1988) "Pharmacologic interactions between valproate and other drugs." Am J Med, 84, p. 29-33

Drug and food interactions

Major

primidone food

Applies to: primidone

GENERALLY AVOID: Concurrent acute use of barbiturates and ethanol may result in additive CNS effects, including impaired coordination, sedation, and death. Tolerance of these agents may occur with chronic use. The mechanism is related to inhibition of microsomal enzymes acutely and induction of hepatic microsomal enzymes chronically.

MANAGEMENT: The combination of ethanol and barbiturates should be avoided.

References (5)
  1. Gupta RC, Kofoed J (1966) "Toxological statistics for barbiturates, other sedatives, and tranquilizers in Ontario: a 10-year survey." Can Med Assoc J, 94, p. 863-5
  2. Misra PS, Lefevre A, Ishii H, Rubin E, Lieber CS (1971) "Increase of ethanol, meprobamate and pentobarbital metabolism after chronic ethanol administration in man and in rats." Am J Med, 51, p. 346-51
  3. Saario I, Linnoila M (1976) "Effect of subacute treatment with hypnotics, alone or in combination with alcohol, on psychomotor skills related to driving." Acta Pharmacol Toxicol (Copenh), 38, p. 382-92
  4. Stead AH, Moffat AC (1983) "Quantification of the interaction between barbiturates and alcohol and interpretation of fatal blood concentrations." Hum Toxicol, 2, p. 5-14
  5. Seixas FA (1979) "Drug/alcohol interactions: avert potential dangers." Geriatrics, 34, p. 89-102
Moderate

divalproex sodium food

Applies to: divalproex sodium

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References (4)
  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc

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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