Carbamazepine with Imipramine Interaction Details
Brand Names Associated with Carbamazepine
- Carbamazepine
- Carbatrol®
- Epitol®
- Equetro®
- Tegretol®
- Tegretol®-XR
- Teril®
Brand Names Associated with Imipramine
- Imipramine
- Tofranil®
- Tofranil® PM
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
Decreased imipramine effectiveness
Interaction Summary
In a retrospective study of 36 children suffering from hyperactivity secondary to attention deficit disorder, the antidepressant levels (imipramine and its metabolite desipramine) were decreased by 50% in children receiving carbamazepine compared to levels obtained with imipramine alone.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor for clinical efficacy of the imipramine therapy and for any signs of toxicity of carbamazepine. Serum levels of both agents should be considered when either agent is added or discontinued, with appropriate dosage adjustments made accordingly.
Mechanism Of Interaction
Increased imipramine metabolism
Literature Reports
A) In a retrospective study, of 36 children with attention deficit hyperactivity disorder, the average plasma concentration of imipramine was significantly lower in patients treated with carbamazepine concurrently. The average dose of imipramine was 1.3 mg/kg in patients receiving imipramine alone, compared to an imipramine dose of 1.8 mg/kg in patients receiving both imipramine and carbamazepine. The plasma level of imipramine, desipramine, and total tricyclic antidepressant plasma levels were significantly lower in patients treated with carbamazepine concurrently. The dose of imipramine may need to be increased if carbamazepine is added to therapy and the dose of imipramine may need to be decreased if carbamazepine is stopped .
B) Combination therapy with carbamazepine decreases steady-state total serum concentrations of imipramine and mean concentrations of desipramine. Thirteen patients were treated with imipramine 2 mg/kg/day for 3 weeks, after which carbamazepine 400 mg/day was added. The ratios of total concentrations of imipramine to desipramine were similar before and two weeks after carbamazepine intake (0.7 +/- 0.41 versus 0.63 +/- 0.36; p greater than 0.05). Free fractions of imipramine and desipramine were elevated after the addition of carbamazepine. Despite lowever imipramine and desipramine total concentrations, the combination treatment with carbamazepine in depressed patients is effective and well tolerated. Dosage increase of imipramine does not appear to be necessary in the depressed patients included in this study .
Carbamazepine Overview
-
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.
Imipramine Overview
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Imipramine tablets and capsules are used to treat depression. Imipramine tablets are also used to prevent bedwetting in children. Imipramine is in a class of medications called tricyclic antidepressants. It treats depression by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance. There is not enough information to explain how imipramine prevents bedwetting.
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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.