Carbamazepine with Rocuronium 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 duration of rocuronium-induced neuromuscular blockade
Interaction Summary
One case report has described a resistance to rocuronium in a patient maintained on chronic carbamazepine therapy. This resistance is similar to that seen during therapy with other neuromuscular blockers and carbamazepine. The precise mechanism of this interaction is not known, but may involve both pharmacodynamic and pharmacokinetic mechanisms. A study involving 22 healthy individuals undergoing neurosurgical procedures also confirmed that the duration of the rocuronium-induced neuromuscular block is significantly shortened by chronic carbamazepine therapy .
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Monitor patients for an appropriate clinical response to the neuromuscular blocker. Closer dosing intervals or higher doses of rocuronium may be needed in patients receiving carbamazepine.
Mechanism Of Interaction
Induction of rocuronium metabolism via cytochrome P450 enzyme system
Literature Reports
A) A 61-year old epileptic male who had been maintained on oral carbamazepine 200 mg three times daily for 20 years underwent cataract surgery. Anesthesia was induced with thiopental and fentanyl prior to the administration of a rapid intravenous bolus dose of rocuronium 0.6 mg/kg. This dose of rocuronium is twice the 95% effective dose (ED95). Rocuronium caused a partial neuromuscular block and was followed by rapid recovery to T1 to 25% of the control value within five minutes. This response suggests that long-term therapy with carbamazepine causes a resistance to the nondepolarizing neuromuscular blocking effects of rocuronium .
B) Twenty-two healthy individuals scheduled for neurosurgical procedures were studied to determine the effect of chronic carbamazepine therapy on the duration of rocuronium-induced neuromuscular blockade. Eleven patients were being treated with carbamazepine for a minimum of four weeks prior to surgery, while the other eleven patients served as controls. All patients received oral diazepam one hour prior to surgery, and anesthesia was induced with fentanyl and thiopental. A single bolus dose of rocuronium 0.6 mg/kg, which is two times the ED95, was given intravenously. Between the two groups, the lag time and the onset time did not differ significantly. However, when comparing the control and carbamazepine groups, the time to 10% recovery was 29.2 min vs. 19.8 min, 25% recovery was 36.1 min vs. 25.7 min, 50% recovery was 43.5 min vs. 30.4 min, and 75% recovery was 57.0 min vs. 36.5 min, respectively. The recovery index, calculated as the time required for the response to the first stimulus to recover from 25% to 75% of baseline, was also decreased from 20.8 min in the control group to 10.9 min in the carbamazepine group .
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.