Clozapine, haloperidol and risperidone plasma levels can be roughly halved by carbamazepine. Aripiprazole, bromperidol, fluphenazine, olanzapine, quetiapine, sertindole, and tiotixene levels are also reduced by carbamazepine. An increase in the serum levels of carbamazepine or its epoxide metabolite (which is thought to cause some of the adverse effects of carbamazepine) has been reported in patients given loxapine, haloperidol, quetiapine, risperidone, or chlorpromazine with amoxapine. Toxicity has occurred. Isolated cases of Stevens-Johnson syndrome and the neuroleptic malignant syndrome have occurred in patients taking antipsychotics with carbamazepine.
Monitor carbamazepine levels if loxapine, haloperidol, quetiapine, risperidone, or chlorpromazine are given. Also monitor concurrent use to ensure that the antipsychotics remain effective, (especially risperidone, clozapine and haloper- idol). The manufacturers recommend using double the dose of aripiprazole in patients taking carbamazepine. The risk of Stevens-Johnson syndrome seems to be highest during the first 2 weeks of treatment and appears to be mostly confined to the first 8 weeks of treatment. Also note that the combination of clozapine and carbamazepine is predicted to increase agranulocytosis and one case of fatal pancytopenia has been reported. It is also important to consider the seizure potential when prescribing antipsychotic medications.
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