title: Effect of felbamate on plasma levels of carbamazepine and its metabolites.
abstract: Felbamate (FBM) is a novel antiepileptic drug (AED) currently undergoing clinical evaluation in the United States. During a controlled clinical trial conducted at the National Institutes of Health Clinical Center, FBM was added to constant carbamazepine (CBZ) monotherapy. CBZ total concentrations were reduced during active FBM treatment (mean reduction 25%, range 10-42%, p less than 0.001). The effect was evident after the first week of treatment and reached a plateau in 2-4 weeks. To clarify the interaction mechanism, free and total concentrations of CBZ and its plasma metabolites were determined by high-performance liquid chromatography (HPLC) and ultrafiltration in four patients. In these patients, FBM treatment reduced CBZ concentrations and increased CBZ-epoxide (CBZ-E) concentrations (p less than 0.01). Free fractions of all compounds were unmodified. FBM appears to be capable of inducing CBZ metabolism. CBZ-FBM interaction may be clinically relevant.
authors.affiliation: Preclinical Pharmacology Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.
authors.forename: F
authors.initials: F
authors.lastname: Albani
authors.forename: W H
authors.initials: WH
authors.lastname: Theodore
authors.forename: P
authors.initials: P
authors.lastname: Washington
authors.forename: O
authors.initials: O
authors.lastname: Devinsky
authors.forename: E
authors.initials: E
authors.lastname: Bromfield
authors.forename: R J
authors.initials: RJ
authors.lastname: Porter
authors.forename: F J
authors.initials: FJ
authors.lastname: Nice
mesh_terms: D000927:Anticonvulsants / Q000494:pharmacology*; D002220:Carbamazepine / Q000031:analogs & derivatives / Q000097:blood* / Q000378:metabolism / Q000494:pharmacology; D002851:Chromatography, High Pressure Liquid; D004311:Double-Blind Method; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000097:blood / Q000188:drug therapy; D000078328:Felbamate; D006801:Humans; D048448:Phenylcarbamates; D010919:Placebos; D011409:Propylene Glycols / Q000494:pharmacology* / Q000627:therapeutic use; D014462:Ultrafiltration
chemical_list: D000927:Anticonvulsants; D048448:Phenylcarbamates; D010919:Placebos; D011409:Propylene Glycols; D002220:Carbamazepine; C004822:10,11-dihydro-10,11-dihydroxy-5H-dibenzazepine-5-carboxamide; C012227:carbamazepine epoxide; D000078328:Felbamate