Other (see comment). affecting hepatic/intestinal enzyme CYP3A4 metabolism. Treatment initiation causes transient release of cytokines that may suppress CYP450 enzymes; highest drug-drug interaction risk is during the first 9 days of the first cycle and the first 2 days of the 2nd cycle in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index. Use Caution/Monitor. Avoid or Use Alternate Drug. Contraindicated. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. Modify Therapy/Monitor Closely. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, signs of kidney problems (such as change in the amount of urine).This is not a complete list of possible side effects. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: certain azole antifungals (isavuconazonium, voriconazole), orlistat.Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Use Caution/Monitor. Avoid or Use Alternate Drug. omeprazole will increase the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. CYP3A4 is responsible for the formation and elimination of cariprazine's active metabolites. Pre-existing hypokalemia and hyperuricemia can also be potentiated by carbonic anhydrase inhibitors. Methamphetamine: (Minor) Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents, such as loop diuretics. Atenolol; Chlorthalidone: (Moderate) Concomitant use of a thiazide diuretiic, or the related drug metolazone, with a loop diuretic can cause additive electrolyte and fluid loss. Monitor Closely (1)telotristat ethyl will decrease the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)carbamazepine will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Either increases levels of the other by unspecified interaction mechanism. Coadministration of ribociclib with strong CYP3A inducers should be avoided. After inducer has been discontinued for at least 14 days, resume previous pralsetinib dose. .crizotinib increases levels of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carbamazepine will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Concomitant therapy may reduce therapeutic effectiveness. Minor/Significance Unknown. Tegretol Flunisolide: (Moderate) Monitor potassium concentrations during concomitant corticosteroid and loop diuretic use due to risk for additive hypokalemia; potassium supplementation may be necessary. Use Caution/Monitor.Serious - Use Alternative (1)phenytoin decreases levels of cyclosporine by increasing metabolism. Avoid or Use Alternate Drug. CYP3A4 inducers may increase the metabolism of ifosfamide to its active alkylating metabolites. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Minor/Significance Unknown. hyaluronidase, phenytoin. Serious - Use Alternative (1)phenytoin will decrease the level or effect of fostamatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated (2)carbamazepine will decrease the level or effect of ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) by increasing metabolism. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Use Caution/Monitor. Contraindicated. Use Caution/Monitor. Use Caution/Monitor.phenytoin, enoxaparin. Avoid or Use Alternate Drug. Contraindicated (1)carbamazepine increases toxicity of selegiline transdermal by unknown mechanism. Guaifenesin; Pseudoephedrine: (Moderate) The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by diuretics. Use Caution/Monitor. phenytoin will decrease the level or effect of estradiol by P-glycoprotein (MDR1) efflux transporter. Comment: Carbamazepine may decrease mifepristone levels via CYP3A4 induction; additionally, mifepristone may increase carbamazepine levels by inhibiting CYP2C8/2C9.Serious - Use Alternative (2)mifepristone will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Use Caution/Monitor. Drug class: Thyroid drugs. budesonide will decrease the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Other (see comment). Use Caution/Monitor. Modify Therapy/Monitor Closely. carbamazepine will decrease the level or effect of tivozanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)carbamazepine will decrease the level or effect of midostaurin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor closely for signs of respiratory depression and sedation. Avoid or Use Alternate Drug. PRECAUTIONS: Before taking carbamazepine, tell your doctor or pharmacist if you are allergic to it; or to other anti-seizure medications (such as fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone) or tricyclic antidepressants (such as amitriptyline, desipramine); or if you have any other allergies. Monitor Closely (1)fleroxacin decreases effects of phenytoin by unknown mechanism. Avoid or Use Alternate Drug. carbamazepine will decrease the level or effect of fostemsavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. When coadministered, hormonal contraceptives are not a reliable method of effective birth control. Monitor Closely (1)eliglustat increases levels of phenytoin by P-glycoprotein (MDR1) efflux transporter. Either increases effects of the other by pharmacodynamic synergism. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose. Monitor Closely (2)topiramate will decrease the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Caution should be exercised when the combined use of risperidone and furosemide is necessary in those with dementia-related psychosis. Avoid or Use Alternate Drug. Monitor Closely (1)carbamazepine will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. influenza virus vaccine quadrivalent, cell-cultured, phenytoin. carbamazepine will decrease the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor for a loss of diabetic control. Use Caution/Monitor. omeprazole will decrease the level or effect of itraconazole by increasing gastric pH. Although hyperthyroidism seems to be the opposite of hypothyroidism, the link between them is complex, and one can lead to the other in certain circumstances. WARNING: Carbamazepine may rarely cause very serious (possibly fatal) skin reactions. Contraindicated. Avoid or Use Alternate Drug. Perindopril: (Major) Discontinue the loop diuretic prior to starting perindopril, if possible, or start perindopril at a lower dose. Use Caution/Monitor. Use Caution/Monitor. Close monitoring of blood pressure is advised. Use Caution/Monitor.primidone will decrease the level or effect of omeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. (Moderate) The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by diuretics. Usual dose range: 20 to 80 mg/day. carbamazepine decreases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Neomycin; Polymyxin B; Bacitracin: (Minor) Additive nephrotoxicity may occur with concurrent use of systemic bacitracin and other nephrotoxic agents. This interference can lead to a loss of diabetic control, so diabetic patients should be monitored closely if these drugs are initiated. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. Use of nonhormonal contraceptives advised. Dichlorphenamide inhibits OAT1. Serious - Use Alternative (2)apalutamide will decrease the level or effect of omeprazole by affecting hepatic enzyme CYP2C19 metabolism. If you are self-treating, tell your doctor if your heartburn lasts after 14 days or if you need to use this medication more than once every 4 months. Cytomel (liothyronine) can interfere with how other medications work, including calcium, blood thinners, insulin, and cholestyramine.Tell your provider or pharmacist about all the medications and supplements that you are currently taking. Minor/Significance Unknown. Minor (1)phenytoin decreases levels of acetaminophen by increasing metabolism. Avoid concomitant use of rivaroxaban with drugs that are combined P-gp and strong CYP3A4 inducers. Contraindicated. If loop diuretics and aminoglycosides are used together, it would be prudent to monitor renal function parameters, serum electrolytes, and serum aminoglycoside concentrations during therapy. carbamazepine will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Hydralazine: Uses, Interactions, Mechanism of Action carbamazepine will decrease the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. If you are planning pregnancy, become pregnant, or think you may be pregnant, discuss with your doctor right away the benefits and risks of using this medication during pregnancy. Dulaglutide: (Minor) Loop diuretics, such as bumetanide, furosemide, and torsemide, may cause hyperglycemia and glycosuria in patients with diabetes mellitus, probably due to diuretic-induced hypokalemia. Avoid or Use Alternate Drug. Drugs that are moderate-to-strong inhibitors of both CYP2C9 and CYP2C19 increase systemic exposure of abrocitinib and its active metabolites, which may increase adverse effects. Well-controlled hypertensive patients receiving pseudoephedrine at recommended doses do not appear at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. Use Caution/Monitor. A causal relationship between sulfonamide hypersensitivity and allergic reactions with non-arylamine sulfonamide derivatives has not been definitively established and remains controversial. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Promethazine; Phenylephrine: (Moderate) The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by diuretics. Avoid coadministration of abiraterone with strong CYP3A4 inducers; if a strong CYP3A4 inducer must be used, increase abiraterone dosage frequency from once daily to twice daily. carbamazepine will decrease the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. ketoconazole will increase the level or effect of phenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown. Use Caution/Monitor. Monitor Closely (2)dalteparin increases levels of phenytoin by unknown mechanism. Both corticosteroids and loop diuretics cause increased renal potassium loss. Well-controlled hypertensive patients receiving pseudoephedrine at recommended doses do not appear at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. NSAIDs may reduce the natriuretic effect of diuretics in some patients. Use Caution/Monitor.phenytoin will decrease the level or effect of fludrocortisone by P-glycoprotein (MDR1) efflux transporter. prescription products. Conflicting evidence regarding this interaction exists. Use Caution/Monitor. Avoid or Use Alternate Drug. CYP3A4 inducers increase rate of toremifene metabolism, lowering the steady-state concentration in serum. Avoid or Use Alternate Drug. Niacin, Niacinamide: (Moderate) Cutaneous vasodilation induced by niacin may become problematic if high-dose niacin is used concomitantly with other antihypertensive agents. Dextromethorphan; Diphenhydramine; Phenylephrine: (Moderate) The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by diuretics. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, ixekizumab could normalize the formation of CYP450 enzymes. Minor/Significance Unknown. Cefaclor: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. phenytoin, sodium oxybate. Contraindicated (1)carbamazepine will decrease the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. There are also case reports of quinolones increasing phenytoin levels. Use Caution/Monitor. Monitor plasma levels when used concomitantly. Do not double the dose to catch up. Use Caution/Monitor. Use Caution/Monitor. Increase belumosudil dosage to 200 mg PO BID when coadministered with strong CYP3A inducers. Careful monitoring of blood pressure is suggested during concurrent therapy of MAOIs with diuretics. Minor/Significance Unknown. 14 Volume of distribution. Minor (1)influenza virus vaccine trivalent, recombinant, phenytoin. Blood pressure and electrolytes should be routinely monitored. carbamazepine will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Vecuronium: (Moderate) Concomitant use of neuromuscular blockers and loop diuretics may prolong neuromuscular blockade, possibly due to hypokalemia or alterations in potassium concentrations across the end-plate membrane. Modify Therapy/Monitor Closely. Because cross-sensitivity with furosemide has rarely been observed, bumetanide can be substituted for furosemide in patients allergic to furosemide. St John's Wort will decrease the level or effect of omeprazole by affecting hepatic enzyme CYP2C19 metabolism. Comment: Methotrexate is partially bound to serum albumin, and toxicity may be increased because of displacement by certain drugs, such as phenytoin. The risk of side effects goes up over time. Minor/Significance Unknown. Minor/Significance Unknown. Seizures may become worse when the drug is suddenly stopped. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. Use Caution/Monitor. enzalutamide will decrease the level or effect of omeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. omeprazole will increase the level or effect of ibuprofen IV by affecting hepatic enzyme CYP2C9/10 metabolism. Consider decreasing the dose of these drugs when given coadministered with methylphenidate. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information. Additive hypotensive effects are possible. STORAGE: Store at room temperature away from light and moisture. phenytoin will decrease the level or effect of nirmatrelvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use Caution/Monitor.carbamazepine will decrease the level or effect of lansoprazole by affecting hepatic enzyme CYP2C19 metabolism. Concomitant use may increase the risk for hypotension or renal failure. Use Caution/Monitor. Avoid or Use Alternate Drug. informational and educational purposes only. Contraindicated. Use Caution/Monitor. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid. provider for the most current information. Avoid or Use Alternate Drug. Monitor Closely (1)carbamazepine increases toxicity of pitavastatin by Other (see comment). Use Caution/Monitor. Avoid coadministration of venetoclax with strong or moderate CYP3A inducers. Minor (1)phenytoin will decrease the level or effect of parecoxib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Levothyroxine Use Caution/Monitor. carbamazepine will decrease the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Enteric-coated budesonide dissolves at pH >5.5. loxapine will increase the level or effect of carbamazepine by decreasing metabolism. Monitor Closely (1)phenytoin decreases levels of mexiletine by increasing metabolism. There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time. Monitor Closely (1)cimetidine will increase the level or effect of phenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown. Use Caution/Monitor. Use Caution/Monitor. carbamazepine will decrease the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)carbamazepine will decrease the level or effect of macimorelin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid or Use Alternate Drug. Reduces anticoagulant effect by decreasing apixaban systemic exposure, carbamazepine will decrease the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use Caution/Monitor. Monitor serum potassium levels to determine the need for potassium supplementation and/or alteration in drug therapy. Monitor Closely (1)carbamazepine will decrease the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. phenytoin will decrease the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)modafinil will increase the level or effect of omeprazole by affecting hepatic enzyme CYP2C19 metabolism. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. Generic Name Propranolol DrugBank Accession Number DB00571 Background. St John's Wort will decrease the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Initially, 40 mg PO once daily, in the morning in combination with spironolactone; dose may be increased after 23 days if no clinical response. Coadministration of lorlatinib with strong CYP3A inducers is contraindicated. Use Caution/Monitor. CYP3A4 substrates may require dosage adjustment.Serious - Use Alternative (2)carbamazepine will decrease the level or effect of stiripentol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor Closely (2)omeprazole will increase the level or effect of fosphenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. carbamazepine will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Bacitracin; Polymyxin B: (Minor) Additive nephrotoxicity may occur with concurrent use of systemic bacitracin and other nephrotoxic agents. Max: 6 mg/kg/dose. oxcarbazepine will increase the level or effect of omeprazole by affecting hepatic enzyme CYP2C19 metabolism. Monitor Closely (1)pentobarbital will decrease the level or effect of phenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. It should be used with caution in patients with a history of pancreatitis. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed. Monitor Closely (1)phenytoin will decrease the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid or Use Alternate Drug. Loop diuretics can decrease the hypoglycemic effects of antidiabetic agents by producing an increase in blood glucose concentrations. Concomitant use increases the risk for developing hyponatremia. Maintenance dose range: 400-800 mg/day PO in divided doses; attempts to reduce or discontinue the drug should be made at least every 3 months throughout the treatment period. Ceftibuten: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. Levothyroxine / liothyronine is part of the Thyroxine / Triiodothyronine Combinations class and treats Thyroid Cancer, Hypothyroidism, and Goiter.