Drug Interaction Report

GENERALLY AVOID: Coadministration of deucravacitinib with other immunosuppressive agents may potentiate the risk of infections as well as lymphoma and other malignancies. Serious infections have been reported in patients with psoriasis who received deucravacitinib. The most common serious infections reported with deucravacitinib included pneumonia and COVID-19. Herpes zoster and herpes simplex viral reactivation were also reported during clinical studies with deucravacitinib, as well as malignancies including lymphoma.

MANAGEMENT: The safety and efficacy of deucravacitinib in combination with immunosuppressive agents has not been evaluated. The manufacturer recommends that the concomitant use of deucravacitinib with potent immunosuppressants (e.g., azathioprine, cyclosporine) should be avoided. Patients receiving deucravacitinib should be closely monitored for the development of signs and symptoms of infection during and after treatment, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy. If a serious infection develops, deucravacitinib should be interrupted until the infection is controlled.

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.