Carbamazepine with Paclitaxel 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
Loss of paclitaxel efficacy
Interaction Summary
Concomitant use of paclitaxel and enzyme-inducing antiepileptic agents (AED) has resulted in decreased paclitaxel exposure and inadequate chemotherapy. In a study in patients with recurrent malignant glioma treated with paclitaxel (N=34), the maximum tolerated dose in patients receiving concomitant enzyme-inducing AEDs was 360 mg/m(2) compared with 240 mg/m(2) in those not receiving AEDs. Paclitaxel AUC and Cmax were significantly decreased and clearance was significantly increased . In another study 0% of patients receiving paclitaxel and phenytoin experienced a complete or partial response to paclitaxel and no hematological toxicities occurred, while receiving paclitaxel 140 mg/m(2). Steady-state paclitaxel concentrations in these patients were less than 30% of those seen in patients not receiving phenytoin . If coadministration of paclitaxel and enzyme-inducing AEDs cannot be avoided, the paclitaxel dose may need to be adjusted with a 50% increase .
Severity
Major
Onset
Delayed
Evidence
Established
How To Manage Interaction
Concomitant use of paclitaxel and enzyme-inducing antiepileptic agents (AED) has resulted in decreased serum concentrations of paclitaxel resulting in inadequate chemotherapy. If coadministration of paclitaxel and enzyme-inducing AEDs cannot be avoided, the paclitaxel dose may need to be adjusted with a 50% increase .
Mechanism Of Interaction
Induction of CYP3A-mediated paclitaxel metabolism
Literature Reports
A) Studies have demonstrated that concomitant use of chemotherapeutic agents, such as paclitaxel, with enzyme-inducing antiepileptic agents, such as phenytoin, carbamazepine, and phenobarbital have resulted in decreased serum concentrations of paclitaxel causing patients to not receive adequate chemotherapy .
B) In a study in patients with recurrent malignant glioma treated with paclitaxel (N=34), dosage requirements were 50% higher in patients receiving concomitant enzyme-inducing antiepileptic agents (AED; 360 mg/m(2)) compared with those not receiving AEDs (240 mg/m(2)). Concomitant use resulted in significantly lower AUC(0 to 24 hours) of paclitaxel (28.74 vs 60.28 mcg x hr/mL), clearance was significantly increased (9.57 vs 4.76 L/hr/m(2)), and Cmax was significantly decreased (5.26 vs 9.61 mcg/mL) .
C) During a study involving paclitaxel at a dose of 140 mg/m(2), none of the ten patients who were also receiving phenytoin therapy experienced a complete or partial response to paclitaxel. Also, no hematological toxicities occurred, even though the dose of paclitaxel was considered to be the maximal tolerated dose. Steady-state paclitaxel concentrations in these patients were less than 30% of those seen in patients not receiving phenytoin .
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.