Major
Atorvastatin × Carbamazepine
HMG-CoA reductase inhibitors (statins)×Antiepileptics. Carboxamide derivatives
Mechanism
Carbamazepine induces CYP3A4 – the main atorvastatin metabolic route. Atorvastatin plasma levels fall by 30–60%; lipid-lowering effect drops proportionally.
Symptoms
The patient feels nothing. Laboratory: LDL cholesterol and total cholesterol rise. In high cardiovascular risk patients, myocardial infarction and stroke risk increase.
Management
During carbamazepine therapy, increase atorvastatin 1.5- to 2-fold with lipid profile and creatine kinase monitoring, or switch to pravastatin (CYP3A4-independent). Alternative anticonvulsants without induction: levetiracetam, lamotrigine.
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.