Drug interactions
Carbamazepine + Paracetamol
Severity: Moderate
Carbamazepine and Paracetamol: moderate 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
Carbamazepine induces CYP enzymes (including CYP3A4, CYP1A2, CYP2E1) and UGTs, increasing formation of the toxic paracetamol metabolite NAPQI. Cases of hepatotoxicity have been described with therapeutic or modestly excessive doses in patients on enzyme-inducing anticonvulsants, and paracetamol effectiveness may be reduced.
What this interaction means in plain words
Carbamazepine and Paracetamol can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Carbamazepine belongs to Central Nervous System; Paracetamol belongs to Musculoskeletal.
Why it happens
Carbamazepine induces hepatic oxidative metabolism of paracetamol, increasing production of the hepatotoxic NAPQI metabolite.
What to do
Keep paracetamol at or below standard maximum daily doses and avoid prolonged high-dose use. Monitor liver function if regular use is needed, and treat overdose early with acetylcysteine at a lower threshold.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Paracetamol
- Ethanol + Paracetamol Major
- Busulfan + Paracetamol Moderate
- Cholestyramine + Paracetamol Moderate
- Felbamate + Paracetamol Moderate
- Fosphenytoin + Paracetamol Moderate
- Imatinib + Paracetamol Moderate
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
Frequently asked questions
Can I take Carbamazepine with Paracetamol?
MediHelp rates the interaction as moderate. Carbamazepine and Paracetamol can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Carbamazepine induces CYP enzymes (including CYP3A4, CYP1A2, CYP2E1) and UGTs, increasing formation of the toxic paracetamol metabolite NAPQI. Cases of hepatotoxicity have been described with therapeutic or modestly excessive doses in patients on enzyme-inducing anticonvulsants, and paracetamol effectiveness may be reduced.
How serious is the interaction between Carbamazepine and Paracetamol?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Keep paracetamol at or below standard maximum daily doses and avoid prolonged high-dose use. Monitor liver function if regular use is needed, and treat overdose early with acetylcysteine at a lower threshold.
What other medicines interact with Paracetamol?
MediHelp also lists interactions of Paracetamol with, for example, Ethanol, Busulfan, Cholestyramine. The full list is on the Paracetamol page.
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