Drug Interaction Report

Hydrocortisone and Carbamazepine: Interaction Details

A pharmacist-reviewed analysis of the Hydrocortisone and Carbamazepine interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Carbamazepine

Carbatrol Epitol Equetro Tegretol
+

Hydrocortisone

Ala-Cort Alkindi Alkindi Sprinkle® Alocane Anti-Itch Anucort-HC Anusol HC Aquanil HC Aquaphor Itch Relief
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 439 documented Hydrocortisone interactions, 167 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
theoretical
Severity
Major

What happens

Reduced hydrocortisone exposure and reduced efficacy of hydrocortisone

Interaction Deep Dive

Concomitant use of carBAMazepine (a CYP3A4 inducer) with hydrocortisone (a corticosteroid metabolized by CYP3A4) may reduce hydrocortisone exposure. If coadministering, closely monitor hydrocortisone levels and adjust the dosage as needed23. Concomitant use may increase the risk of adverse reactions, including adrenal crisis. Hence, concomitant use of CYP3A4 inducers may require an increase in the hydrocortisone dose 1. CarBAMazepine has been demonstrated to increase the metabolism of corticosteroids 45.

Why it happens (mechanism)

Induction of CYP3A4-mediated metabolism of hydrocortisone

Literature reports

1 report — tap to read

a) CarBAMazepine has been demonstrated to increase the metabolism of corticosteroids 45.

Common questions

Can I take Hydrocortisone and Carbamazepine together?

Reduced hydrocortisone exposure and reduced efficacy of hydrocortisone Always confirm with your pharmacist or prescriber before making any change.

How serious is the Hydrocortisone and Carbamazepine interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

From our Q&A

Real reader questions about these medications, each personally answered by our pharmacist:

Questions for your pharmacist

  • Does my dose of Hydrocortisone or Carbamazepine need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (5)

  1. Product Information: KHINDIVI(R) oral solution, hydrocortisone oral solution. Eton Pharmaceuticals (per Manufacturer), Cranbury, NJ, 2025. DailyMed
  2. Product Information: Tegretol(R)-XR oral extended-release tablets, carbamazepine oral extended-release tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
  3. Product Information: Tegretol(R) oral chewable tablets, oral tablets, oral suspension, carbamazepine oral chewable tablets, oral tablets, oral suspension. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
  4. Olivesi A: Modified elimination of prednisolone in epileptic patients on carbamazepine monotherapy, and in women using low-dose oral contraceptives. Biomed Pharmacother 1986; 40:301-308.
  5. Privitera MR, Greden JF, Gardner RW, et al: Interference by carbamazepine with the dexamethasone suppression test. Biol Psychiatry 1982; 17:611-620.
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Carbamazepine

Keep reading about Carbamazepine

All Carbamazepine interactions (256)
Also serious with: Lurasidone Linezolid Injection Doravirine Lenacapavir Oral
Hydrocortisone

Keep reading about Hydrocortisone

All Hydrocortisone interactions (439) Hydrocortisone drug information
Also serious with: Mifepristone Desmopressin Ensitrelvir Desmopressin Nasal
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Carbamazepine + 1,4-butanediol Activated Charcoal Asarabacca Beer Gamma-hydroxybutyrate (ghb) Grapefruit Kava L-tryptophan + 276 more
Hydrocortisone + Activated Charcoal Grapefruit Lily-of-the-valley St. John's Wort Acacia Rigidula Active Hexose Correlated Compound (ahcc) Adrafinil African Wild Potato + 197 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.