Carbamazepine with Atracurium Interaction Details
Brand Names Associated with Carbamazepine
- Carbamazepine
- Carbatrol®
- Epitol®
- Equetro®
- Tegretol®
- Tegretol®-XR
- Teril®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
Decreased atracurium duration of action
Interaction Summary
The effects of carbamazepine on the neuromuscular blocking effects of atracurium have been contradictory in well-controlled studies. The effect of atracurium was significantly shortened in patients taking carbamazepine, with or without phenytoin or valproic acid, compared to patients not taking anticonvulsants. Other researchers reported that carbamazepine had no effect on the onset time or duration of atracurium .
Severity
Moderate
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Monitor patients for an appropriate clinical response to the neuromuscular blocker. Closer dosing intervals or higher doses of atracurium may be needed in patients receiving carbamazepine.
Mechanism Of Interaction
Increased atracurium metabolism
Literature Reports
A) Researchers studied the effect of carbamazepine on the onset and duration of neuromuscular blockade induced by atracurium. Three groups of patients were studied; 21 nonepileptic patients, 14 epileptic patients treated with carbamazepine alone, and 18 epileptic patients receiving carbamazepine and either phenytoin or valproic acid. Patients receiving carbamazepine had been maintained for many years. All patients were treated with atracurium 0.5 mg/kg intravenously following standard induction of anesthesia. The time to onset of neuromuscular blockade was not significantly different for the three groups of patients. However, time to recovery of baseline and train-of-four response was significantly shorter for the two groups receiving carbamazepine .
B) Carbamazepine had no effect on the neuromuscular blockade induced by atracurium in one study. After standard induction of anesthesia, 0.5 mg/kg of atracurium was administered in two groups of patients, with eight patients receiving carbamazepine and ten patients not receiving carbamazepine. The average duration of carbamazepine therapy was 41 weeks. There was no significant difference between the two groups in lag time, onset time, or time to recovery of the neuromuscular blockade induced by atracurium .
Carbamazepine Overview
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Carbamazepine is used alone or in combination with other medications to control certain types of seizures in people with epilepsy. It is also used to treat trigeminal neuralgia (a condition that causes facial nerve pain). Carbamazepine extended-release capsules (Equetro brand only) are also used to treat episodes of mania (frenzied, abnormally excited or irritated mood) or mixed episodes (symptoms of mania and depression that happen at the same time) in patients with bipolar I disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Carbamazepine is in a class of medications called anticonvulsants. It works by reducing abnormal electrical activity in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.