Dizzy and Depressed

Fatal Forty DDI: nefazodone, carbamazepine, CYP3A4


This case discusses the pharmacokinetic interaction between carbamazepine and nefazodone leading to supratherapeutic carbamazepine levels. Carbamazepine is a cytochrome P450 3A4 substrate and nefazodone is a 3A4 inhibitor.


Carbamazepine Tegretol Pharmacokinetic Inhibition CYP3A4 Nefazodone Toxicity Induction CYP Cytochrome P450 3A4 


  1. 1.
    Kerr BM, Thummel KE, Wurden CJ, et al. Human liver carbamazepine metabolism: role of CYP3A4 and CYP2C8 in 10,11-epoxide formation. Biochem Pharmacol. 1994;47:1969–79.PubMedCrossRefGoogle Scholar
  2. 2.
    Ashton AK, Wolin RE. Nefazodone-induced carbamazepine toxicity. Am J Psychiatry. 1996;153:733.PubMedCrossRefGoogle Scholar
  3. 3.
    Laroudie C, Salazar DE, Cosson JP, et al. Carbamazepine-nefazodone interaction in healthy subjects. J Clin Psychopharmacol. 2000;20:46–53.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of AnesthesiologyMayo ClinicRochesterUSA

Personalised recommendations