Methylprednisolone Carbamazepine

Erythromycin Drugs that may be affected by erythromycin include alfentanil, anticoagulants, benzodiazepines, buspirone, carbamazepine, cisapride, cyclosporine, digoxin, disopyramide, ergot alkaloids, felodipine, fluoroquinolones, HMG-CoA reductase inhibitors, lincosamides, methylprednisolone, penicillins, and theophyllines. Drugs that may affect erythromycin include antacids, pimozide, rifamycins, and theophyllines. 

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. 

Erythromycin inhibits a cytochrome P450 isoenzyme and impairs the metabolism of theophylline, warfarin, carbamazepine and methylprednisolone. The mean reduction in drug clearance is 20-25%. 

A 17-year-old girl developed Stevens-Johnson syndrome after using carbamazepine 400 mg/day for 2 weeks (63). She was treated with intravenous immunoglobulin and intravenous methylprednisolone and recovered completely. 

Clinically important, potentially hazardous interactions with alprazolam, astemizole, carbamazepine, cisapride, clarithromycin, dexamethasone, diltiazem, docetaxel, ifosfamide, imatinib, irinotecan, itraconazole, ketoconazole, methylprednisolone, midazolam, nefazodone, oral contraceptives, paroxetine, phenytoin, pimozide, rifampin, ritonavir, terfenadine, tolbutamide, trabectedin, troleandomycin, vinblastine, vincristine, warfarin... 

Clinically important, potentially hazardous interactions with alprazolam, aprepitant, astemizole, atorvastatin, benzodiazepines, carbamazepine, chlordiazepoxide, cilostazol, clonazepam, clorazepate, colchicine, conivaptan, cyclosporine, dabigatran, dasatinib, diazepam, digoxin, dihydroergotamine, disopyramide, ergot alkaloids, fesoterodine, fluoxetine, flurazepam, fluvastatin, HMG-CoA reductase inhibitors, imatinib, ixabepilone, lapatinib, lopinavir, lorazepam, lovastatin, methylprednisolone, methysergide, midazolam, nilotinib, oxazepam, paroxetine, pimozide, pravastatin, prednisone, quazepam, repaglinide, rimonabant, rivaroxaban, sertraline, silodosin, simvastatin, solifenacin, temazepam, temsirolimus, tolvaptan, trabectedin, triazolam, warfarin, zidovudine... 

Simultaneous acebutolol, acetazolamide, acetophenetidin, adrenosterone, aldosterone, amitriptyline, androsten-3,17-dione, aspirin, carbamazepine, cephalothin, chlorothiazide, dehydrocorticosterone, deoxycorticosterone, deo cortisol, desipramine, dexamethasone, diazepam, equilenin, estradiol, estriol, estrone, fluorometholone, furosemide, hydrochlorothiazide, hydroxycorticosterone, hydroxyprogesterone, hydroxyprogesterone, imip-ramine, indomethacin, methylhydroxyprogesterone, methylprednisolone, nandrolone, nordiazepam, nortriptyline, pheniramine, phenobarbital, phenytoin, prednisolone, prednisone, primidone, probenecid, progesterone, quinine, spironolactone, testosterone, theophylline, triamcinolone, tripelennamine... 

The clearance of dexamethasone, methylprednisolone and prednisolone is increased in patients taking carbamazepine, and the results of the dexamethasone suppression test may be invaUd in those taking carbamazepine. 

A study in asthmatie ehildren found that carbamazepine increased the clearance of prednisolone by 79% and increased the clearance of methylprednisolone by 342%. A patient taking carbamazepine and valproate required high-dose prednisolone (20 to 60 mg daily) for polymyalgia... 

Information is limited but the interaction appears to be established. Patients taking carbamazepine are likely to need increased doses of dexamethasone, methylprednisolone or prednisolone. Prednisolone is less affected than methylprednisolone and is probably preferred. The same interaction seems likely with other corticosteroids but more study is needed to confirm this. Note that hydrocortisone and prednisone are affected by another potent enzyme inducer, phenobarbital , (p.l052), and would therefore also be expected to interact with carbamazepine. 

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