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Interactions between Equetro and Eravacycline

1 drug interaction and 23 additional warnings found for the following 2 drugs:

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Drug interactions

Major drug interactions

Major:

carBAMazepine eravacycline

Applies to: Equetro (carbamazepine) and eravacycline
Adjust dose

Coadministration with potent inducers of CYP450 3A4 may decrease the plasma concentrations of eravacycline, which undergoes oxidation by CYP450 3A4 and flavin monooxygenase (FMO). When eravacycline was given with the potent CYP450 3A4 inducer, rifampin, eravacycline systemic exposure (AUC) decreased by 35% and clearance increased by 54%. Reduced therapeutic efficacy of eravacycline may occur.

Management

Eravacycline dosage should be increased to 1.5 mg/kg every 12 hours when used with potent CYP450 3A4 inducers. When a CYP450 3A4 inducer is started, it is important to remember that they exert their effect in a time-dependent manner and may take at least 2 weeks to reach maximal effect. Likewise, when discontinuing a CYP450 3A4 inducer, the induction may take at least 2 weeks to decline. No dosage adjustment is warranted when eravacycline is used with a weak or moderate inducer.

References (2)
  1. (2022) "Product Information. Xerava (eravacycline)." PAION Deutschland GmbH
  2. (2021) "Product Information. Xerava (eravacycline)." Tetraphase Pharmaceuticals, Inc

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

carBAMazepine Food/Lifestyle

Applies to: Equetro (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

Disease interactions

22 potential interactions Applies to: 19 conditions, including Depression, Underactive Thyroid, Heart Failure, Seizures, and Arrhythmia.

Adrenal Insufficiency

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Adrenal Insufficiency.

Some anticonvulsants can cause clinically significant hyponatremia (Na < 125 mmol/L). Therapy with these drugs should be administered cautiously in patients with conditions predisposing to hyponatremia, such as SIADH, use of diuretics or drugs associated with inappropriate antidiuretic hormone secretion, adrenal insufficiency, hypothyroidism, primary polydipsia, and edema (e.g., due to liver cirrhosis, congestive heart failure, or nephrotic syndrome). Serum sodium levels should be monitored during maintenance therapy, and patients should be monitored for signs and symptoms possibly indicating hyponatremia such as nausea, malaise, headache, lethargy, confusion, obtundation, and increase in seizure frequency or severity. If hyponatremia occurs, conservative measures such as fluid restriction, a reduction in dosage, or discontinuation of therapy will usually suffice.

Arrhythmia

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Arrhythmia.

Aromatic antiepileptic drugs such as phenytoin, carbamazepine, and oxcarbazepine, inhibit voltage- gated sodium channels and reduce membrane excitability in neurons and muscle and can be associated with cardiovascular effects. Individual agents have demonstrated AV heart block, including second and third-degree block following treatment. This occurred generally, but not solely in patients with underlying EKG abnormalities or risk factors for conduction abnormalities. Therapy with these agents should be considered and administered cautiously in patients with a history of cardiovascular disease and conduction abnormalities.

Bone Marrow Depression/Low Blood Counts

Major:

Equetro

The carBAMazepine in Equetro has a major potential interaction with Bone Marrow Depression/Low Blood Counts.

The use of carbamazepine has been associated with hematologic toxicities such as leukopenia, neutropenia, thrombocytopenia and, rarely, aplastic anemia and agranulocytosis. Carbamazepine should not be used in patients with history of bone marrow depression. Complete blood counts, including platelets and possibly reticulocytes and serum iron, should be performed prior to initiating therapy and regularly during therapy. Patients who exhibit decreases in blood counts at any time during treatment should be monitored more closely. Marked depression of blood counts may be indication for permanent withdrawal of carbamazepine therapy.

Cardiovascular Conditions and Disorders

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Cardiovascular Conditions and Disorders.

Aromatic antiepileptic drugs such as phenytoin, carbamazepine, and oxcarbazepine, inhibit voltage- gated sodium channels and reduce membrane excitability in neurons and muscle and can be associated with cardiovascular effects. Individual agents have demonstrated AV heart block, including second and third-degree block following treatment. This occurred generally, but not solely in patients with underlying EKG abnormalities or risk factors for conduction abnormalities. Therapy with these agents should be considered and administered cautiously in patients with a history of cardiovascular disease and conduction abnormalities.

Depression

Major:

Equetro

The carBAMazepine in Equetro has a major potential interaction with Depression.

Antiepileptic drugs can increase depression and suicidal thoughts or behaviors in patients receiving these drugs for any indication. Patients should be monitored for the emergence or worsening of depression, suicidal thoughts and unusual changes in mood or behavior. Caregivers and family should be alert for the emergence or worsening of symptoms. Behaviors of concern should be reported immediately to the healthcare providers.

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Depression.

Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders; phentermine-topiramate should be avoided in patients with history of suicidal attempts or active suicidal ideation. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.

Fructose Intolerance

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Fructose Intolerance.

Carbamazepine in chewable tablets and suspension contains sorbitol and should not be administered to patients with rare hereditary problems of fructose intolerance.

Glaucoma/Intraocular Hypertension

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

Carbamazepine is structurally related to the tricyclic antidepressants and has shown mild anticholinergic activity. Therapy with carbamazepine should be administered cautiously in patients with conditions that may be exacerbated by anticholinergic activity, such as urinary retention or obstruction and elevated intraocular pressure, especially angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma.

Heart Failure

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Heart Failure.

Some anticonvulsants can cause clinically significant hyponatremia (Na < 125 mmol/L). Therapy with these drugs should be administered cautiously in patients with conditions predisposing to hyponatremia, such as SIADH, use of diuretics or drugs associated with inappropriate antidiuretic hormone secretion, adrenal insufficiency, hypothyroidism, primary polydipsia, and edema (e.g., due to liver cirrhosis, congestive heart failure, or nephrotic syndrome). Serum sodium levels should be monitored during maintenance therapy, and patients should be monitored for signs and symptoms possibly indicating hyponatremia such as nausea, malaise, headache, lethargy, confusion, obtundation, and increase in seizure frequency or severity. If hyponatremia occurs, conservative measures such as fluid restriction, a reduction in dosage, or discontinuation of therapy will usually suffice.

Hyponatremia

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Hyponatremia.

Some anticonvulsants can cause clinically significant hyponatremia (Na < 125 mmol/L). Therapy with these drugs should be administered cautiously in patients with conditions predisposing to hyponatremia, such as SIADH, use of diuretics or drugs associated with inappropriate antidiuretic hormone secretion, adrenal insufficiency, hypothyroidism, primary polydipsia, and edema (e.g., due to liver cirrhosis, congestive heart failure, or nephrotic syndrome). Serum sodium levels should be monitored during maintenance therapy, and patients should be monitored for signs and symptoms possibly indicating hyponatremia such as nausea, malaise, headache, lethargy, confusion, obtundation, and increase in seizure frequency or severity. If hyponatremia occurs, conservative measures such as fluid restriction, a reduction in dosage, or discontinuation of therapy will usually suffice.

Liver Disease

Major:

Equetro

The carBAMazepine in Equetro has a major potential interaction with Liver Disease.

Most anticonvulsants are primarily metabolized by the liver. Metabolic activity may be decreased in patients with liver disease, resulting in elevated drug levels and increased risk of toxicity. Therapy with anticonvulsants should be administered cautiously in patients with mild and moderate liver impairment. Therapy with these drugs is mostly not recommended in patients with severe liver impairment. Caution is also advised when treating patients with a history of liver disease, since the use of some anticonvulsants has been associated with hepatotoxicity. Baseline and periodic evaluation of liver function is recommended. Therapy should be discontinued and not readministered if evidence of liver damage is observed and felt to be drug-related.

Moderate:

eravacycline

Eravacycline has a moderate potential interaction with Liver Disease.

The dosage of eravacycline should be adjusted in patients with severe liver dysfunction (Child-Pugh C); caution is recommended. No dosage adjustment is required in patients with mild to moderate liver dysfunction (Child-Pugh A and B).

Noninfectious Colitis

Major:

eravacycline

Eravacycline has a major potential interaction with Noninfectious Colitis.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

Porphyria

Major:

Equetro

The carBAMazepine in Equetro has a major potential interaction with Porphyria.

The use of carbamazepine should be avoided in patients with a history of hepatic porphyria (e.g., acute intermittent porphyria, variegate porphyria, porphyria cutanea tarda). Acute attacks have been reported in such patients receiving carbamazepine therapy.

Psychosis

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Psychosis.

Antiepileptic drugs (AEDs) have been associated with an increased risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Pooled analyses of 199 placebo-controlled clinical studies involving the use of 11 different AEDs showed that patients receiving AEDs had approximately twice the risk of suicidal thinking or behavior compared to patients receiving placebo. AEDs should be administered cautiously in patients with depression or other psychiatric disorders; phentermine-topiramate should be avoided in patients with history of suicidal attempts or active suicidal ideation. The risk of suicidal thoughts and behavior should be carefully assessed against the risk of untreated illness, bearing in mind that epilepsy and many other conditions for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Patients, caregivers, and families should be alert to the emergence or worsening of signs and symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. If patients have symptoms of suicidal ideation or behavior, a dosage reduction or treatment discontinuation should be considered.

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Psychosis.

Carbamazepine is structurally related to the tricyclic antidepressants (TCAs). The possibility of activation of a latent psychosis or exacerbation of psychotic symptoms, especially in elderly patients, should be borne in mind.

Renal Dysfunction

Major:

Equetro

The carBAMazepine in Equetro has a major potential interaction with Renal Dysfunction.

Most anticonvulsants are primarily excreted by the kidney. The plasma clearance may be decreased and the half-life prolonged in patients with impaired renal function. Therapy with anticonvulsants should be administered cautiously in patients with significant renal dysfunction. In most cases it is recommended to adjust the dosage in patients with CrCl <50 mL/min to half the usual starting dose and then increase slowly to achieve the desired clinical response. The renal function should be monitored regularly in patients receiving therapy.

Seizures

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Seizures.

Carbamazepine should be used with caution in patients with mixed seizure disorder that includes atypical absence seizures, as in these patients it has been associated with increased frequency of generalized convulsions.

SIADH

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with SIADH.

Some anticonvulsants can cause clinically significant hyponatremia (Na < 125 mmol/L). Therapy with these drugs should be administered cautiously in patients with conditions predisposing to hyponatremia, such as SIADH, use of diuretics or drugs associated with inappropriate antidiuretic hormone secretion, adrenal insufficiency, hypothyroidism, primary polydipsia, and edema (e.g., due to liver cirrhosis, congestive heart failure, or nephrotic syndrome). Serum sodium levels should be monitored during maintenance therapy, and patients should be monitored for signs and symptoms possibly indicating hyponatremia such as nausea, malaise, headache, lethargy, confusion, obtundation, and increase in seizure frequency or severity. If hyponatremia occurs, conservative measures such as fluid restriction, a reduction in dosage, or discontinuation of therapy will usually suffice.

Thyroid Disease

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Thyroid Disease.

Decreased values for thyroid function tests have been observed with carbamazepine administration. One study reported decreased serum levels of T4, FT4, and T3. In that study, TSH concentrations were not significantly altered. Clinicians should be cognizant of these effects when prescribing or administering carbamazepine therapy to patients with thyroid disorders.

Underactive Thyroid

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Underactive Thyroid.

Some anticonvulsants can cause clinically significant hyponatremia (Na < 125 mmol/L). Therapy with these drugs should be administered cautiously in patients with conditions predisposing to hyponatremia, such as SIADH, use of diuretics or drugs associated with inappropriate antidiuretic hormone secretion, adrenal insufficiency, hypothyroidism, primary polydipsia, and edema (e.g., due to liver cirrhosis, congestive heart failure, or nephrotic syndrome). Serum sodium levels should be monitored during maintenance therapy, and patients should be monitored for signs and symptoms possibly indicating hyponatremia such as nausea, malaise, headache, lethargy, confusion, obtundation, and increase in seizure frequency or severity. If hyponatremia occurs, conservative measures such as fluid restriction, a reduction in dosage, or discontinuation of therapy will usually suffice.

Urinary Retention

Moderate:

Equetro

The carBAMazepine in Equetro has a moderate potential interaction with Urinary Retention.

Carbamazepine is structurally related to the tricyclic antidepressants and has shown mild anticholinergic activity. Therapy with carbamazepine should be administered cautiously in patients with conditions that may be exacerbated by anticholinergic activity, such as urinary retention or obstruction and elevated intraocular pressure, especially angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma.

More resources

Equetro

A total of 851 drugs are known to interact with Equetro.

eravacycline

A total of 209 drugs are known to interact with eravacycline.

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.