Vincristine Carbamazepine

Antipsychotics, bromocriptine, carbamazepine, chlorpropamide, cyclophosphamide, desmopressin, ecstasy, lamotrigine, monamine oxidase inhibitors, NSAIDs, oxcarbazepine, oxytocin, tricyclic antidepressants, selective serotonin reuptake inhibitors, vasopressin, vinblastine, and vincristine... 

VINCA ALKALOIDS - VINBLASTINE, VINCRISTINE 1. ANTIBIOTICS-rifampicin 2. ANTICANCER AND IMMUNOMODULATING DRUGS - dexamethasone 3. ANTIDEPRESSANTS-St John s wort 4. ANTI EPILEPTICS -carbamazepine, phenobarbital, phenytoin 1 of plasma concentrations of vinblastine and vincristine, with risk of inadequate therapeutic response. Reports of 1 AUC by 40% and elimination half life by 35%, and t clearance by 63%, in patients with brain tumours taking vincristine, which could lead to dangerously inadequate therapeutic responses Due to induction of CYP3A4-mediated metabolism Monitor for clinical efficacy, and t dose of vinblastine and vincristine as clinically indicated in the latter case, monitor clinically and radiologically for clinical efficacy in patients with brain tumours and t dose to obtain desired response... 

In a small pharmacokinetic study the clearance of vincristine was 65% greater than in patients who were not taking carbamazepine and the half-life and AUC of vincristine were reduced by 35 and 43% respectively (93). 

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 aminophylline, carbamazepine, cyclosporine, mercaptopurine, methotrexate, phenobarbital, prednisone, vincristine, warfarin... 

Clinically important, potentially hazardous interactions with abacavir, atorvastatin, bepridil, bupropion, carbamazepine, clarithromycin, cyclosporine, dexamethasone, digoxin, felodipine, fluticasone propionate, fosamprenavir, itraconazole, ketoconazole, lovastatin, methadone, midazolam, nicardipine, nifedipine, phenobarbital, phenytoin, rifabutin, simvastatin, sirolimus, St John s wort, systemic lidocaine, tacrolimus, tenofovir, trazodone, vinblastine, vincristine, voriconazole, warfarin, zidovudine... 

The most common cause of hyponatremia in hospital patients is SIADH. However, other disorders can cause dilutional hyponatremia and must be differentiated from SIADH. These conditions include (1) congestive heart failure, (2) renal insufficiency, (3) nephrotic syndrome, (4) liver cirrhosis, and (5) hypothyroidism. Excessive administration of hypotonic fluids and treatment with drugs that stimulate AVP (e.g., chlorpropamide, vincristine, clofibrate, carbamazepine, nicotine, phenothiazines, and cyclophosphamide) can cause dilutional hyponatremia as well. Hyponatremia may also occur from renal or extrarenal sodium losses (depietional hyponatremia) as a result of vomiting, diarrhea, excessive sweating, diuretic abuse, saltlosing nephropathy, or mineralocorticoid deficiency. 

Phenytoin followed by Carbamazepine Vincristine Cytarabine Hydroxycarbamide Daunorubicin Methotrexate Tioguanine Cyclophosphamide Carmustine Stage iV T-ceii iymphoma Phenytoin faiied to reach therapeutic ieveis and so was substituted with carbamazepine. Chemotherapy caused carbamazepine levels to drop below therapeutic levels resulting in seizures, increasing the dose from 30 to 50 mg/kg per day prevented subtherapeutic ieveis. 8... 

Carbamazepine andphenytoin appear to reduce the plasma levels of vincristine, and may reduce its efficacy. A number of case reports have described reduced phenytoin levels in patients receiving chemotherapy including vinca alkaloids. 

These enzyme-inducing antiepileptics increase the metabolism of vincristine by the cytochrome P450 isoenzyme CYTBA4. However, in vitro studies have shown that phenytoin may potentiate the antineoplastic (antimitotic) effects of the vinca alkaloids. Thus, further study is required to determine the overall effect of phenytoin on the efficacy and toxicity of vincristine and other vinca alkaloids. Carbamazepine would be expected to reduce the efficacy of vincristine. 

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