Antiepileptics(continued)
▶Phenobarbitaldecreases the concentration ofantifungals,
azoles(itraconazole). Avoid and for 14 days after stopping
phenobarbital,p. 216.oStudy
▶Phenytoinvery markedly decreases the exposure toantifungals,
azoles(itraconazole). Avoid and for 14 days after stopping
phenytoin,p. 205.oStudy
▶Primidoneis predicted to decrease the concentration of
antifungals, azoles(itraconazole).oTheoretical
▶Carbamazepineis predicted to decrease the efficacy of
antifungals, azoles(itraconazole, voriconazole)andantifungals,
azoles(itraconazole, voriconazole)increase the concentration
ofcarbamazepine. Avoid or adjust dose.oTheoretical→
Also seeTABLE 1p. 847
▶Carbamazepineis predicted to decrease the efficacy of
antifungals, azoles(ketoconazole)andantifungals, azoles
(ketoconazole)slightly increase the concentration of
carbamazepine. Avoid or monitorcarbamazepine
concentration and adjust dose accordingly,p. 196.o
Study
▶Phenobarbitalis predicted to decrease the concentration of
antifungals, azoles(ketoconazole). Avoid.oStudy
▶Antiepileptics(fosphenytoin, phenytoin)decrease the exposure
toantifungals, azoles(ketoconazole). Avoid.oStudy
▶Primidoneis predicted to decrease the concentration of
antifungals, azoles(ketoconazole, posaconazole). Avoid.
oStudy
▶Carbamazepineis predicted to decrease the efficacy of
antifungals, azoles(posaconazole)andantifungals, azoles
(posaconazole)increase the concentration ofcarbamazepine.
Avoid.oTheoretical
▶Phenobarbitalis predicted to decrease the concentration of
antifungals, azoles(posaconazole). Avoid.oStudy
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to
decrease the exposure toantifungals, azoles(posaconazole).
Avoid.oStudy
▶Fosphenytoindecreases the exposure toantifungals, azoles
(voriconazole)andantifungals, azoles(voriconazole)increase
the exposure tofosphenytoin. Avoid or adjustvoriconazole
dose and monitor phenytoin concentration,p. 377.o
Study
▶Phenytoindecreases the exposure toantifungals, azoles
(voriconazole)andantifungals, azoles(voriconazole)increase
the exposure tophenytoin. Avoid or adjustvoriconazoledose
and monitorphenytoinconcentration,p. 377, p. 205.o
Study
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the concentration ofantifungals, azoles(voriconazole).
Avoid.oTheoretical
▶Antihistamines, sedating(hydroxyzine)potentially increase the
risk of overheating and dehydration when given with
zonisamide. Avoid in children.rTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toantimalarials(artemether)(with lumafantrine). Avoid.
rStudy
▶Antimalarials(pyrimethamine)increase the risk of
haematological toxicity when given withantiepileptics
(fosphenytoin, phenytoin).rStudy
▶Antimalarials(pyrimethamine)are predicted to increase the risk
of haematological toxicity when given withantiepileptics
(phenobarbital, primidone).rTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the
concentration ofantimalarials(piperaquine). Avoid.o
Theoretical
▶Antiepileptics(carbamazepine, phenobarbital, primidone)
potentially increase the risk of toxicity when given with
antimalarials(quinine).qStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to moderately decrease
the exposure toapixaban. Use with caution or avoid.r
Study
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)moderately decrease the exposure to
apremilast. Avoid.rStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to markedly decrease the
exposure toaprepitant. Avoid.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to moderately decrease
the exposure toaripiprazole. Adjustaripiprazoledose,p. 249.
oStudy→Also seeTABLE 11p. 849
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toaxitinib. Avoid or adjust dose.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tobazedoxifene.oTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)decrease the exposure tobedaquiline.
Avoid.rStudy
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tobeta blockers, non-selective(carvedilol,
labetalol).oTheoretical
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tobeta blockers, non-selective
(propranolol).oStudy
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tobeta blockers, selective(acebutolol,
bisoprolol, metoprolol, nebivolol).oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)slightly decrease the exposure to
bortezomib. Avoid.rStudy→Also seeTABLE 12p. 850
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)affect the exposure tobosentan. Avoid.
rStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to very markedly decrease
the exposure tobosutinib. Avoid.rStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to markedly decrease the
exposure tobupropion.rStudy
▶Valproateincreases the exposure tobupropion.rStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tobuspirone. Use with caution and adjust dose.rStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)moderately decrease the exposure to
cabozantinib. Avoid.oStudy
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to
moderately increase the clearance ofcaffeine citrate. Monitor
and adjust dose.oStudy
▶Calcium channel blockers(diltiazem)increase the concentration
ofcarbamazepineandcarbamazepineis predicted to decrease
the exposure tocalcium channel blockers(diltiazem). Monitor
concentration and adjust dose.rAnecdotal
▶Calcium channel blockers(verapamil)increase the concentration
ofcarbamazepineandcarbamazepineis predicted to decrease
the exposure tocalcium channel blockers(verapamil).r
Anecdotal
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tocalcium channel blockers(amlodipine, felodipine, lacidipine,
lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and
adjust dose.oStudy
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tocalcium channel blockers(diltiazem,
verapamil).rStudy
▶Calcium channel blockers(diltiazem, verapamil)potentially
increase the concentration ofantiepileptics(fosphenytoin,
phenytoin)andantiepileptics(fosphenytoin, phenytoin)are
predicted to decrease the exposure tocalcium channel blockers
(diltiazem, verapamil).rStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tocannabis extract. Avoid.rTheoretical→Also seeTABLE 11
p. 849
864 Antiepileptics—Antiepileptics BNFC 2018 – 2019
Interactions
|Appendix 1
A1