Adding carbamazepine to lithium.
- Lithium is eliminated by the kidney for about 95%. Changes in the rate of excretion can cause unwanted effects.
- Carbamazepine is principally metabolized by CYP3A4, and is a potent inducer of CYP1A2, CYP2C9, CYP3A4 and UDP-glucuronosyltransferases.
- The addition of carbamazepine allowes patients to function better while maintaining lower lithium levels.
- The available data suggest that the combination of lithium and carbamazepine is safe and effective, especially for rapid-cycling patients.
- Lithium and carbamazepine may work synergistically.
- Patients receiving both lithium and carbamazepine experience better prophylaxis against bipolar episodes than patients treated with either medication alone.
- Start carbamazepine according to the general dosing advice.
- The combination may rarely cause neurotoxicity without increased plasma levels. 
- The combination of these two drugs is generally safe and effective, but it should be avoided for patients with comorbid CNS (central nervous system) disease. Cases of neurotoxicity and asterixis have been reported with the concomitant use of lithium and carbamazepine.
Farmacotherapeutisch Kompas - lithium (dutch)
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- WHO Collaborating Centre for Drug Statistics Methodology ATC=N03AF01
- Farmacotherapeutisch Kompas; Toxicologie (dutch)
- KNMP; Informatorium Medicamentorum 2015; Monografie "carbamazepine" (Dutch)
- Freeman et al. Mood stabilizer Combinations: A Review of Safety and Efficacy. Am J Psychiatry 1998;155:12-21
- Marcoux AW. Carbamazepine-lithium drug interaction. Ann Pharmacother 1996;30:547
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