Interactions between Antiepileptic and Antipsychotic Drugs

  title={Interactions between Antiepileptic and Antipsychotic Drugs},
  author={Frank M. C. Besag and David J. Berry},
  journal={Drug Safety},
Antiepileptic and antipsychotic drugs are often prescribed together. Interactions between the drugs may affect both efficacy and toxicity. This is a review of human clinical data on the interactions between the antiepileptic drugs carbamazepine, valproic acid (sodium valproate), vigabatrin, lamotrigine, gabapentin, topiramate, tiagabine, oxcarbazepine, levetiracetam, pregabalin, felbamate, zonisamide, phenobarbital and phenytoin with the antipsychotic drugs risperidone, olanzapine, quetiapine… 

Antiepileptic Drug Interactions - Principles and Clinical Implications

Clinical relevant interactions where AEDs are involved and especially on pharmacokinetic interactions are focused upon, although it is not meant to oversimplify fact matters.

Clinically relevant drug interactions with antiepileptic drugs.

  • E. Perucca
  • Medicine, Biology
    British journal of clinical pharmacology
  • 2006
Some patients with difficult-to-treat epilepsy benefit from combination therapy with two or more antiepileptic drugs (AEDs), and pharmacodynamic interactions involving AEDs have not been well characterized, but their understanding is important for a more rational approach to combination therapy.

Interactions between antiepileptics and second-generation antipsychotics

The authors believe that collaboration is needed from drug agencies and pharmaceutical companies, the clinicians using these combinations, researchers with expertise in meta-analyses, grant agencies, pharmacoepidemiologists and DI pharmacologists for future progression in this field.

Metabolic drug interactions with newer antipsychotics: a comparative review.

Differences in the interaction potential among the novel antipsychotics currently available may be predicted based on their metabolic pathways, and the clinical relevance of these interactions should be interpreted in relation to the relative width of their therapeutic index.

Enzyme induction with antiepileptic drugs: Cause for concern?

Induction of enzyme‐inducing AEDs may contribute to the development of a number of comorbidities, including osteoporosis, sexual dysfunction, and vascular disease, and perhaps consideration should be given to starting treatment with, or even switching patients to, non–enzyme‐inducingAEDs.

Effect of Topiramate on Plasma Concentrations of Clozapine, Olanzapine, Risperidone, and Quetiapine in Patients With Psychotic Disorders

Findings indicate that topiramate, at the dosages recommended for use as a mood stabilizer, does not affect the plasma levels of the new antipsychotics-clozapine, olanzapines, risperidone, and quetiapine.

Phenytoin toxicity due to drug interaction with doxepin and changes in patient factors

Phenytoin is an antiepileptic drug that is commonly used for epilepsy treatment and Doxepin is a tricyclic antidepressant that was introduced in 1969 for the treatment of depression and anxiety, although, due to its adverse reaction profi le, it is primarily used in modern medicine for the Treatment of insomnia.

Therapeutic Drug Monitoring of Antiepileptic Medications

This chapter focuses on therapeutic drug monitoring of AEMs in treatment of epilepsy, emphasizing whether the pharmacokinetics and clinical profile of the drug make TDM useful.


The development of the new antipsychotics in the last decades, their intensive study and increased use in clinical practice have revealed a broad spectrum of data on drug-drug interactions with other



Clinical Significance of Pharmacokinetic Interactions Between Antiepileptic and Psychotropic Drugs

Serum level monitoring of AEDs and psychotropic drugs can be useful in determining the need for dosage adjustments, especially if there is any change in seizure control, or possible toxicity, as well as predicting and avoiding clinically significant interactions.

Metabolic drug interactions with new psychotropic agents

The potential for metabolically based drug interactions of any new psychotropic agent may be anticipated on the basis of knowledge about the CYP enzymes responsible for its metabolism and about its effect on the activity of these enzymes.

Fluvoxamine Inhibition and Carbamazepine Induction of the Metabolism of Clozapine: Evidence from a Therapeutic Drug Monitoring Service

It is concluded that carbamazepine causes decreased clozapine plasma levels, while fluvoxamine increases the levels.

Enzyme induction and inhibition by new antiepileptic drugs: a review of human studies

  • M. Benedetti
  • Biology, Medicine
    Fundamental & clinical pharmacology
  • 2000
The aim of this paper is to review a number of new antiepileptic agents for their inducing and/or inhibitory properties in humans, mainly considering the interactions where they are involved as the cause rather than the object of such interactions.

Adverse drug interaction between risperidone and carbamazepine in a patient with chronic schizophrenia and deficient CYP2D6 activity.

Findings indicate that an inducible cytochrome is involved in the metabolism of risperidone and suggest that the CYP2D6 genotype may influence susceptibility to a clinically important interaction with carbamazepine.

A pharmacokinetic interaction between carbamazepine and olanzapine: observations on possible mechanism

Olanzapine is a novel antipsychotic, which is effective against both the positive and negative symptoms of schizophrenia and causes fewer extrapyramidal adverse effects than conventional antipsychotics, and carbamazepine has been shown to induce several P450 cytochromes including CYP3A4 and CYP1A2.

Pharmacokinetic interactions involving clozapine

  • David Taylor
  • Medicine, Psychology
    British Journal of Psychiatry
  • 1997
The co-administration of clozapine and compounds reported to alter its metabolism should be avoided where possible and caution should be exercised when co-administering drugs which affect the function of CYPIA2 and CYP2D6.

Pharmacokinetic and pharmacodynamic drug interactions during treatment with vigabatrin

  • A. Richens
  • Medicine, Biology
    Acta neurologica Scandinavica. Supplementum
  • 1995
Vigabatrin is relatively free of pharmacokinetic interactions, and though it is associated with about a 20% decrease in serum levels of concomitantly administered phenytoin, the reduction is of little clinical significance.

Antiepileptic-Antipsychotic Drug Interactions: A Critical Review of the Evidence

This paper focuses on the metabolic pharmacokinetic interactions between two classes of psychotropic drugs: antiepileptic and antipsychotic drugs.