Multiple inductive effects of carbamazepine on combined therapy with paliperidone and amlodipine

Y Akamine; H Uehara; M Miura; N Yasui-Furukori; T Uno

doi:10.1111/jcpt.12286

Multiple inductive effects of carbamazepine on combined therapy with paliperidone and amlodipine

J Clin Pharm Ther. 2015 Aug;40(4):480-2. doi: 10.1111/jcpt.12286. Epub 2015 May 26.

Authors

Y Akamine¹, H Uehara², M Miura¹, N Yasui-Furukori³, T Uno⁴

Affiliations

¹ Department of Pharmacy, Akita University Hospital, Akita, Japan.
² Department of Hospital Pharmacy, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
³ Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, Japan.
⁴ Department of Pharmacy, Zikeikai-Aoimori Hospital, Aomori, Japan.

PMID: 26009790
DOI: 10.1111/jcpt.12286

Abstract

What is known and objective: Carbamazepine is a potent inducer of cytochrome P450 3A and P-glycoprotein. However, there are no reports of the effects of carbamazepine on more than one co-administered drug.

Case summary: A 53-year-old female patient with schizophrenia and hypertension was on paliperidone 12 mg/day and amlodipine 5 mg/day. When carbamazepine was added to this prescription, the plasma concentrations of both drugs decreased dramatically in a dose-dependent manner. Although the patient's psychotic symptoms did not change, as a result, her mean blood pressure increased to 160·1/103·6 mmHg from 138·4/91·4 mmHg at a carbamazepine dose of 600 mg/day.

What is new and conclusion: Theses cases show the effect of carbamazepine induction on two drugs simultaneously. Care is required when carbamazepine is added to drug regimens including paliperidone or amlodipine alone or together.

Keywords: CYP3A; P-glycoprotein; carbamazepine; pharmacodynamics; pharmacokinetics.

Publication types

Case Reports

MeSH terms

ATP Binding Cassette Transporter, Subfamily B, Member 1 / drug effects
ATP Binding Cassette Transporter, Subfamily B, Member 1 / metabolism
Amlodipine / administration & dosage
Amlodipine / pharmacokinetics*
Amlodipine / therapeutic use
Antipsychotic Agents / therapeutic use
Blood Pressure / drug effects
Carbamazepine / administration & dosage
Carbamazepine / pharmacology*
Carbamazepine / therapeutic use
Cytochrome P-450 CYP3A / drug effects
Cytochrome P-450 CYP3A / metabolism
Cytochrome P-450 CYP3A Inducers / administration & dosage
Cytochrome P-450 CYP3A Inducers / pharmacology
Cytochrome P-450 CYP3A Inducers / therapeutic use
Dose-Response Relationship, Drug
Drug Interactions
Female
Humans
Hypertension / drug therapy
Middle Aged
Paliperidone Palmitate / administration & dosage
Paliperidone Palmitate / pharmacokinetics*
Paliperidone Palmitate / therapeutic use
Schizophrenia / drug therapy

Substances

ATP Binding Cassette Transporter, Subfamily B, Member 1
Antipsychotic Agents
Cytochrome P-450 CYP3A Inducers
Amlodipine
Carbamazepine
Cytochrome P-450 CYP3A
Paliperidone Palmitate