Version May 2024
| Interacting drugs | Effects (probable mechanism) | Management |
| Carbamazepine, with: | ||
| Brivaracetam | Possible carbamazepine toxicity (decreased metabolism of active epoxide metabolite¶) | Monitor clinical status; reduction of carbamazepine dose may be needed |
| Decreased brivaracetam effect (increased metabolism by CYP2C19) | Monitor clinical status; brivaracetam dose may need to be adjusted | |
| Clonazepam | Decreased clonazepam effect (increased metabolism by CYP3A4) | Monitor clinical status |
| Felbamate | Possible carbamazepine toxicity (increased concentration of active epoxide metabolite¶) | Monitor clinical status; felbamate and carbamazepine dose may need to be adjusted |
| Decreased felbamate effect (increased metabolism by CYP3A4) | A reduction in carbamazepine dose is recommended when felbamate is added to carbamazepine therapy. Specific dose adjustment recommendations are provided in the Lexicomp monograph. | |
| Lamotrigine | Carbamazepine toxicity (increased concentration of active epoxide metabolite¶) | Monitor clinical status; serum carbamazepine measurements alone may not predict toxicity |
| Decreased lamotrigine effect (increased metabolism; glucuronidation) | Monitor clinical status and lamotrigine concentrations; lamotrigine dose may need to be increased. Specific lamotrigine dose adjustment recommendations are provided in the Lexicomp monograph. | |
| Levetiracetam | Possible increased risk of carbamazepine toxicity (mechanism not established) | Monitor for clinical evidence of carbamazepine toxicity |
| Possible decreased levetiracetam concentrations (increased metabolism) | Monitor clinical effect | |
| Perampanel | Decreased perampanel effect (increased metabolism by CYP3A4) | Monitor clinical status; perampanel dosage may need to be adjusted |
| Phenytoin | Decreased carbamazepine effect (increased metabolism) | Monitor clinical status and carbamazepine and phenytoin concentrations |
| Altered phenytoin effect may include decreased or increased phenytoin levels (mechanism not established) | ||
| Tiagabine | Decreased tiagabine effect (increased metabolism by CYP3A4) | Monitor clinical status |
| Topiramate | Possible decreased topiramate effect (increased metabolism); possible additive CNS side effects (mechanism not established) | Monitor clinical status; may need higher doses of topiramate |
| Valproate | Decreased valproate effect and possible increased toxicity (increased metabolism by CYP 2C9, 2C19, glucuronidation, and formation of toxic metabolite) | Monitor clinical status and valproate concentrations |
| Carbamazepine toxicity (increased concentration of active epoxide metabolite¶ and displacement from binding sites) | Monitor clinical status, carbamazepine, and carbamazepine epoxide concentrations; carbamazepine dose may need to be adjusted | |
| Zonisamide | Decreased zonisamide effect (increased metabolism by CYP3A4) | Monitor zonisamide concentrations and clinical status; zonisamide dosage may need to be adjusted |
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