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Fatal Forty DDI: diltiazem, carbamazepine, CYP3A4
  • Catherine Marcucci
  • Jerusha Taylor
  • Ansgar M. Brambrink
  • Neil B. Sandson

Abstract

This case discusses a complex pharmacokinetic interaction between carbamazepine and diltiazem, resulting in carbamazepine toxicity and decreased efficacy of diltiazem. Carbamazepine is both a cytochrome P450 3A4 substrate and inducer and diltiazem is a 3A4 inhibitor and substrate.

Keywords

Pharmacokinetic Inducer Inhibitor Induction Inhibition Carbamazepine Diltiazem CYP3A4 Paninducer Paninduction Toxicity Dizziness Ataxia Tremor Nystagmus Therapeutic drug monitoring Serum levels Cytochrome P450. CYP 3A4 

References

  1. 1.
    Ahmad S. Diltiazem-carbamezapine interaction. Am Heart J. 1990;120:1485.PubMedCrossRefGoogle Scholar
  2. 2.
    Bahls F, et al. Interactions between calcium channel blockers and the anticonvulsants carbamazepine and phenytoin. Neurology. 1991;41:740.PubMedCrossRefGoogle Scholar
  3. 3.
    Hansten P, Horn J. Drug interactions analysis and management. St Louis: Wolters Kluwer Health, Inc.; 2007. p. 294–5.Google Scholar
  4. 4.
    DeVane CL, Markowitz JS. Avoiding psychotropic drug interactions in the cardiovascular patient. Bull Menninger Clin. 2000;64(1):49–59.PubMedGoogle Scholar
  5. 5.
    Spina E, Pisani F, Perucca E. Clinically significant pharmacokinetic drug interactions with carbamazepine. An update. Clin Pharmacokinet. 1996;31(3):198–214.PubMedCrossRefGoogle Scholar
  6. 6.
    Crawford P, Chadwick DJ, Martin C, et al. The interaction of phenytoin and carbamazepine with combined oral contraceptive steroids. Br J Clin Pharmacol. 1990;30(6):892–6.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Ogg MS, Williams JM, Tarbit M, et al. A reporter gene assay to assess the molecular mechanisms of xenobiotic-dependent induction of the human CYP3A4 gene in vitro. Xenobiotica. 1999;29(3):269–79.PubMedCrossRefGoogle Scholar
  8. 8.
    Mück W, Ahr G, Kuhlmann J. Nimodipine. Potential for drug-drug interactions in the elderly. Drugs Aging. 1995;6(3):229–42.PubMedCrossRefGoogle Scholar
  9. 9.
    Yasui-Furukori N, Tateishi T. Carbamazepine decreases antihypertensive effect of nilvadipine. J Clin Pharmacol. 2002;42(1):100–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Catherine Marcucci
    • 1
  • Jerusha Taylor
    • 2
  • Ansgar M. Brambrink
    • 3
  • Neil B. Sandson
    • 4
    • 5
  1. 1.Anesthesia Services DepartmentPhiladelphia Veterans Affairs Medical CenterPhiladelphiaUSA
  2. 2.Department of PharmacyOregon Health and Science UniversityPortlandUSA
  3. 3.Department of Anesthesiology and Perioperative MedicineOregon Health and Science UniversityPortlandUSA
  4. 4.Department of PsychiatryUniversity of Maryland Medical SystemBaltimoreUSA
  5. 5.Department of PsychiatryVA Maryland Health Care SystemBaltimoreUSA

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