Drug-Drug Interaction

CARBAMAZEPINE/MACROLIDE ANTIBIOTICS

MECHANISM OF ACTION
Troleandomycin inhibits the hepatic metabolism of carbamazepine. Erythromycin has a similar but lesser effect (1,2).

DISCUSSION
There are numerous reports of elevated carbamazepine serum levels in patients receiving erythromycin concurrently. Frequently, symptoms of carbamazepine toxicity have accompanied these increased levels. The effects of this interaction may occur rapidly (i.e., in less than 24 hours).

CLINICAL EFFECTS
Increased serum carbamazepine levels with subsequent increases in the pharmacological and toxic effects of carbamazepine.

SEVERITY LEVEL
2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

PATIENT MANAGEMENT
Avoid coadministration of these drugs. If given together, monitor carbamazepine serum concentration and observe patient for signs of toxicity (dizziness, ataxia, blurred vision, SIADH). Consider discontinuing either drug or decreasing the dose of carbamazepine.

PREDISPOSING FACTORS
Simultaneous use of other drugs, i.e. other anticonvulsants, or carbamazepine blood levels already near the toxic range before macrolide administration probably increase the risk of a severe interaction.

REFERENCES

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