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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.

http://icnapedia.org/wiki/2767
APA Style
Expected changes in plasma concentrations when an AED is added to a pre-existing regimen. (n.d.). In ICNApedia. Retrieved June 18,2019 19:55:52 from http://icnapedia.org/wiki/neurolists/aed-plasma-concentration-changes
MLA Style
"Expected changes in plasma concentrations when an AED is added to a pre-existing regimen." ICNApedia: The Child Neurology Knowledge Environment, Inc. May 06, 2018. Web. June 18,2019 19:55:52
AMA Style
ICNApedia contributors. Expected changes in plasma concentrations when an AED is added to a pre-existing regimen. ICNApedia, The Child Neurology Knowledge Environment. May 06, 2018. Available at: http://icnapedia.org/wiki/neurolists/aed-plasma-concentration-changes.Accessed June 18,2019 19:55:52.

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