Table 7.

Potential DDIs between antiseizure medications and anxiolytics and a synthesis of results of clinical studies and case reports.

Anxiolytics	Effects of Antiseizure Medications on Anxiolytic Drugs (Affected Drug)
Diazepam	Information from Drug Compendia
	CYP3A4 and/or CYP2C19 induction or inhibition
	Carbamazepine Phenytoin Phenobarbital Oxcarbazepine Rufinamide Felbamate Cannabidiol Stiripentol Cenobamate	↓↓ ↓↓ ↓↓ ↓ ↓ ↑↑ ↑↑ ↓↓↑↑ ↓↓↑↑
	Clinical studies have confirmed that carbamazepine increases diazepam metabolism, although without significantly decreasing its effect. In an experimental study, valproic acid resulted to inhibit diazepam metabolism and to increase its free fraction. In previous studies, it has also been reported that diazepam induces phenobarbital metabolism (not reported in drug compendia)
Chlordiazepoxide	Information from Drug Compendia
	CYP3A4 induction or CYP3A5 induction/inhibition
	Carbamazepine Phenytoin Phenobarbital Stiripentol	↓↓ ↓↓ ↓↓ ↓↓↑↑
	No DDIs studies on humans or case reports in the literature
Clorazepate	Information from Drug Compendia
	CYP3A4 induction or CYP3A4 induction/inhibition
	Carbamazepine Phenytoin Phenobarbital Cenobamate Stiripentol	↓↓ ↓↓ ↓↓ ↓↓ ↓↓↑↑
	No DDIs studies in humans or case reports have been described
Lorazepam	Information from Drug Compendia
	UGT2B7 inhibition
	Cannabidiol	↑↑
	No DDIs studies in humans or case reports have been described
Alprazolam	Information from Drug Compendia
	CYP3A4 induction or CYP3A4 induction/inhibition
	Carbamazepine Cenobamate Eslicarbazepine acetate Oxcarbazepine Phenytoin Phenobarbital Rufinamide Topiramate Stiripentol	↓↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓↓↑↑
	In a pharmacokinetic study, carbamazepine has significantly increased alprazolam clearance
Buspirone	Information from Drug Compendia
	CYP3A4 induction or CYP3A4 induction/inhibition
	Carbamazepine Cenobamate Phenytoin Phenobarbital Topiramate Oxcarbazepine Rufinamide Stiripentol	↓↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓↓ ↓↓↑↑
	No DDIs studies in humans or case reports have been described

Note: All searches were performed through consultation of Medscape Interaction checker [9] and RxList [10] and in the SmPC or FDA PI of each drug. A more detailed description of clinical studies and relative references is reported in the text.

(↓): mild, (↓↓): moderate; (↓↓↓): severe decrease of plasma concentrations. (↑): mild, (↑↑): moderate, (↑↑↑): severe increase of plasma concentration; (↓↑): opposite effects on drug concentrations may be expected.