The
serum levels of amitriptyline, desipramine, doxepin, imipramine and nortripty- line, but possibly not clomipramine, can be reduced (halved or more) by the concurrent use of
carbamazepine but there is evidence to suggest that this is not necessarily clinically important.
It seems unlikely that any action is needed, but bear this interaction in mind in case of a reduced response to a tricyclic. Note that the
tricyclics can lower the convulsive threshold and should therefore be used with caution in patients with
epilepsy.