MajorAntiepileptics. Carboxamide derivatives×Immunosuppressants. Calcineurin inhibitors
Updated · Methodology
Mechanism
Carbamazepine induces CYP3A4 – the main cyclosporine metabolic route. Cyclosporine plasma levels drop sharply; immunosuppression weakens, raising transplant rejection risk.
Symptoms
Rejection symptoms depend on the organ: fever, graft tenderness, rising creatinine (kidney); jaundice and rising liver enzymes (liver); dyspnoea (heart, lungs). Symptoms appear 1–3 weeks after starting carbamazepine.
Management
Avoid the combination. Alternative anticonvulsants in transplant patients: levetiracetam, lamotrigine, or gabapentin (minimal CYP3A4 effect). If carbamazepine is unavoidable, measure cyclosporine levels 2–3 times weekly and increase the dose.
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 (carbamazepine) prescribing information (2009)– ; DailyMed setid 8d409411-aa9f-4f3a-a52c-fbcb0c3ec053
- AEMPS: Ficha técnica: Carbamazepina (nº registro 62621), sección 4.5 (2025)– AEMPS, CIMA, nº registro 62621, sección 4.5
- AEMPS: Ficha técnica: Ciclosporina (nº registro 78331), sección 4.5 (2026)– AEMPS, CIMA, nº registro 78331, revisión 06/2026, sección 4.5