Adding carbamazepine to aripiprazole.
- Aripiprazole is metabolized by CYP2D6 and CYP3A4 to an active metabolite.
- Carbamazepine is principally metabolized by CYP3A4, and is a potent inducer of CYP1A2, CYP2C9, 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 aripiprazole via induction of CYP450 3A4 and p-glycoprotein.
- Aripiprazole should be given at higher dosage to control psychotic symptoms. 
- Pharmacologic response and plasma aripiprazole levels should be monitored more closely whenever carbamazepine is added to or withdrawn from therapy. 
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