Adding carbamazepine to risperidone.
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- Risperidone is principally metabolized by CYP2D6 to an active metabolite 9-OH-risperidone (paliperidone).
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- Carbamazepine is principally metabolized by CYP3A4, and is a potent inducer of CYP1A2, CYP2C9, CYP3A4 and UDP-glucuronosyltransferases.
- Risperidone is principally metabolized by CYP2D6 to an active metabolite.
- Carbamazepine is principally metabolized by CYP3A4 (also CYP2C8), but is also a potent inducer of CYP1A2, 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.
- Coadministration with carbamazepine may decrease the plasma concentrations of risperidone and its pharmacologically active metabolite, 9-hydroxyrisperidone.
- Risperidone should be given at higher dosage to control psychotic symptoms. 
- Pharmacologic response and plasma risperidone levels should be monitored more closely whenever carbamazepine is added to or withdrawn from therapy. 
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