Carbamazepine 10,11-epoxide

Active ingredient: Carbamazepine Chemical name: 5H-dibenzo[b,f]azepine-5-carboxamide.

1. Cytochrome P4503A4 (CYP3A4) is the enzyme that plays the main catalytic role in the active metabolite 10,11-epoxycarbamazepine. Taking CYP3A4 inhibitors at the same time can lead to an increase in the plasma concentration of carbamazepine, thereby inducing adverse reactions. If CYP3A4 inducers are taken at the same time, the metabolic rate of carbamazepine may be increased, resulting in a potential decrease in the plasma level and efficacy of carbamazepine. Similarly, if CYP3A4 inducers are discontinued, the metabolic rate of carbamazepine will decrease, causing an increase in the plasma level of carbamazepine. 2. Carbamazepine is a potent inducer of CYP3A4 and other phase I and phase II enzyme systems in the liver, and therefore can reduce the plasma concentration of drugs that are mainly metabolized by CYP3A4. 3. Human microsomal epoxide hydrolase was found to be the main enzyme responsible for the formation of 10,11-trans diol from carbamazepine-10,11 epoxide. Coadministration with human microsomal epoxide hydrolase may result in increased plasma concentrations of carbamazepine-10,11-epoxide. 4. Preparations that can increase the plasma levels of carbamazepine and/or carbamazepine-10,11 epoxide 5. Since increased plasma levels of carbamazepine and/or carbamazepine-10,11 epoxide can lead to adverse reactions (such as dizziness, drowsiness, ataxia, diplopia), the dose of Delevofloxacin should be adjusted accordingly based on the monitored plasma levels when the following drugs are used concomitantly: Analgesics, anti-inflammatory drugs: dextropropoxyphene, ibuprofen Androgens: danazol Antibiotics: macrolide antibiotics (such as erythromycin, troleandomycin, josamycin, clarithromycin) Antidepressants: may include desipramine, fluoxetine, fluvoxamine, nefazodone, paroxetine, trazodone, viloxazine Antiepileptic preparations: stiripentol, vigabatrin Antifungal drugs: azoles (such as itraconazole, ketoconazole, fluconazole, voriconazole) Antihistamines: loratadine, terfenadine Antipsychotics: olanzapine Anti-tuberculosis drugs: isoniazid Antiviral drugs: protease inhibitors used for HIV treatment (such as ritonavir) Carbonic anhydrase inhibitors: acetazolamide Cardiovascular drugs: diltiazem, verapamil Gastrointestinal drugs: possibly cimetidine, omeprazole Muscle relaxants: oxybutynin, dantrolene Platelet aggregation inhibitors: ticlopidine Other interactions: grapefruit, niacinamide (only in high doses in adults) 6. Preparations that can increase the plasma levels of the active metabolite carbamazepine-10,11-epoxide 7. Because increased plasma levels of carbamazepine-10,11-epoxide may cause adverse reactions (such as dizziness, drowsiness, ataxia, diplopia), the dose of Delevo should be adjusted accordingly based on the monitored plasma levels when the following drugs are used simultaneously: 8. It has been reported that loxapine, quetiapine, primidone, progamide, valproic acid and valproamide can increase the concentration of the active metabolite 10,11-epoxide carbamazepine. 9. Preparations that can reduce the plasma level of carbamazepine 10. The dose of Deletox must be adjusted when the following drugs are used in combination: Antiepileptic preparations: Felbamate, methsuximide, oxcarbazepine, phenobarbital, phensuximide, phenytoin and fosphenytoin, primidone, although the data may be somewhat contradictory, it is generally believed that clonazepam is also included. Antineoplastic drugs: Cisplatin or doxorubicin Antituberculosis drugs: Rifampicin Bronchodilators or antiasthmatic drugs: Theophylline, aminophylline Dermatological drugs: Isotretinoin Other interactions: Chinese herbal preparations containing Hypericum perforatum (Hypericum) 0 11. The effect of Deletox on the plasma level of concomitantly used preparations 12. Carbamazepine can reduce the plasma levels of certain specific drugs, or weaken or even eliminate the active effects of these drugs. The doses of the following drugs must be adjusted according to clinical requirements: Analgesics, anti-inflammatory drugs: Buprenorphine, methadone, acetaminophen, phenazone (antipyrine), tramadol. Antibiotics: doxycycline Anticoagulants: Oral anticoagulants (such as warfarin, phenprocoumon, dicoumarol and acenocoumarol) Antidepressants: aminopropion, citalopram, mianserin, nefazodone, sertraline, trazodone, tricyclic antidepressants (such as imipramine, amitriptyline, nortriptyline, clomipramine). It is not recommended to use Deliduo in combination with monoamine oxidase inhibitors (MAOI); before taking Deliduo, if the clinical situation allows, MAOIs should be stopped at least two weeks in advance or more (see [Contraindications]) Antiepileptic preparations: clobazam, clonazepam, ethosuximide, felbamate, lamotrigine, oxcarbazepine, primidone, tiagabine, topiramate, valproic acid, zonisamide. It has been reported that plasma phenytoin levels can be both increased and decreased under the action of carbamazepine, but there are rare case reports of increased plasma levels of mephenytoin. Antifungal drugs: itraconazole Anthelmintics: praziquantel Antineoplastic drugs: imatinib Antipsychotics: clozapine, haloperidol and bromperidol, olanzapine, quetiapine, risperidone, ziprasidone Antiviral drugs: protease inhibitors used for HIV treatment (such as indinavir, ritonavir, saquinavir). Antianxiety drugs: alprazolam, midazolam Bronchodilators or antiasthmatic drugs: theophylline Contraceptives: hormonal contraceptives (other alternative contraceptive methods should be considered) Cardiovascular drugs: calcium channel blockers (dihydropyridine series), such as felodipine, digoxin Corticosteroids: corticosteroids (such as prednisolone, dexamethasone) Immunosuppressants: cyclosporine, everolimus Thyroxine: levothyroxine. Other drug interactions: Drugs containing estrogen and/or progesterone. 13. Co-administration of drugs that require special attention It has been reported that the combined use of carbamazepine and levetiracetam can increase carbamazepine-induced toxicity. It has been reported that the combined use of carbamazepine and isoniazid can increase the incidence of isoniazid-induced liver toxicity. The combined use of carbamazepine with lithium salts or metoclopramide, or with neuroleptics (such as haloperidol, thioridazine), can increase the adverse effects of the nervous system (and the latter method of administration will increase neurological adverse reactions even at therapeutic blood drug concentrations). The combined use of carbamazepine and acetaminophen, especially a single overdose or long-term large amounts, increases the risk of liver poisoning and may reduce the efficacy of the latter. The combined use of carbonic anhydrase inhibitors increases the risk of osteoporosis. 14. Due to the hepatic enzyme induction effect of this product, the antidiuretic effect can be enhanced when used in combination with chlorpropamide, clofibrate (clofibrate), desmopressin, lypressin, vasopressin, vasopressin, etc., and the dose of each drug used in combination needs to be reduced. 15. Phenobarbital, phenytoin, primidone, progabin, and theophylline can reduce the blood concentration of carbamazepine, and clonazepam, valproic acid, and valproamide also have the same effect, although the experimental data are somewhat contradictory. In addition, it has been reported that valproic acid, valproamide, and primidone can increase the blood concentration of the active metabolite 10,11-epoxycarbamazepine, so the dose of carbamazepine needs to be adjusted accordingly. 16. Combination with some diuretics (such as hydrochlorothiazide, furosemide) may cause hyponatremia. 17. Lithium salts can reduce the antidiuretic effect of carbamazepine. 18. Carbamazepine has an antagonistic effect on non-depolarizing muscle relaxants (such as pancuronium); if necessary, the dose can be increased and the patient should be closely monitored because the recovery of neuromuscular blockade may be faster than expected. 19. Carbamazepine can reduce the absorption of nomifensine and accelerate its elimination. 20. It has been reported that isotretinoin changes the bioavailability and/or clearance of carbamazepine and 10,11-epoxycarbamazepine, so the blood concentration of carbamazepine should be monitored. 21. Like other psychotropic drugs, carbamazepine can reduce alcohol tolerance, so during treatment, advise patients to abstain from alcohol. 22. Vaginal bleeding may occur when used in combination with oral contraceptives. 23. Carbamazepine has been reported to reduce or increase the blood concentration of phenytoin. There are very few reports of increased plasma concentrations of mephenytoin.

Active ingredient: Carbamazepine Chemical name: 5H-dibenzo[b,f]azepine-5-carboxamide.

1. Cytochrome P4503A4 (CYP3A4) is the enzyme that plays the main catalytic role in the active metabolite 10,11-epoxycarbamazepine. Taking CYP3A4 inhibitors at the same time can lead to an increase in the plasma concentration of carbamazepine, thereby inducing adverse reactions. If CYP3A4 inducers are taken at the same time, the metabolic rate of carbamazepine may be increased, resulting in a potential decrease in the plasma level and efficacy of carbamazepine. Similarly, if CYP3A4 inducers are discontinued, the metabolic rate of carbamazepine will decrease, causing an increase in the plasma level of carbamazepine. 2. Carbamazepine is a potent inducer of CYP3A4 and other phase I and phase II enzyme systems in the liver, and therefore can reduce the plasma concentration of drugs that are mainly metabolized by CYP3A4. 3. Human microsomal epoxide hydrolase was found to be the main enzyme responsible for the formation of 10,11-trans diol from carbamazepine-10,11 epoxide. Coadministration with human microsomal epoxide hydrolase may result in increased plasma concentrations of carbamazepine-10,11-epoxide. 4. Preparations that can increase the plasma levels of carbamazepine and/or carbamazepine-10,11 epoxide 5. Since increased plasma levels of carbamazepine and/or carbamazepine-10,11 epoxide can lead to adverse reactions (such as dizziness, drowsiness, ataxia, diplopia), the dose of Delevofloxacin should be adjusted accordingly based on the monitored plasma levels when the following drugs are used concomitantly: Analgesics, anti-inflammatory drugs: dextropropoxyphene, ibuprofen Androgens: danazol Antibiotics: macrolide antibiotics (such as erythromycin, troleandomycin, josamycin, clarithromycin) Antidepressants: may include desipramine, fluoxetine, fluvoxamine, nefazodone, paroxetine, trazodone, viloxazine Antiepileptic preparations: stiripentol, vigabatrin Antifungal drugs: azoles (such as itraconazole, ketoconazole, fluconazole, voriconazole) Antihistamines: loratadine, terfenadine Antipsychotics: olanzapine Anti-tuberculosis drugs: isoniazid Antiviral drugs: protease inhibitors used for HIV treatment (such as ritonavir) Carbonic anhydrase inhibitors: acetazolamide Cardiovascular drugs: diltiazem, verapamil Gastrointestinal drugs: possibly cimetidine, omeprazole Muscle relaxants: oxybutynin, dantrolene Platelet aggregation inhibitors: ticlopidine Other interactions: grapefruit, niacinamide (only in high doses in adults) 6. Preparations that can increase the plasma levels of the active metabolite carbamazepine-10,11-epoxide 7. Because increased plasma levels of carbamazepine-10,11-epoxide may cause adverse reactions (such as dizziness, drowsiness, ataxia, diplopia), the dose of Delevo should be adjusted accordingly based on the monitored plasma levels when the following drugs are used simultaneously: 8. It has been reported that loxapine, quetiapine, primidone, progamide, valproic acid and valproamide can increase the concentration of the active metabolite 10,11-epoxide carbamazepine. 9. Preparations that can reduce the plasma level of carbamazepine 10. The dose of Deletox must be adjusted when the following drugs are used in combination: Antiepileptic preparations: Felbamate, methsuximide, oxcarbazepine, phenobarbital, phensuximide, phenytoin and fosphenytoin, primidone, although the data may be somewhat contradictory, it is generally believed that clonazepam is also included. Antineoplastic drugs: Cisplatin or doxorubicin Antituberculosis drugs: Rifampicin Bronchodilators or antiasthmatic drugs: Theophylline, aminophylline Dermatological drugs: Isotretinoin Other interactions: Chinese herbal preparations containing Hypericum perforatum (Hypericum) 0 11. The effect of Deletox on the plasma level of concomitantly used preparations 12. Carbamazepine can reduce the plasma levels of certain specific drugs, or weaken or even eliminate the active effects of these drugs. The doses of the following drugs must be adjusted according to clinical requirements: Analgesics, anti-inflammatory drugs: Buprenorphine, methadone, acetaminophen, phenazone (antipyrine), tramadol. Antibiotics: doxycycline Anticoagulants: Oral anticoagulants (such as warfarin, phenprocoumon, dicoumarol and acenocoumarol) Antidepressants: aminopropion, citalopram, mianserin, nefazodone, sertraline, trazodone, tricyclic antidepressants (such as imipramine, amitriptyline, nortriptyline, clomipramine). It is not recommended to use Deliduo in combination with monoamine oxidase inhibitors (MAOI); before taking Deliduo, if the clinical situation allows, MAOIs should be stopped at least two weeks in advance or more (see [Contraindications]) Antiepileptic preparations: clobazam, clonazepam, ethosuximide, felbamate, lamotrigine, oxcarbazepine, primidone, tiagabine, topiramate, valproic acid, zonisamide. It has been reported that plasma phenytoin levels can be both increased and decreased under the action of carbamazepine, but there are rare case reports of increased plasma levels of mephenytoin. Antifungal drugs: itraconazole Anthelmintics: praziquantel Antineoplastic drugs: imatinib Antipsychotics: clozapine, haloperidol and bromperidol, olanzapine, quetiapine, risperidone, ziprasidone Antiviral drugs: protease inhibitors used for HIV treatment (such as indinavir, ritonavir, saquinavir). Antianxiety drugs: alprazolam, midazolam Bronchodilators or antiasthmatic drugs: theophylline Contraceptives: hormonal contraceptives (other alternative contraceptive methods should be considered) Cardiovascular drugs: calcium channel blockers (dihydropyridine series), such as felodipine, digoxin Corticosteroids: corticosteroids (such as prednisolone, dexamethasone) Immunosuppressants: cyclosporine, everolimus Thyroxine: levothyroxine. Other drug interactions: Drugs containing estrogen and/or progesterone. 13. Co-administration of drugs that require special attention It has been reported that the combined use of carbamazepine and levetiracetam can increase carbamazepine-induced toxicity. It has been reported that the combined use of carbamazepine and isoniazid can increase the incidence of isoniazid-induced liver toxicity. The combined use of carbamazepine with lithium salts or metoclopramide, or with neuroleptics (such as haloperidol, thioridazine), can increase the adverse effects of the nervous system (and the latter method of administration will increase neurological adverse reactions even at therapeutic blood drug concentrations). The combined use of carbamazepine and acetaminophen, especially a single overdose or long-term large amounts, increases the risk of liver poisoning and may reduce the efficacy of the latter. The combined use of carbonic anhydrase inhibitors increases the risk of osteoporosis. 14. Due to the hepatic enzyme induction effect of this product, the antidiuretic effect can be enhanced when used in combination with chlorpropamide, clofibrate (clofibrate), desmopressin, lypressin, vasopressin, vasopressin, etc., and the dose of each drug used in combination needs to be reduced. 15. Phenobarbital, phenytoin, primidone, progabin, and theophylline can reduce the blood concentration of carbamazepine, and clonazepam, valproic acid, and valproamide also have the same effect, although the experimental data are somewhat contradictory. In addition, it has been reported that valproic acid, valproamide, and primidone can increase the blood concentration of the active metabolite 10,11-epoxycarbamazepine, so the dose of carbamazepine needs to be adjusted accordingly. 16. Combination with some diuretics (such as hydrochlorothiazide, furosemide) may cause hyponatremia. 17. Lithium salts can reduce the antidiuretic effect of carbamazepine. 18. Carbamazepine has an antagonistic effect on non-depolarizing muscle relaxants (such as pancuronium); if necessary, the dose can be increased and the patient should be closely monitored because the recovery of neuromuscular blockade may be faster than expected. 19. Carbamazepine can reduce the absorption of nomifensine and accelerate its elimination. 20. It has been reported that isotretinoin changes the bioavailability and/or clearance of carbamazepine and 10,11-epoxycarbamazepine, so the blood concentration of carbamazepine should be monitored. 21. Like other psychotropic drugs, carbamazepine can reduce alcohol tolerance, so during treatment, advise patients to abstain from alcohol. 22. Vaginal bleeding may occur when used in combination with oral contraceptives. 23. Carbamazepine has been reported to reduce or increase the blood concentration of phenytoin. There are very few reports of increased plasma concentrations of mephenytoin.

Active ingredient: Carbamazepine Chemical name: 5H-dibenzo[b,f]azepine-5-carboxamide.

1. Cytochrome P4503A4 (CYP3A4) is the enzyme that plays the main catalytic role in the active metabolite 10,11-epoxycarbamazepine. Taking CYP3A4 inhibitors at the same time can lead to an increase in the plasma concentration of carbamazepine, thereby inducing adverse reactions. If CYP3A4 inducers are taken at the same time, the metabolic rate of carbamazepine may be increased, resulting in a potential decrease in the plasma level and efficacy of carbamazepine. Similarly, if CYP3A4 inducers are discontinued, the metabolic rate of carbamazepine will decrease, causing an increase in the plasma level of carbamazepine. 2. Carbamazepine is a potent inducer of CYP3A4 and other phase I and phase II enzyme systems in the liver, and therefore can reduce the plasma concentration of drugs that are mainly metabolized by CYP3A4. 3. Human microsomal epoxide hydrolase was found to be the main enzyme responsible for the formation of 10,11-trans diol from carbamazepine-10,11 epoxide. Coadministration with human microsomal epoxide hydrolase may result in increased plasma concentrations of carbamazepine-10,11-epoxide. 4. Preparations that can increase the plasma levels of carbamazepine and/or carbamazepine-10,11 epoxide 5. Since increased plasma levels of carbamazepine and/or carbamazepine-10,11 epoxide can lead to adverse reactions (such as dizziness, drowsiness, ataxia, diplopia), the dose of Delevofloxacin should be adjusted accordingly based on the monitored plasma levels when the following drugs are used concomitantly: Analgesics, anti-inflammatory drugs: dextropropoxyphene, ibuprofen Androgens: danazol Antibiotics: macrolide antibiotics (such as erythromycin, troleandomycin, josamycin, clarithromycin) Antidepressants: may include desipramine, fluoxetine, fluvoxamine, nefazodone, paroxetine, trazodone, viloxazine Antiepileptic preparations: stiripentol, vigabatrin Antifungal drugs: azoles (such as itraconazole, ketoconazole, fluconazole, voriconazole) Antihistamines: loratadine, terfenadine Antipsychotics: olanzapine Anti-tuberculosis drugs: isoniazid Antiviral drugs: protease inhibitors used for HIV treatment (such as ritonavir) Carbonic anhydrase inhibitors: acetazolamide Cardiovascular drugs: diltiazem, verapamil Gastrointestinal drugs: possibly cimetidine, omeprazole Muscle relaxants: oxybutynin, dantrolene Platelet aggregation inhibitors: ticlopidine Other interactions: grapefruit, niacinamide (only in high doses in adults) 6. Preparations that can increase the plasma levels of the active metabolite carbamazepine-10,11-epoxide 7. Because increased plasma levels of carbamazepine-10,11-epoxide may cause adverse reactions (such as dizziness, drowsiness, ataxia, diplopia), the dose of Delevo should be adjusted accordingly based on the monitored plasma levels when the following drugs are used simultaneously: 8. It has been reported that loxapine, quetiapine, primidone, progamide, valproic acid and valproamide can increase the concentration of the active metabolite 10,11-epoxide carbamazepine. 9. Preparations that can reduce the plasma level of carbamazepine 10. The dose of Deletox must be adjusted when the following drugs are used in combination: Antiepileptic preparations: Felbamate, methsuximide, oxcarbazepine, phenobarbital, phensuximide, phenytoin and fosphenytoin, primidone, although the data may be somewhat contradictory, it is generally believed that clonazepam is also included. Antineoplastic drugs: Cisplatin or doxorubicin Antituberculosis drugs: Rifampicin Bronchodilators or antiasthmatic drugs: Theophylline, aminophylline Dermatological drugs: Isotretinoin Other interactions: Chinese herbal preparations containing Hypericum perforatum (Hypericum) 0 11. The effect of Deletox on the plasma level of concomitantly used preparations 12. Carbamazepine can reduce the plasma levels of certain specific drugs, or weaken or even eliminate the active effects of these drugs. The doses of the following drugs must be adjusted according to clinical requirements: Analgesics, anti-inflammatory drugs: Buprenorphine, methadone, acetaminophen, phenazone (antipyrine), tramadol. Antibiotics: doxycycline Anticoagulants: Oral anticoagulants (such as warfarin, phenprocoumon, dicoumarol and acenocoumarol) Antidepressants: aminopropion, citalopram, mianserin, nefazodone, sertraline, trazodone, tricyclic antidepressants (such as imipramine, amitriptyline, nortriptyline, clomipramine). It is not recommended to use Deliduo in combination with monoamine oxidase inhibitors (MAOI); before taking Deliduo, if the clinical situation allows, MAOIs should be stopped at least two weeks in advance or more (see [Contraindications]) Antiepileptic preparations: clobazam, clonazepam, ethosuximide, felbamate, lamotrigine, oxcarbazepine, primidone, tiagabine, topiramate, valproic acid, zonisamide. It has been reported that plasma phenytoin levels can be both increased and decreased under the action of carbamazepine, but there are rare case reports of increased plasma levels of mephenytoin. Antifungal drugs: itraconazole Anthelmintics: praziquantel Antineoplastic drugs: imatinib Antipsychotics: clozapine, haloperidol and bromperidol, olanzapine, quetiapine, risperidone, ziprasidone Antiviral drugs: protease inhibitors used for HIV treatment (such as indinavir, ritonavir, saquinavir). Antianxiety drugs: alprazolam, midazolam Bronchodilators or antiasthmatic drugs: theophylline Contraceptives: hormonal contraceptives (other alternative contraceptive methods should be considered) Cardiovascular drugs: calcium channel blockers (dihydropyridine series), such as felodipine, digoxin Corticosteroids: corticosteroids (such as prednisolone, dexamethasone) Immunosuppressants: cyclosporine, everolimus Thyroxine: levothyroxine. Other drug interactions: Drugs containing estrogen and/or progesterone. 13. Co-administration of drugs that require special attention It has been reported that the combined use of carbamazepine and levetiracetam can increase carbamazepine-induced toxicity. It has been reported that the combined use of carbamazepine and isoniazid can increase the incidence of isoniazid-induced liver toxicity. The combined use of carbamazepine with lithium salts or metoclopramide, or with neuroleptics (such as haloperidol, thioridazine), can increase the adverse effects of the nervous system (and the latter method of administration will increase neurological adverse reactions even at therapeutic blood drug concentrations). The combined use of carbamazepine and acetaminophen, especially a single overdose or long-term large amounts, increases the risk of liver poisoning and may reduce the efficacy of the latter. The combined use of carbonic anhydrase inhibitors increases the risk of osteoporosis. 14. Due to the hepatic enzyme induction effect of this product, the antidiuretic effect can be enhanced when used in combination with chlorpropamide, clofibrate (clofibrate), desmopressin, lypressin, vasopressin, vasopressin, etc., and the dose of each drug used in combination needs to be reduced. 15. Phenobarbital, phenytoin, primidone, progabin, and theophylline can reduce the blood concentration of carbamazepine, and clonazepam, valproic acid, and valproamide also have the same effect, although the experimental data are somewhat contradictory. In addition, it has been reported that valproic acid, valproamide, and primidone can increase the blood concentration of the active metabolite 10,11-epoxycarbamazepine, so the dose of carbamazepine needs to be adjusted accordingly. 16. Combination with some diuretics (such as hydrochlorothiazide, furosemide) may cause hyponatremia. 17. Lithium salts can reduce the antidiuretic effect of carbamazepine. 18. Carbamazepine has an antagonistic effect on non-depolarizing muscle relaxants (such as pancuronium); if necessary, the dose can be increased and the patient should be closely monitored because the recovery of neuromuscular blockade may be faster than expected. 19. Carbamazepine can reduce the absorption of nomifensine and accelerate its elimination. 20. It has been reported that isotretinoin changes the bioavailability and/or clearance of carbamazepine and 10,11-epoxycarbamazepine, so the blood concentration of carbamazepine should be monitored. 21. Like other psychotropic drugs, carbamazepine can reduce alcohol tolerance, so during treatment, advise patients to abstain from alcohol. 22. Vaginal bleeding may occur when used in combination with oral contraceptives. 23. Carbamazepine has been reported to reduce or increase the blood concentration of phenytoin. There are very few reports of increased plasma concentrations of mephenytoin.