Cisplatin Carbamazepine

Drugs that can decrease carbamazepine serum levels include charcoal, cisplatin, doxorubicin, felbamate, hydantoins, rifampin, phenobarbital, primidone, theophylline. The serum levels of oral contraceptives, haloperidol, bupropion, anticoagulants, felbamate, valproic acid, felodipine, tricyclic antidepressants, acetaminophen, ziprasidone, voriconazole, topiramate, tiagabine, olanzapine, and lamotrigine can be lowered by carbamazepine. 

Drugs that may affect tacrolimus include nephrotoxic agents (aminoglycosides, amphotericin B, cisplatin, cyclosporine), antifungals, bromocriptine, calcium channel blockers, cimetidine, clarithromycin, danazol, diltiazem, erythromycin, methylprednisolone, metoclopramide, carbamazepine, phenobarbital, phenytoin, rifamycins, cisapride, chloramphenicol, metronidazole, nefazodone, omeprazole, protease inhibitors, macrolide antibiotics, fosphenytoin, and St. John s wort. 

Uses Edema, HTN, CHF, hepatic cirrhosis Action Loop diuretic X- reabsorption of Na+ Cl- in ascending loop of Henle distal tubule Dose 5—20 mg/d PO or IV 200 mg/d max Caution [B, ] Contra Sulfonylurea sensitivity Disp Tabs, inj SE Orthostatic X- BP, HA, dizziness, photosens, electrolyte imbalance, blurred vision, renal impair Notes 20 mg torsemide = 40 mg furosemide Interactions T Risk of ototox W/ aminoglycosides, cisplatin T effects W/ thiazides T effects OF anticoagulants, antihypertensives, Li, salicylates X- effects W/ barbiturates, carbamazepine, cholestyramine, NSAIDs, phenytoin, phenobarbital, probenecid, dandelion EMS T Effects of anticoagulants monitor for S/Sxs tinnitus, monitor ECG for hypokalemia (flattened T waves) OD May cause HA, hypotension, hypovolemia, and hypokalemia give IV fluids symptomatic and supportive... 

Incompatibilities of metoclopramide depend on drug concentration, pH, and temperature. It is incompatible with cephalosporins, chloramphenicol, sodium bicarbonate, doxorubicin, cisplatin, and cyclophosphamide. Caution should be exercised with simultaneous administration of metoclopramide with lithium, sym-pathomimetics, antidepressants, bromocriptine, and carbamazepine. Omperazole interacts with tolbutamide, clarithromycin, and phenytoin. Coadministration of rantidine and cisapride increases the plasma concentration of rantidine. Abuse of senna laxative has been reported and may cause hepatitis.176-178... 

Cisplatin Carbamazepine Phenytoin Valproate Reduced effect of phenytoin interaction poorly documented Unknown... 

Plasma concentrations of antiepileptic drugs (for example carbamazepine, valproic acid, phenytoin) should be measured more frequently during cisplatin-containing cancer chemotherapy (266,267). 

Cisplatin caused subtherapeutic carbamazepine and valproic acid concentrations in a 38-year-old woman with epilepsy undergoing cytotoxic cancer chemotherapy with doxorubicin and cisplatin, resulting in tonic-clonic seizures the mechanism was not clear (266). 

Phenytoin Carbamazepine Sodium valproate Doxorubicin Cisplatin Cyclophosphamide Altretamine Papillary adenocarcinoma of the ovaries Seizures occurred 2 to 3 days after starting chemotherapy. All drug levels dropped to one-third or iower. Doses increased to compensate, which led to phenytoin toxicity when the chemotherapy finished. 5... 

Carbamazepine levels are increased by CYP3A4 inhibitors (cimetidine, macrolides, diltiazem, fluoxetine, ketoconazole, verapamil, valproate) levels are decreased by CYP3A4 inducers (cisplatin, doxorubicin, felbamate, phenobarbital, phenytoin, primidone, rifampin, theophylline). Carbamazepine may increase levels of clomipramine, phenytoin, and primidone and lithium toxicity may decrease levels of phenytoin, warfarin, oral contraceptives, doxycycline, theophylline, haloperidol, alprazolam, clozapine, ethosuximide, and valproate may interfere with other anticonvulsants. 

Noninterfering amitriptyline, carbamazepine, carmustine, chlorpromazine, cimeti-dine, cisplatin, cyclophosphamide, dexamethasone, diazepam, digoxin, etoposide, furo-semide, haloperidol, ibuprofen, imipramine, indomethacin, methotrexate, phenobarbi-tal, phen3doin, propranolol, ranitidine, theophylline, triazolam, warfarin... 

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