Interactions between antiepileptics and second-generation antipsychotics

Jose De Leon, Vincenza Santoro, Concetta D'Arrigo, Edoardo Spina

Research output: Contribution to journalReview articlepeer-review

70 Scopus citations


Introduction: Pharmacokinetic and pharmacodynamic drug interactions (DIs) can occur between antiepileptics (AEDs) and second-generation antipsychotics (SGAPs). Some AED and SGAP pharmacodynamic mechanisms are poorly understood. AEDSGAP combinations are used for treating comorbid illnesses or increasing efficacy, particularly in bipolar disorder. Areas covered: This article provides a comprehensive review of the interactions between antiepileptics and second-generation antipsychotics. The authors cover pharmacokinetic AEDSGAP DI studies, the newest drug pharmacokinetics in addition to the limited pharmacodynamic DI studies. Expert opinion: Dosing correction factors and measuring SGAP levels can help to compensate for the inductive properties of carbamazepine, phenytoin, phenobarbital and primidone. Further studies are needed to establish the clinical relevance of combining: i) AED strong inducers with amisulpride, asenapine, iloperidone, lurasidone and paliperidone; ii) valproate with aripiprazole, asenapine, clozapine and olanzapine; iii) high doses of oxcarbazepine (≥ 1500 mg/day) or topiramate (≥ 400 mg/day) with aripiprazole, lurasidone, quetiapine, risperidone, asenapine and olanzapine. Two pharmacodynamic DIs are beneficial: i) valproateSGAP combinations may have additive effects in bipolar disorder, ii) combining topiramate or zonisamide with SGAPs may decrease weight gain. Three pharmacodynamic DIs contributing to decreased safety are common: sedation, weight gain and swallowing disturbances. A few AEDSGAP combinations may increase risk for osteoporosis or nausea. Three potentially lethal but rare pharmacodynamic DIs include pancreatitis, agranulocytosis/leukopenia and heat stroke. The authors believe that collaboration is needed from drug agencies and pharmaceutical companies, the clinicians using these combinations, researchers with expertise in meta-analyses, grant agencies, pharmacoepidemiologists and DI pharmacologists for future progression in this field.

Original languageEnglish
Pages (from-to)311-334
Number of pages24
JournalExpert Opinion on Drug Metabolism and Toxicology
Issue number3
StatePublished - Mar 2012


  • Amisulpride
  • Anticonvulsants
  • Antipsychotics
  • Aripiprazole
  • Asenapine
  • Bipolar disorder
  • Carbamazepine
  • Clozapine
  • Drug interactions
  • Eslicarbazepine
  • Ethosuximide
  • Felbamate
  • Gabapentin
  • Iloperidone
  • Lacosamide
  • Lamotrigine
  • Levetiracetam
  • Lurasidone
  • Olanzapine
  • Oxcarbazepine
  • Paliperidone
  • Pharmacokinetics
  • Phenobarbital
  • Phenytoin
  • Pregabalin
  • Primidone
  • Quetiapine
  • Retigabine
  • Risperidone
  • Rufinamide
  • Stiripentol
  • Tiagabine
  • Topiramate
  • Valproate
  • Vigabatrin
  • Ziprasidone
  • Zonisamide

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology


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