Interacting drugs | Effects (probable mechanism) | Management |
Phenytoin or fosphenytoin, with: | ||
| Decreased brivaracetam effect (increased metabolism by CYP2C19) | Monitor clinical status |
Possible phenytoin toxicity (decreased metabolism by CYP2C19) | Monitor clinical status and phenytoin concentrations | |
| Decreased carbamazepine effect (increased metabolism) | Monitor carbamazepine and phenytoin concentrations |
Altered phenytoin effect may include decreased or increased phenytoin levels (mechanism not established) | ||
| Decreased clonazepam effect (increased metabolism) | Monitor clinical status |
Monitor phenytoin concentrations | ||
| Decreased eslicarbazepine concentrations (increased metabolism) | Monitor clinical status; eslicarbazepine dose may need to be increased |
Possible phenytoin toxicity (decreased metabolism by CYP2C19) | Monitor clinical status and phenytoin concentrations | |
| Decreased felbamate effect (increased metabolism) | Monitor felbamate effect; dose may need to be increased |
Possible phenytoin toxicity (mechanism not established) | Phenytoin dose reduction may be needed; refer to Lexicomp for detail. Monitor clinical status and phenytoin concentrations. | |
| Decreased lamotrigine serum concentrations (increased metabolism; induction of glucuronidation by phenytoin) | Monitor clinical status and lamotrigine serum concentrations; lamotrigine dose may need to be adjusted |
| Possible decreased levetiracetam concentrations (increased metabolism) | Monitor clinical effect |
| Possible decreased oxcarbazepine effect (increased metabolism) | Monitor clinical status and oxcarbazepine concentration |
Possible phenytoin toxicity with oxcarbazepine doses of 1200 mg/day or higher (decreased metabolism by CYP2C19) | Monitor phenytoin concentrations especially when oxcarbazepine dosage is 1200 mg/day or higher; reduction of phenytoin dose may be needed | |
| Decreased perampanel effect (increased metabolism by CYP3A4) | Monitor clinical status; perampanel dose may need to be adjusted |
| Decreased tiagabine effect (increased metabolism by CYP3A4) | Monitor clinical status |
| Possible decreased topiramate effect (increased metabolism) | Monitor clinical status; may need to increase topiramate dose |
Possible phenytoin toxicity (decreased metabolism by CYP2C19) with high doses of topiramate | Monitor clinical status and phenytoin concentrations | |
| Possible phenytoin toxicity (displacement from binding and decreased metabolism, complex time course) | Monitor clinical status and phenytoin concentrations (unbound concentrations may be more helpful than total) |
Possible decreased valproate effect and increased toxicity (increased metabolism and formation of toxic metabolite) | Monitor clinical status and valproate serum concentrations | |
| Decreased zonisamide effect (increased metabolism by CYP3A4) | Monitor clinical status and zonisamide concentrations; zonisamide dose may need to be adjusted |
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