Drug-Drug Interaction

CARBAMAZEPINE/PROPOXYPHENE

MECHANISM OF ACTION
Propoxyphene may inhibit carbamazepine metabolism.

DISCUSSION
In a study, carbamazepine levels increased 66% after 6 days of dextropropoxyphene. Additional increases were seen in 3 subjects after an additional 7 days of dextropropoxyphene.(1)

CLINICAL EFFECTS
Concurrent use of propoxyphene may result in elevated levels of and toxicity from carbamazepine.

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

PATIENT MANAGEMENT
If both drugs are administered, monitor plasma carbamazepine levels and observe the patient for signs and symptoms of carbamazepine toxicity. Adjust the dose of the drug accordingly.

PREDISPOSING FACTORS
None determined.

REFERENCES

  1. Hansen BS, Dam M, Brandt J, Hvidberg EF, Angelo H, Christensen JM, Lous P. .Hansen BS, Dam M, Brandt J, Hvidberg EF, Angelo H, Christensen JM, Lous P. Influence of dextropropoxyphene on steady state serum levels and protein binding of three anti-epileptic drugs in man. Acta Neurol Scand 1980 Jun; 61(6):357-67.
  2. Dam M, Kristensen CB, Hansen BS, Christiansen J. Interaction between .Dam M, Kristensen CB, Hansen BS, Christiansen J. Interaction between carbamazepine and propoxyphene in man. Acta Neurol Scand 1977 Dec; 56(6):603-7.
  3. Bergendal L, Friberg A, Schaffrath AM, Holmdahl M, Landahl S. The clinical .Bergendal L, Friberg A, Schaffrath AM, Holmdahl M, Landahl S. The clinical relevance of the interaction between carbamazepine and dextropropoxyphene in elderly patients in Gothenburg, Sweden. Eur J Clin Pharmacol 1997; 53(3-4):203-6.
  4. Yu YL, Huang CY, Chin D, Woo E, Chang CM. Interaction between .Yu YL, Huang CY, Chin D, Woo E, Chang CM. Interaction between carbamazepine and dextropropoxyphene. Postgrad Med J 1986 Mar; 62(725):231-3.
  5. Kubacka RT, Ferrante JA. Carbamazepine-propoxyphene interaction. Clin .Kubacka RT, Ferrante JA. Carbamazepine-propoxyphene interaction. Clin Pharm 1983 Mar-Apr;2(2):104.
  6. Oles KS, Mirza W, Penry JK. Catastrophic neurologic signs due to drug .Oles KS, Mirza W, Penry JK. Catastrophic neurologic signs due to drug interaction: Tegretol and Darvon. Surg Neurol 1989 Aug;32(2):144-51.
  7. Allen S. Cerebellar dysfunction following dextropropoxyphene-induced .Allen S. Cerebellar dysfunction following dextropropoxyphene-induced carbamazepine toxicity. Postgrad Med J 1994 Oct;70(828):764.
  8. Bertholon P, Convers P, Lachheb N, Guy C, Martin C, Ollagnier M, Michel D. .Bertholon P, Convers P, Lachheb N, Guy C, Martin C, Ollagnier M, Michel D. Predominant central vestibular symptomatology caused by carbamazepine and dextropropoxyphene interaction. Presse Med 1997 Nov 15;26(35):1675.