Adding topiramate to carbamazepine.
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- Carbamazepine is principally metabolized by CYP3A4, and is a potent inducer of CYP1A2, CYP2C9, CYP3A4 and UDP-glucuronosyltransferases.
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- Topiramate induces CYP3A4 and is an inhibitor of CYP2C19.
- Carbamazepine can increase topiramate clearance. By adding topiramate to carbamazepine no dose adaptation is necessary.   
- This combination of drugs is subject to pharmacokinetic drug interactions. Discontinuation or dose reduction of either drug will need monitoring of the clinical effects and dose adaptation of the drug remained.
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