Adding carbamazepine to olanzapine.
- Olanzapine is principally metabolized by CYP1A2 and CYP2D6.
- Carbamazepine is principally metabolized by CYP3A4, and is a potent inducer of CYP1A2, CYP2C9, CYP3A4 and UDP-glucuronosyltransferases.
- This combination of drugs may have possible synergistic effects. However, the pharmacokinetic drug interactions will influence the plasma levels. Dose adaptation will be recommended for this combination.
- Consider alternative for carbamazepine, otherwise start carbamazepine according to the general dosing advice.
- Check clinical effect or olanzapine plasma concentration after 2 weeks and adapt dose if necessary.  
- Close clinical monitoring for evidence of altered olanzapine effect is recommended in patients receiving carbamazepine.
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