Table 8.

Selection of possible clinical consequences (loss of efficacy or adverse effects) caused by DDIs between antiseizure and psychiatric medications.

Drug Interaction	Clinical Consequence	Mechanism of Interaction	Refs.
Nortriptyline-carbamazepine	Inefficacy	Carbamazepine induces nortriptyline metabolism with a consequent decrease by more than 50% of its concentrations and loss of efficacy	[35]
Clomipramine-valproic acid	Status epilepticus	Inhibition of clomipramine metabolism and increased clomipramine free fraction by valproic acid coadministration may lead to toxic clomipramine levels with consequent proconvulsant effects	[29]
Clozapine-valproic acid	Myocarditis	This idiosyncratic adverse drug reaction has been associated with rapid clozapine titration. Valproic acid inhibits clozapine metabolism and increases the frequency of this reaction	[102, 103]
Quetiapine-carbamazepine	Ataxia	Quetiapine may inhibit epoxide hydrolase and/or glucuronidation of carbamazepine epoxide leading to toxic levels of the main active carbamazepine metabolite	[124]
Alprazolam-carbamazepine	Loss of anxiolytic effect	Carbamazepine induces alprazolam metabolism leading to more than 50% reduction of alprazolam concentrations and loss of efficacy	[146]