procarbazine.

Anecdotal

▶ Fosphenytoin is predicted to increase the risk of

Anecdotal

hypersensitivity when given with procarbazine.r

▶ Valproate potentially increases the concentration of propofol.

Adjust dose.rTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to quetiapine.oStudy → Also see TABLE 11 p. 1377

▶ Valproate potentially increases the risk of neutropenia when

given with quetiapine.oStudy

▶ Quinolones (ciprofloxacin) affect the concentration of

antiepileptics (fosphenytoin, phenytoin). Monitor concentration

and adjust dose.rStudy

▶ Antiepileptics (fosphenytoin, phenobarbital, phenytoin,

primidone) are predicted to affect the exposure to raltegravir.

Use with caution or avoid.oTheoretical

▶ Carbamazepine is predicted to affect the exposure to

raltegravir.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to ranolazine. Avoid.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to reboxetine.oAnecdotal

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to regorafenib. Avoid.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to

o

repaglinide. Monitor blood glucose and adjust dose.

Study

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to markedly decrease the

exposure to ribociclib. Avoid.rStudy

▶ Antiepileptics (phenobarbital, primidone) are predicted to

decrease the exposure to rifampicin and rifampicin is predicted

to decrease the exposure to antiepileptics (phenobarbital,

primidone). Use with caution and adjust dose.oStudy

▶ Rifampicin decreases the concentration of antiepileptics

(fosphenytoin, phenytoin)

o

. Use with caution and adjust dose.

Study

▶ Rifampicin slightly decreases the exposure to brivaracetam.

Adjust dose.oStudy

▶ Rifampicin markedly increases the clearance of lamotrigine.

Adjust lamotrigine dose, p. 318.oStudy

▶ Rifampicin is predicted to decrease the exposure to

perampanel. Monitor and adjust dose.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) markedly decrease the exposure to

rilpivirine. Avoid.rStudy

BNF 78 Antiepileptics — Antiepileptics 1397

Interactions | Appendix 1

A1

Antiepileptics (continued)

▶ Oxcarbazepine is predicted to decrease the concentration of

rilpivirine. Avoid.rTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to risperidone. Adjust dose.oStudy → Also see TABLE 11

p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to moderately decrease

the exposure to rivaroxaban. Avoid unless patient can be

monitored for signs of thrombosis.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to roflumilast. Avoid.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to markedly decrease the

exposure to rolapitant. Avoid.rStudy

▶ Rucaparib is predicted to increase the exposure to phenytoin.

Monitor and adjust dose.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to ruxolitinib. Monitor and adjust dose.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to moderately decrease

the exposure to saxagliptin.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenytoin) are

predicted to decrease the exposure to the active metabolite of

selexipag. Adjust dose.oStudy

▶ Valproate

q

is predicted to increase the exposure to selexipag.

Theoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the

concentration of sirolimus. Avoid.rStudy

▶ Valproate increases the exposure to sodium oxybate. Adjust

sodium oxybate dose, p. 491.oStudy

▶ Valproate potentially decreases the effects of sodium

phenylbutyrate.oAnecdotal

▶ Antiepileptics (fosphenytoin, oxcarbazepine, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to sofosbuvir. Avoid.rTheoretical

▶ Carbamazepine is predicted to decrease the exposure to

sofosbuvir. Avoid.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to solifenacin.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to sorafenib.oTheoretical

▶ SSRIs (fluoxetine, fluvoxamine) are predicted to increase the

concentration of antiepileptics (fosphenytoin, phenytoin).

Monitor and adjust dose.rAnecdotal

▶ SSRIs (sertraline) potentially increase the risk of toxicity when

given with antiepileptics (fosphenytoin, phenytoin). Monitor

concentration and adjust dose.rAnecdotal

▶ Antiepileptics (fosphenytoin, phenytoin) decrease the

concentration of SSRIs (paroxetine).oStudy

▶ St John’s Wort is predicted to decrease the concentration of

antiepileptics (fosphenytoin, phenobarbital, phenytoin,

primidone). Avoid.rTheoretical

▶ St John’s Wort is predicted to decrease the exposure to

brivaracetam.oTheoretical

▶ St John’s Wort is predicted to decrease the concentration of

carbamazepine. Monitor and adjust dose.oTheoretical

▶ St John’s Wort is predicted to decrease the exposure to

perampanel. Monitor and adjust dose.oTheoretical

▶ St John’s Wort is predicted to decrease the exposure to

tiagabine. Avoid.nTheoretical

▶ Antiepileptics (carbamazepine, eslicarbazepine) are predicted to

decrease the exposure to statins (atorvastatin). Monitor and

adjust dose.oTheoretical → Also see TABLE 1 p. 1375

▶ Antiepileptics (fosphenytoin, phenytoin) potentially decrease

the exposure to

Anecdotal

statins (atorvastatin, simvastatin).o

▶ Carbamazepine moderately decreases the exposure to statins

(simvastatin). Monitor and adjust dose.rStudy → Also see

TABLE 1 p. 1375

▶ Eslicarbazepine moderately decreases the exposure to statins

(simvastatin). Monitor and adjust dose.oStudy

▶ Sulfonamides (sulfadiazine) are predicted to increase the

concentration of

o

fosphenytoin. Monitor and adjust dose.

Study

▶ Sulfonamides (sulfadiazine) increase the concentration of

phenytoin. Monitor and adjust dose.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to

Study

sunitinib. Avoid or adjust sunitinib dose, p. 999.o ▶ Antiepileptics (fosphenytoin, phenytoin) increase the effects of

suxamethonium.oStudy

▶ Carbamazepine increases the risk of prolonged neuromuscular

blockade when given with suxamethonium.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) decrease the concentration of

tacrolimus. Monitor and adjust dose.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to taxanes (cabazitaxel, paclitaxel). Avoid.rStudy → Also

see TABLE 12 p. 1378

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to taxanes (docetaxel).rTheoretical → Also see TABLE 12

p. 1378

▶ Tegafur potentially increases the concentration of

antiepileptics (fosphenytoin, phenytoin). Monitor concentration

and adjust dose.rAnecdotal

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the

concentration of temsirolimus. Avoid.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, oxcarbazepine,

phenobarbital, phenytoin, primidone) are predicted to decrease

the exposure to

Theoretical

tenofovir alafenamide. Avoid.o ▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) decrease the exposure to tetracyclines

(doxycycline). Monitor and adjust dose.oStudy → Also

see TABLE 1 p. 1375

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to tezacaftor. Avoid.rTheoretical

▶ Antiepileptics (fosphenytoin, phenytoin) are predicted to

decrease the exposure to

Study

theophylline. Adjust dose.o ▶ Antiepileptics (phenobarbital, primidone) are predicted to

increase the clearance of

Theoretical

theophylline. Adjust dose.o ▶ Carbamazepine potentially increases the clearance of

theophylline and theophylline decreases the exposure to

carbamazepine. Adjust dose.oAnecdotal

▶ Stiripentol is predicted to increase the exposure to

theophylline. Avoid.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenytoin) are

predicted to increase the risk of hypothyroidism when given

with thyroid hormones.oStudy

▶ Antiepileptics (phenobarbital, primidone) are predicted to

decrease the effects of thyroid hormones.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to markedly decrease the

exposure to ticagrelor. Avoid.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to tivozanib.rStudy

▶ Antiepileptics (fosphenytoin, phenytoin) moderately decrease

the exposure to tizanidine.nStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to tofacitinib. Avoid.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

1398 Antiepileptics — Antiepileptics BNF 78

Interactions | Appendix 1

A1