MajorTricyclic antidepressants (TCA)×Antiepileptics. Carboxamide derivatives
Updated · Methodology
Mechanism
Carbamazepine is a potent inducer of CYP3A4 and other phase I and phase II liver enzymes (carbamazepine SmPC). It speeds up the metabolism of tricyclic antidepressants, their plasma levels fall and the antidepressant response weakens (amitriptyline SmPC).
Symptoms
Return of depressive symptoms or neuropathic pain. In depression: relapse risk.
Management
Per the carbamazepine SmPC, adjust the amitriptyline dose to clinical response. After carbamazepine is started or its dose changed, watch for return of depressive symptoms or pain; if they return, increase the amitriptyline dose. The FDA label also allows monitoring amitriptyline plasma levels. When carbamazepine is stopped, induction wears off, so review the amitriptyline dose again.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Tegretol / Tegretol-XR (carbamazepine) prescribing information (2026)– FDA label, DailyMed setid 8d409411-aa9f-4f3a-a52c-fbcb0c3ec053, PRECAUTIONS, Drug Interactions
- AEMPS: Ficha técnica de Carbamazepina Normon 400 mg comprimidos (2026)– AEMPS CIMA, nregistro 62621, secciones 4.3, 4.5
- AEMPS: Ficha técnica de Tryptizol 10 mg comprimidos (amitriptilina) (2026)– AEMPS CIMA, nregistro 51064, secciones 4.5