MajorAntiepileptics. Carboxamide derivatives×Calcineurin inhibitor (immunosuppressant)
Updated · Methodology
Mechanism
Carbamazepine strongly induces CYP3A4 and P-glycoprotein. Tacrolimus plasma levels fall 2- to 3-fold; immunosuppression is lost, raising rejection risk.
Symptoms
Rejection symptoms depend on the organ: fever, graft tenderness, rising creatinine (kidney); jaundice and rising liver enzymes (liver). Symptoms appear 1–3 weeks after starting carbamazepine.
Management
Avoid the combination. Alternative anticonvulsants without induction: levetiracetam, lamotrigine, gabapentin. If carbamazepine is unavoidable, raise tacrolimus 2- to 3-fold with trough (C0) twice weekly.
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 (2018)– ; DailyMed setid 8d409411-aa9f-4f3a-a52c-fbcb0c3ec053
- AEMPS: Ficha técnica: Tacrolimus (nº registro 84607), sección 4.4 (2026)– AEMPS, CIMA, nº registro 84607, revisión 03/2026, sección 4.4