CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Bipolar disorder - Management
What are the drug interactions of carbamazepine?
- The plasma concentration of carbamazepine may be increased (increasing the risk of toxicity) by the concomitant use of:
- Azole antifungals.
- Cimetidine.
- Danazol.
- Macrolide antibiotics (clarithromycin and erythromycin).
- Selective serotonin reuptake inhibitors (fluoxetine and fluvoxamine).
- Carbamazepine accelerates the metabolism of:
- Ciclosporin — leading to reduced levels of ciclosporin.
- Clozapine — leading to reduced plasma concentration of clozapine; also avoid concomitant use of drugs with a potential for causing agranulocytosis.
- Corticosteroids (systemic) — leading to reduced steroidal effect.
- Oestrogens and progestogens — oral contraceptives become less effective, so recommend alternative method of contraception.
- Tricyclic antidepressants (TCAs) — leading to reduced effect of TCAs.
- Warfarin — leading to reduced anticoagulant effect.
- The use of carbamazepine is not recommended in combination with monoamine oxidase inhibitors (MAOIs), or for 2 weeks after stopping an MAOI.
- St John's wort reduces plasma levels of carbamazepine.
[ABPI Medicines Compendium, 2008c; Baxter, 2008; BNF 56, 2008; Micromedex, 2009]
© NHS Institute for Innovation and Improvement