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Diagonal Method to Measure Synergy Among Any Number of Drugs

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Multiple drug interaction across medical specializations.

¹M.D., Additional Professor & Head, Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India.

Indian Journal of Psychiatry

|April 2, 2011

Summary

Drug interactions can cause serious side effects. A patient on carbamazepine developed neurotoxicity after taking erythromycin and ketoconazole, highlighting the need for careful medication review across specialties.

Keywords:

Carbamazepine drug interaction erythromycin ketoconazole metabolic interactions neurotoxicity pharmacokinetic interactions

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Area of Science:

Pharmacology
Clinical Toxicology
Neuroscience

Background:

Carbamazepine is an antiepileptic drug often used as monotherapy.
Drug interactions can alter the pharmacokinetics and pharmacodynamics of medications.
Polypharmacy increases the risk of adverse drug events, especially in patients with chronic conditions.

Purpose of the Study:

To report a case of carbamazepine-induced neurotoxicity.
To investigate the pharmacokinetic interaction between carbamazepine, erythromycin, and ketoconazole.
To emphasize the importance of interdisciplinary communication in managing potential drug interactions.

Main Methods:

Case report of an epileptic patient.
Analysis of concurrent medication use (carbamazepine, erythromycin, ketoconazole).
Assessment of potential pharmacokinetic interactions based on known drug metabolism pathways.

Main Results:

The patient developed neurotoxicity while on high-dose carbamazepine monotherapy.
Concurrent use of erythromycin and ketoconazole likely inhibited carbamazepine metabolism.
This pharmacokinetic interaction led to elevated carbamazepine levels and toxicity.

Conclusions:

Drug interactions involving medications prescribed by different specialists can lead to severe adverse events.
Physicians must be aware of potential interactions, particularly with drugs affecting cytochrome P450 enzymes.
Interprofessional collaboration and comprehensive medication review are crucial for patient safety.