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Dual Extracellular Recordings in the Mouse Hippocampus and Prefrontal Cortex
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Published on: February 16, 2024

Interaction between paliperidone and carbamazepine.

Norio Yasui-Furukori1, Kazutoshi Kubo, Masamichi Ishioka

  • 1Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan.

Therapeutic Drug Monitoring
|September 21, 2013
PubMed
Summary

Carbamazepine significantly lowers paliperidone levels in patients with schizophrenia, even at low doses. This drug interaction may impact treatment efficacy and requires careful monitoring.

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Published on: July 8, 2025

Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Psychiatry

Background:

  • Understanding drug-drug interactions is crucial for effective patient care.
  • Paliperidone is an antipsychotic medication used to treat schizophrenia.
  • Carbamazepine is an anticonvulsant medication with known enzyme-inducing properties.

Purpose of the Study:

  • To investigate the pharmacokinetic interaction between carbamazepine and paliperidone.
  • To determine the effect of varying carbamazepine doses on paliperidone plasma concentrations.

Main Methods:

  • A pharmacokinetic study involving six schizophrenic patients.
  • Patients received escalating doses of carbamazepine (200-600 mg/d) while on paliperidone.
  • Plasma concentrations were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS).

Main Results:

  • Carbamazepine significantly reduced paliperidone plasma concentrations in a dose-dependent manner.
  • Reductions ranged from 33.6% to 55.7% of baseline levels with carbamazepine coadministration.
  • The effect plateaued at carbamazepine doses above 400 mg/d, and psychotic symptoms worsened in some patients.

Conclusions:

  • Adjunctive carbamazepine treatment decreases paliperidone concentration.
  • This interaction is likely due to carbamazepine inducing drug-metabolizing enzymes and transporters.
  • Clinical implications include potential for reduced paliperidone efficacy when co-administered with carbamazepine.