Drug interactions
Carbamazepine + Mitotane
Severity: Major
Carbamazepine and Mitotane: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Mitotane is a strong CYP3A4 inducer and can substantially lower carbamazepine concentrations, risking breakthrough seizures. The induction persists for weeks after mitotane is stopped because of its long half-life.
What this interaction means in plain words
Carbamazepine and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Carbamazepine belongs to Central Nervous System; Mitotane belongs to Oncology.
Why it happens
Mitotane induces CYP3A4, increasing carbamazepine clearance.
What to do
Monitor carbamazepine serum concentrations and seizure control, and raise the dose as needed. Consider a non-inducible anticonvulsant and recheck levels after mitotane discontinuation.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Carbamazepine
- Artemether / lumefantrine + Carbamazepine Contraindicated
- Cabotegravir + Carbamazepine Contraindicated
- Carbamazepine + Delamanid Contraindicated
- Carbamazepine + Dienogest / estradiol valerate Contraindicated
- Carbamazepine + Doravirine Contraindicated
- Carbamazepine + Elbasvir / grazoprevir Contraindicated
Other interactions of Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Apixaban + Mitotane Major
- Aprepitant + Mitotane Major
Frequently asked questions
Can I take Carbamazepine with Mitotane?
MediHelp rates the interaction as major. Carbamazepine and Mitotane can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Mitotane is a strong CYP3A4 inducer and can substantially lower carbamazepine concentrations, risking breakthrough seizures. The induction persists for weeks after mitotane is stopped because of its long half-life.
How serious is the interaction between Carbamazepine and Mitotane?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor carbamazepine serum concentrations and seizure control, and raise the dose as needed. Consider a non-inducible anticonvulsant and recheck levels after mitotane discontinuation.
What other medicines interact with Carbamazepine?
MediHelp also lists interactions of Carbamazepine with, for example, Artemether / lumefantrine, Cabotegravir, Delamanid. The full list is on the Carbamazepine page.
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