Changes

* Carbamazepine A synergistic effect is principally metabolized by CYP3A4 (also CYP2C8), but is also a potent inducer of CYP1A2, CYP3A4 and UDP-glucuronosyltransferasessuggested.* Valproic acid is principally metabolized by CYP2C9, CYP2C19, CYP2A6 and UDP-glucuronosyltransferases<ref name="freeman">{{Pubmed|9433333|Freeman et al. Valproic acid is an inhibitor Mood stabilizer Combinations: A Review of the enzymes CYP2C9, epoxide-hydroxylase Safety and UDPEfficacy. Am J Psychiatry 1998;155:12-glucuronosyltransferases.21}}</ref> 

* Define carbamazepine serum concentration (+ epoxide) before starting valproate. Check carbamazepine serum concentration (+ epoxide) again after 2 weeks and adapt dose if necessary. <ref name=”medicatiebewaking”> Schalekamp T. et al, Interacties met Psychofarmaca, Stichting Health Base, Houten, 2002. </ref> | cave =* Valproate can inhibit carbamazepine metabolic pathways, resulting in raised carbamazepine-epoxide concentrations. <ref> {{Pubmed|9241092|Bernus et al. The mechanism of the carbamazepine-valproate interaction in humans. Br J Clin Pharmacol 1997;44:21CombiCaVa}}</ref>