Carbamazepine contraindications

Mebendazole is contraindicated in patients witii known hypersensitivity. Mebendazole is also contraindicated during pregnancy (Category C). The drug, like albendazole, has exhibited embryotoxic and teratogenic effects in experimental animals. Administration of mebendazole with tiie hydantoins and carbamazepine may reduce plasma levels of mebendazole. 

The miscellaneous anticonvulsants are contraindicated in patients with known hypersensitivity to any of the dru. Carbamazepine is contraindicated in patients with bone marrow depression or hepatic or renal impairment and during pregnancy (Category D). Valproic acid is not administered to patients with renal impairment or during pregnancy (Category D). Oxcarbazepine (Trileptal), a miscellaneous anticonvulsant, may exacerbate dementia... 

Carbamazepine is an effective agent for the treatment of partial seizures and generalized tonic-clonic seizures its use is contraindicated in absence epilepsy. Carbamazepine is also useful in the treatment of trigeminal neuralgia and is an effective agent for the treatment of bipolar disorders (see Chapter 33). 

Contraindications Co-administration of terfenadine, astemizole, cisapride, pimozide, or carbamazepine hypersensitivity to other phenylpiperazine antidepressants those who were withdrawn from nefazodone due to evidence of hepatic injury use within 14 days of MAOIs... 

Contraindications Concurrent administration of carbamazepine ergot alkaloids pimozide or quinidine( may cause prolonged QT interval or torsades depointes) rifabutin rifampin orsirolimus... 

Clozapine is contraindicated in patients who have myeloprohf-erative disorders or who are immunocompromised as a result of diseases such as active tuberculosis or human immunodeficiency virus infection because of their increased risk for agranulocytosis. Concomitant administration of medications that are associated with bone marrow suppression, such as carbamazepine, is also contraindicated. 

Because of the potential for hematological and hepatic toxicity, carbamazepine should not be administered to patients with liver disease or thrombocytopenia or to those at risk for agranulocytosis. For this reason, carbamazepine is strictly contraindicated in patients receiving clozapine. Because of reports of teratogenicity, including increased risks of spina bifida (Rosa 1991), microcephaly (Bertol-lini et al. 1987), and craniofacial defects (Jones et al. 1989), carbamazepine is relatively contraindicated in pregnant women. Pretreatment evaluation should include a complete blood count and determination of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. 

Assessment of physical, as well as psychiatric status, is also critically important. The presence of intercurrent medical disorders, as well as any medication used to manage them, increases the likelihood of an adverse outcome with an otherwise appropriate medication. With a recent history of myocardial infarction, certain tricyclic antidepressants (TCAs) or low-potency antipsychotics might be contraindicated due to potential adverse effects on cardiac function. Another example is the avoidance of carbamazepine in a bipolar patient with a persistently low white blood cell count. Finally, b-blockers are typically contraindicated in a patient with asthma. 

Mebendazole is teratogenic in animals and therefore contraindicated in pregnancy. It should be used with caution in children younger than 2 years of age because of limited experience and rare reports of convulsions in this age group. Plasma levels may be decreased by concomitant use of carbamazepine or phenytoin and increased by cimetidine. Mebendazole should be used with caution in patients with cirrhosis. 

Status epilepticus can occasionally be fatal therefore, seizures should be treated aggressively. Seizures can be managed with antiepileptic medications such as carbamazepine. The common antiepileptic drug valproic acid is contraindicated because it depletes the body of carnitine, which may in fact exacerbate symptoms. The potential risk of stroke may be reduced using appropriate medication. The complications... 

While there are no absolute contraindications to lithium, patients with advanced kidney disease or unstable fluid/ electrolyte balance may be more safely treated with an alternative mood stabilizer, such as carbamazepine, valproate, lamotrigine, or olanzapine. 

Should certain antiepileptic drugs be contraindicated in patients with active psychosis Unfortunately there is not enough solid information to answer this question. Undoubtedly, anticonvulsants that are less likely to cause psychosis (lamotrigine, carbamazepine, oxcarbaze-pine, valproate) should be preferred (52,53). However, patients with psychoses have been successfully treated even with drugs that are believed to be associated with psychosis, such as vigabatrin. For example, in a prospective study in 10 patients with psychosis and epilepsy to whom vigabatrin was added, there was no aggravation of the psychiatric disorder (54). 

Most anticonvulsants are excreted in the breast milk in limited amounts, and their use is not generally a contraindication to breastfeeding. Barbiturates, ethosuximide, lamotrigine, and to a lesser extent carbamazepine and benzodiazepines can reach appreciable serum concentrations in breast-fed infants, who should be carefully observed. 

Carbamazepine is contraindicated in patients taking monoamine oxidase inhibitors (101,102). The combination can cause sudden high body temperature, extremely high blood pressure, and severe convulsions at least 14 days should be allowed between stopping treatment with one medicine and starting the other. 

Two anticonvulsants, carbamazepine (Tegretol) and valproic acid, also referred to as valproate (Depakote, Depakene), have proven mood-stabilizing properties (see figure 15-E). These agents are most useful when lithium is contraindicated or when a patient does not respond to or cannot tolerate lithium. Rapid cyclers, who often are poorly controlled with lithium, are good candidates for one of these alternative agents. Valproic acid appears to be indicated more for manic or mixed states of bipolar disorder, and is probably not as effective in depressed states. The anticonvulsants are often employed in conjunction with lithium. 

I Carbamazepine has shown efficacy and may be an alternative if BDZs contraindicated... 

In resistant patients, the combination of SCAs and lithium or carbamazepine seems a reasonable approach. Carbamazepine is contraindicated as augmentation therapy to clozapine, due to their synergistic effects on bone marrow suppression. Electroconvulsive therapy (ECT) may also be considered for patients with severe or treatment-resistant... 

Note also that carbamazepine may reduce the levels of azole antifungals a marked reduction in itraconazole levels has been reported, and some manufacturers of itraconazole consequently say that concurrent use of potent enzyme inducers such as carbamazepine is not recommended. Based on the interaction with phenytoin , (p.552), which results in reduced posaconazole levels, the manufacturer of posaconazole suggests that concurrent use of posaconazole and carbamazepine should be avoided, unless the benefits outweigh the risks. If both drugs are given it would seem sensible to consider increasing the posaconazole dose, and increase monitoring of carbamazepine levels. Based on the interaction with phenytoin , (p.552), the manufacturers of voriconazole also contraindicate the concurrent use of carbamazepine and voriconazole. " ... 

Carbamazepine has been shown to lower the levels of a number of ealei-um-channel blockers. Given that the majority are metabolised by CYP3A4 (see calcium-channel blockers , (p.860)) most calcium-channel bloekers would be expected to interact similarly. If a calcium-charmel blocker is given to a patient taking carbamazepine expeet to need to use a larger dose. If earbamazepine is added to existing treatment with a calcium-ehan-nel bloeker monitor the blood pressure and expeet to need to increase the dose. Note that the manufacturer of nimodipine contraindicates its use with carbamazepine. 

Information is limited, but it would seem prudent to monitor for signs of carbamazepine toxicity if nefazodone is added to established treatment, especially with doses of carbamazepine above 800 mg. The nefazodone dosage may need to be increased in the presence of carbamazepine, so be alert for a reduced effect. Nefazodone has largely been withdrawn, but the US manufacturer of nefazodone did contraindicate its concurrent use with carbamazepine. ... 

The manufacturers of sertindole contraindicate the concurrent use of cimetidine, diltiazem, erythromycin, itraconazole, ketoco-nazole, terfenadine and verapamil because of an increased risk of cardiac arrhythmias. Carbamazepine and phenytoin reduce plasma sertindole levels whereas fluoxetine and paroxetine increase them. No clinically relevant interactions occur with alprazolam, antacids, food or tobacco smoking. 

Carbamazepine should not be used in patients with a history of previous bone m arrow depression, or known hypersensitivity to carbamazepine or tricyclic compounds. It is contraindicated with concomitant use of an MAOI or within 14 days of discontinuing an MAOI. Co-administration of carbamazepine and nefazodone may result in insufficient plasma concentrations of nefazodone and decreased drug effectiveness. Coadministration of carbamazepine with nefazodone is contraindicated. 

In addition to the warning/contraindications as discussed above, consider the following disadvantages of carbamazepine increased risk of contraceptive failure in women with concomitant use risk of congenital malformations especially spina bifida increasing dosage may be necessary with prolonged treatment. 

---