Carbamazepine with Pipecuronium 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
Resistance to neuromuscular blockade
Interaction Summary
Phenytoin and carbamazepine have been reported to cause some resistance to neuromuscular blockade in patients treated with pipecuronium. A prolonged onset time of action was observed in patients with therapeutic carbamazepine levels, but the accelerated recovery from paralysis was seen in all patients treated with anticonvulsants, regardless of the plasma level.
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
In patients on chronic carbamazepine therapy, higher doses of pipecuronium may be needed. Monitor the depth of neuromuscular blockade and adjust the dose of pipecuronium accordingly.
Mechanism Of Interaction
Unknown
Literature Reports
A) Twenty adults scheduled for neurosurgery were enrolled in a study. The patients were then divided into two groups: group 1 (n=10) was not on anticonvulsant therapy, and group 2 (n=10) was being treated with either phenytoin (n=5) or carbamazepine (n=5). All patients achieved muscle relaxation by a single intravenous dose of pipecuronium 0.08 mg/kg. The onset time was prolonged in patients receiving anticonvulsants when compared to controls (230.5 seconds vs. 203 seconds). Of the patients who had therapeutic anticonvulsant levels (n=6), the onset time was more prolonged (279.2 seconds) than the patients (n=4) who had subtherapeutic levels (181.8 seconds). The recovery index was also significantly shortened in patients who were receiving anticonvulsant therapy when compared to controls (35 min vs. 65.6 min). The plasma anticonvulsant level was not a discriminant factor for recovery from the neuromuscular blockade .
B) An accelerated recovery rate from pipecuronium-induced neuromuscular blockade in patients receiving carbamazepine alone and in combination with other anticonvulsants was observed. Nineteen adult patients were divided into two groups: six healthy patients who had never received any anticonvulsant medications, and 13 epileptic patients with intractable seizures who had been treated for years with anticonvulsants. Of these 13 epileptic patients, they were further divided into a group who received carbamazepine as monotherapy (n=6) and a group who was treated with carbamazepine plus either phenytoin or valproic acid (n=7). Anesthesia was induced with thiopental sodium and fentanyl prior to a single intravenous bolus dose of pipecuronium 0.08 mg/kg. No statistical significance was reached when comparing the time to 25% recovery (T-1 25%), T-1 50%, and T-1 75%, although there was a trend suggesting that patients on carbamazepine recovered from the effects of pipecuronium more quickly than controls. However, the train-of-four recovery times were significantly shortened in the carbamazepine monotherapy group and the multiple anticonvulsant group when compared to controls. Results were as follows when comparing controls with the carbamazepine monotherapy and carbamazepine plus other anticonvulsant groups: train-of-four recovery to 10% (TR 10%), 142 vs. 101 vs. 78 minutes; TR 20%, 163 vs. 122 vs. 89 minutes; and TR 25%, 172 vs. 130 vs. 101 minutes .
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.