Carbamazepine with Vortioxetine Interaction Details

Brand Names Associated with Carbamazepine

Brand Names Associated with Vortioxetine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 25, 2023

Interaction Effect

Reduced vortioxetine exposure and an increased risk of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)

Interaction Summary

Use caution when coadministering carBAMazepine, a CYP3A4 inducer, and vortioxetine, a CYP3A4 substrate, as this may result in decreased plasma concentrations and efficacy of vortioxetine. Additionally, coadministration of vortioxetine, a serotonergic antidepressant, with another serotonergic drug, such as carBAMazepine, may result in additive serotonergic effects and increase the risk of serotonin syndrome. If coadministration is required for greater than 14 days, consider increasing the vortioxetine dose up to 3 times the original dose. If concomitant use is discontinued, reduce the vortioxetine dose to the original level within 14 days. Closely monitor patients during coadministration, particularly during treatment initiation and dosage increases. If serotonin syndrome develops, discontinue treatment with carBAMazepine and vortioxetine and initiate supportive care.

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Caution is advised with concomitant administration of carBAMazepine, a CYP3A4 inducer, and vortioxetine, a CYP3A4 substrate, as this may result in decreased plasma concentrations and efficacy of vortioxetine. Additionally, coadministration of vortioxetine, a serotonergic antidepressant, with another serotonergic drug, such as carBAMazepine, may result in additive serotonergic effects and increase the risk of serotonin syndrome. If coadministration is required for greater than 14 days, consider increasing the vortioxetine dose up to 3 times the original dose. If concomitant use is discontinued, reduce the vortioxetine dose to the original level within 14 days. Close monitoring of the patient is recommended during coadministration, particularly during treatment initiation and dosage increases. If serotonin syndrome develops, discontinue treatment with carBAMazepine and vortioxetine and initiate supportive care.

Mechanism Of Interaction

Induction of CYP3A4-mediated metabolism of vortioxetine by carBAMazepine; additive serotonergic effects

Literature Reports

A) Coadministration of vortioxetine (a CYP3A4 substrate) and rifAMPin (a strong CYP3A4 inducer) in an drug interaction study resulted in an decrease of vortioxetine Cmax and AUC by 0.5-fold approximately .

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.

Vortioxetine Overview

• Vortioxetine is used to treat depression in adults. Vortioxetine is in a class of medications called serotonin modulators. It works mainly by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.