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  • Expected changes in plasma concentrations when an AED is added to a pre-existing regimen

Expected changes in plasma concentrations when an AED is added to a pre-existing regimen

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AED drug interactions
Expected changes in plasma concentrations when an AED is added to a pre-existing regimen
AED added PB PHT PRM ETS CBZ VPA OXC LTG GBP TPM TGB LEV ZNS VGB FBM
PB - PHT ↑↓ NCCP ETS ↓↓ CBZ ↓↓ VPA ↓↓ H-OXC ↓ LTG ↓↓ ↔ TPM ↓↓ TGB ↓↓ ↔ ZNS ↓↓ ↔ FBM ↓↓
PHT PB ↑ - PRM ↓ PB ↑ ETS ↓↓ CBZ ↓↓ VPA ↓↓ H-OXC ↓ LTG ↓↓ ↔ TPM ↓↓ TGB ↓↓ ↔ ZNS ↓↓ ↔ FBM ↓↓
PRM NCCP PHT ↑↓ - ETS ↓↓ CBZ ↓↓ VPA ↓↓ ? LTG ↓↓ ↔ TPM ↓↓ TGB ↓↓ ↔ ZNS ↓↓ ↔ FBM ↓↓
ETS ↔ ↔ NE - ↔ VPA ↓ NE NE NE NE NE NE NE NE NE
CBZ ↔ PHT I↓ PRM ↓ PB ↑ ETS ↓↓ - VPA ↓↓ H-OXC ↓ LTG ↓↓ ↔ TPM ↓↓ TGB ↓↓ ↔ ZNS ↓↓ NE FBM ↓↓
VPA PB ↑↑ PHT ↓* PB ↑↑ ETS I↓ CBZ-E ↑ - ↔ LTG ↑↑ ↔ TPM ↓ EE ↔ ↔ NE ↔
OXC PB ↑ PHT ↑ ? ? CBZ ↓ ↔ - LTG ↓ NE ? ? NE ? NE ?
LTG ↔ ↔ NE NE ↔ ↔ NE - NE NE NE ↔ ↔ NE NE
GBP ↔ ↔ NE NE ↔ ↔ NE NE - NE NE ↔ NE NE NE
TBP ↔ PHT ↑ ↔ NE ↔ VPA ↓ ? ? NE - ? NE ? NE ?
TGB ↔ ↔ ↔ NE ↔ ↔ NE NE NE NE - NE NE NE NE
LEV ↔ ↔ ↔ NE ↔ ↔ NE ↔ ↔ NE NE - NE NE NE
ZNS ↔ ↔ NE NE CBA ↑↓ ↔ ? ↔ NE NE NE NE - NE ?
VGB PB ↓ PHT ↓ PRM ↓ PB ↓ NE CBZ ↑ ↔ NE NE NE NE NE NE NE - NE
FBM PB ↑↑ PHT ↑↑ ? ? CBZ ↓ CBZ-E ↑ VPA ↑↑ ↔ ↔ NE ? ? NE ? ↔ -

PB = Phenobarbital; PHT = phenytoin; PRM = Primidone; ETS = Ethosuximide; CBZ = Carbamazepine; VPA = Valproic acid; OXC = Oxcarbazepine; LTG = Lamotrigine

GBP = Gabapentin; TPM = Topiramate; TGB = Tiagabine; LEV = Levetiracetam; ZNS = Zonisamide; VGB = Vigabatrin; FBM = felbamate
H-OXO = 10-hydroxy-oxcarbazepine(active metabolite of OXC); CBZ-E = Cabamazepine 10,11 epoxide
NE = None Expected; * Free (pharmacologically active) concentration may increase; NCCP = not commonly coprescribed; ↔ = No change; ↓ = a minor (or inconsistent) decrease in plasma concentration; 
↓↓ = a clinically significant decrease in plasma concentration; ↑ = a minor (or inconsistent) increase in plasma concentration; ↑↑ = a clinically significant increase in plasma concentration.  

Source: Patsalos PN, Perucca E (2003) Clinically important drug interactions in epilepsy: general features and interactions between antiepileptic drugs.Lancet Neurol 2 (6):347-56. PMID: 12849151.

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