Changes

* Valproic acid A synergistic effect is principally metabolized by CYP2C9, CYP2C19, CYP2A6 and UDP-glucuronosyltransferasessuggested.<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 UDP-glucuronosyltransferasesEfficacy. * Carbamazepine is principally metabolized by CYP3A4 (also CYP2C8), but is also a potent inducer of CYP1A2, CYP3A4 and UDPAm J Psychiatry 1998;155:12-glucuronosyltransferases.21}}</ref>* 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.

* Valproate can increase carbamazepine-epoxide serum concentrations. Define valproate serum concentration before starting carbamazepine. * Start carbamazepine according to the general dosing advice. Check valproate and carbamazepine serum concentration (+ epoxide) after 2 weeks of therapy and adapt dose if necessary.| cave = * Carefully monitoring for clinical and laboratory evidence of altered effects is recommended, particularly when the dosage of either drug is changed. <ref name=”medicatiebewaking”> Schalekamp T. et al, Interacties met Psychofarmaca, Stichting Health Base, Houten, 2002. </ref> <ref name| cave =”bazire”> Bazire S, Psychotropic Drug Directory 2007, HealthComm UK Limited, Aberdeen, 2007. </ref>{{CombiCaVa}}