Carbamazepine with Oxcarbazepine Interaction Details
Brand Names Associated with Carbamazepine
- Carbamazepine
- Carbatrol®
- Epitol®
- Equetro®
- Tegretol®
- Tegretol®-XR
- Teril®
Brand Names Associated with Oxcarbazepine
- Oxcarbazepine
- Oxtellar XR®
- Trileptal®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 25, 2023
Interaction Effect
Decreased expsoure of the active 10-monohydroxy metabolite of oxcarbazepine
Interaction Summary
Concurrent administration of oxcarbazepine and carbamazepine (CBZ; strong CYP3A inducer) has resulted in a 40% decrease in the plasma concentration of the active 10-monohydroxy derivative (MHD) of oxcarbazepine.If coadministered, monitor MHD concentrations. Oxcarbazepine dosage adjustment may be necessary after initiation, dose modification, or discontinuation of carbamazepine; consider initiating oxcarbazepine at 900 mg once daily for adults and 12 to 15 mg/kg (not to exceed 900 mg/day in the first week) in pediatric patients .
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Coadministration of oxcarbazepine and carbamazepine (strong CYP3A inducer) may result in decreased exposure of the active 10-monohydroxy (MHD) metabolite of oxcarbazepine. If coadministered, monitor MHD concentrations. Oxcarbazepine dosage adjustment may be necessary after initiation, dose modification, or discontinuation of carbamazepine; consider initiating oxcarbazepine at 900 mg once daily for adults and 12 to 15 mg/kg (not to exceed 900 mg/day in the first week) in pediatric patients.
Mechanism Of Interaction
Induction of CYP3A-mediated metabolism of oxcarbazepine and its active metabolite
Literature Reports
A) In a randomized, double-blind, placebo-controlled trial in adults, coadministration of carbamazepine (CBZ) and oxcarbazepine resulted in decreased levels of the pharmacologically active 10-monohydroxy derivative (MHD) of oxcarbazepine. Patients (n=12) being treated with a mean CBZ dose of 1025 milligrams (mg) (range 400 to 2000 mg) were administered a single 600 mg oral dose of oxcarbazepine and were randomized, a week later, to received either 300 mg oxcarbazepine three times daily or matched placebo for 3 weeks. Active controls (n=7) were untreated patients who received the single 600 mg oxcarbazepine dose and 3 weeks active treatment. Study results showed that the area under the concentration-time curve (AUC) for MHD at steady state was reduced by 40% (90% confidence interval: 17% decrease, 57% decrease) in the CBZ-treated group compared to the active controls (p less than 0.05) while AUC for CBZ did not alter significantly. Although the exact mechanism for this decrease is unknown, it was partially attributed to a potential induction of oxcarbazepine metabolism by carbamazepine, a strong inducer of cytochrome P450 enzymes .
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.
Oxcarbazepine Overview
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Oxcarbazepine (Trileptal) is used alone or in combination with other medications to control certain types of seizures in adults and children. Oxcarbazepine extended-release tablets (Oxtellar XR) are used in combination with other medications to control certain types of seizures in adults and children 6 years of age and older. Oxcarbazepine is in a class of medications called anticonvulsants. It works by decreasing 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.