In addition, L-methylfolate plasma levels may be decreased when administered with primidone. Barbiturates should be used with caution to treat convulsions produced by acetylcholinesterase inhibitors. Coadministration with another strong CYP3A4 inducer decreased dapsone levels by 7-fold to 10-fold; in leprosy, this reduction has not required a change in dosage. Indinavir: (Major) Barbiturates may increase the metabolism of indinavir and lead to decreased antiretroviral efficacy. Phenobarbital sodium acidizes to synthesize thio Phenobarbital, iii. Barbiturates induce CYP3A4; fentanyl is a CYP3A4 substrate. Lurasidone is primarily metabolized by CYP3A4. 8 to 12 years: 2,000 mg/day PO.1 to 8 years: 25 mg/kg/day or 750 mg/day PO. Primidone is considered to have a low potential for abuse. Ritonavir is a CYP3A substrate and inducer and barbiturates are CYP3A inducers. The dosage requirements of amlodipine may be increased in patients receiving concurrent enzyme inducers; monitor blood pressure closely. Concomitant use may decrease the exposure of both drugs, resulting in reduced efficacy. Concomitant use may decrease nefazodone exposure. Lidocaine is a CYP3A4 and CYP1A2 substrate; phenobarbital, the active metabolite of primidone, induces both hepatic isoenzymes. The manufacturer recommends that delavirdine not be given with barbiturates when used as anticonvulsants due to the potential for subtherapeutic antiretroviral activity and the subsequent possibility for the development of resistant mutations of HIV. An enhanced effect of the displaced drug may occur. Coadministration may increase the risk of CNS depressant-related side effects. Stiripentol: (Major) Avoid coadministration of stiripentol with primidone. Dasabuvir (minor), paritaprevir, and ritonavir are substrates of this isoenzyme. Phenobarbital, which is a metabolite of primidone, directly interacts with GABA-A receptors and chloride channels. The text only version may be available in large print, Braille or audio CD . Delavirdine: (Major) Barbiturates may increase the metabolism of delavirdine, lead to substantial reductions in delavirdine concentrations and efficacy. (Minor) Chronic therapy with barbiturates can increase the metabolism and decrease the effectiveness of acetaminophen. Carbinoxamine; Pseudoephedrine: (Moderate) Additive CNS depression may occur if barbiturates are co-used with sedating antihistamines, such as carbinoxamine. Doravirine is a CYP3A4 substrate; primidone is a strong CYP3A4 inducer. Barbiturates are inducers of the hepatic isoenzyme CYP3A4; rilpivirine is metabolized by this isoenzyme. Monitor patients during concurrent use. Monitor patients for sedation or respiratory depression. Coadministration of strong CYP3A4 inducers decreases pitolisant exposure by 50%. A dose increase of the barbiturate may be necessary. Thyroid hormones: (Minor) Hepatic enzyme-inducing drugs, including barbiturates, can increase the catabolism of thyroid hormones. In addition, phenobarbital may induce P-glycoprotein (P-gp), a drug efflux transporter for which dasabuvir, ombitasvir, paritaprevir, and ritonavir are substrates. Additionally, barbiturates may increase the metabolism of chlordiazepoxide. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. Periodic monitoring of drug concentrations and evaluation of symptoms should be used to adjust doses, along with monitoring for adverse effects. Coadministration with other CNS depressants, including alcohol, can magnify CNS depression. Diphenhydramine; Naproxen: (Major) Because diphenhydramine can cause pronounced sedation, an enhanced CNS depressant effect may occur when it is combined with other CNS depressants including anxiolytics, sedatives, and hypnotics, such as barbiturates. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. (Minor) Chronic therapy with barbiturates can increase the metabolism and decrease the effectiveness of acetaminophen. Lurbinectedin is a CYP3A substrate and primidone is a strong CYP3A inducer. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. During acute overdoses, barbiturates can enhance the formation of toxic acetaminophen metabolites. Limit the use of opioid pain medications with barbiturates to only patients for whom alternative treatment options are inadequate. Cobimetinib is a CYP3A substrate in vitro; primidone is a strong inducer of CYP3A. During acute overdoses, barbiturates can enhance the formation of toxic acetaminophen metabolites. [52123] If used, monitor the neonate via serum primidone concentrations and clinical status.[63503]. Caution should be exercised during concomitant use of anxiolytics, sedatives, and hypnotics and any barbiturate. Everolimus: (Major) Avoid coadministration of everolimus with primidone due to the risk of decreased efficacy of everolimus. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Limit the use of opioid pain medications with barbiturates to only patients for whom alternative treatment options are inadequate. Coadministration with another strong CYP3A4 inducer decreased single-dose cabozantinib exposure by 77%. Rabeprazole: (Moderate) Concurrent administration of rabeprazole with barbiturates may result in decreased rabeprazole plasma concentrations; monitor for signs and symptoms of reduced rabeprazole efficacy. Primidone is a strong CYP3A4 inducer. Barbiturates induce CYP3A4; oxycodone is a CYP3A4 substrate. Barbiturates should be used cautiously in patients with renal impairment. (Minor) Chronic therapy with barbiturates can increase the metabolism and decrease the effectiveness of acetaminophen. Additionally, concomitant use of codeine with a barbiturate can decrease codeine concentrations, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. Cetirizine: (Moderate) Concurrent use of cetirizine/levocetirizine with barbiturates should generally be avoided. Gilteritinib: (Major) Avoid coadministration of gilteritinib and primidone due to the potential for decreased gilteritinib exposure and risk of decreased efficacy. Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Barbiturates may potentiate orthostatic hypotension when used concurrently with thiazide diuretics. For hormonal contraceptives, this interaction could result in unintended pregnancy or breakthrough bleeding. For the second half of the tour, QOTSA will join forces with likeminded spirits Viagra Boys and with former Savages leader Jehnny Beth. Elagolix is a CYP3A substrate; phenobarbital, the active metabolite of primidone, is a strong inducer of CYP3A. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. A double-blind controlled study", "Primidone inhibits TRPM3 and attenuates thermal nociception in vivo", "The newest TRP channelopathy: Gain of function TRPM3 mutations cause epilepsy and intellectual disability", "Microassay for primidone and its metabolites phenylethylmalondiamide, phenobarbital and p-hydroxyphenobarbital in human serum, saliva, breast milk and tissues by gas chromatography--mass spectrometry using selected ion monitoring", "Identification of p-hydroxyprimidone as a minor metabolite of primidone in rat and man", "Broad but distinct role of pregnane x receptor on the expression of individual cytochrome p450s in human hepatocytes", "The disposition of primidone in elderly patients", "The evaluation of "mysoline," a new anticonvulsant drug", "Clinical experience with new antiepileptic drugs: antiepileptic drugs in Europe", "Megaloblastic anemia following the use of primidone", "Megaloblastic anaemia and vitamin-B12 deficiency after anticonvulsant therapy; report of two cases", "Observations on megaloblastic anaemias after primidone", "Megaloblastic anaemia occurring during primidone therapy", "Folic acid in the treatment of pernicious anemia", "Drugs used in the management of epilepsy", "Valeant Pharmaceuticals International: Products", "Primidone 250 mg Tablets & Primidone 99.5% Powder", "Acorus Therapeutics Ltd. - Ordering - UK", "Toxicology and Carcinogenesis Studies of Primidone in F344/N Rats and B6C3F1 Mice (Feed Studies)", "Testing Status of Primidone (primaclone) 10270-A", 4-Aminopyridine (fampridine/dalfampridine), Transient receptor potential channel modulators, https://en.wikipedia.org/w/index.php?title=Primidone&oldid=1158078452, GABAA receptor positive allosteric modulators, Articles with dead external links from October 2010, Articles with dead external links from September 2018, Articles with permanently dead external links, Short description is different from Wikidata, Multiple chemicals in an infobox that need indexing, Drugboxes which contain changes to watched fields, Articles needing additional medical references from February 2018, All articles needing additional references, Articles requiring reliable medical sources, Wikipedia medicine articles ready to translate, Creative Commons Attribution-ShareAlike License 3.0, desoxyphenobarbital, desoxyphenobarbitone, This page was last edited on 1 June 2023, at 21:18. While not systematically studied, these drugs may induce the metabolism of bupropion and may decrease bupropion exposure. In subjects who received ixazomib with another strong CYP3A4 inducer, the ixazomib Cmax and AUC values were decreased by 54% and 74%, respectively. (Minor) Barbiturates may decrease the half-life and plasma concentrations of metronidazole. Additive CNS effects are possible, including drowsiness or dizziness. The clinical significance of this effect is uncertain. Alpelisib: (Major) Avoid coadministration of alpelisib with primidone due to decreased exposure to alpelisib which could decrease efficacy. Discontinuation of a barbiturate may increase the risk of seizures, serotonin syndrome, and the risk of opioid-related adverse reactions, such as fatal respiratory depression. Methyclothiazide: (Moderate) Barbiturates may potentiate orthostatic hypotension when used concurrently with thiazide diuretics. [7] It is taken by mouth. Taking these drugs together may decrease sofosbuvir plasma concentrations, potentially resulting in loss of antiviral efficacy. [6] How it works is not entirely clear. Required fields are marked *. The effect on oral verapamil is greater than for IV verapamil, but a significant increase in clearance has been noted for both verapamil dosage forms during concomitant administration of a barbiturate. In theory, the use of barbiturates and iloperidone may also result in an increase in iloperidone elimination as a result of the CYP inducing effects of barbiturates. Concomitant use may result in decreased plasma concentrations of dronabinol. Methazolamide can also increase the rate of excretion of weakly acidic drugs, such as barbiturates. Take primidone everyday in regularly spaced doses as ordered by your doctor. If coadministration cannot be avoided, monitor for decreased efficacy of ketoconazole; a ketoconazole dose increase may be necessary. Methylprednisolone: (Moderate) Coadministration may result in decreased exposure to methylprednisolone. Atogepant is a CYP3A substrate and barbiturates are strong CYP3A inducers. Monitor for decreased response to fluticasone during concurrent use. Estrogens affected by CYP3A inducers: (Major) Women taking both estrogens and barbiturates should report breakthrough bleeding to their prescribers. Barbiturates induce CYP3A4. Lovastatin: (Moderate) Barbiturates are significant hepatic CYP3A4 inducers. Therapy should be prescribed only after critical benefit-to-risk appraisal in patients with a history of adverse hematologic (i.e., agranulocytosis), hypersensitivity, or other adverse reactions to barbiturates or other anticonvulsants. If these drugs are used together, significant decreases in the plasma concentrations of the antiretrovirals may occur, resulting in reduction of antiretroviral efficacy and development of viral resistance. Prior to concurrent use of buprenorphine in patients taking a CNS depressant, assess the level of tolerance to CNS depression that has developed, the duration of use, and the patient's overall response to treatment. Mitotane: (Moderate) Mitotane can cause sedation, lethargy, vertigo, and other CNS side effects. Additionally, concomitant use of codeine with a barbiturate can decrease codeine concentrations, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. Patients and caregivers should be informed of the increased risk of suicidal thoughts and behaviors and should be advised to immediately report the emergence or worsening of depression, the emergence of suicidal thoughts or behavior, thoughts of self-harm, or other unusual changes in mood or behavior. Therefore, concurrent use of flibanserin and phenobarbital or other barbiturates, which are strong CYP3A4 inducers, is not recommended. Pralsetinib is a CYP3A substrate and primidone is a strong CYP3A inducer. According to the Beers Criteria, anticonvulsants are considered potentially inappropriate medications (PIMs) in geriatric patients with a history of falls or fractures and should be avoided in these patient populations, with the exception of treating seizure and mood disorders, since anticonvulsants can produce ataxia, impaired psychomotor function, syncope, and additional falls. Coadministration with another strong CYP3A4 inducer decreased exemestane exposure by 54%. Since primidone is used as an anticonvulsant, alcohol use may reduce seizure control. Currently, there are insufficient data to make dosing recommendations; however, predictions regarding this interaction can be made based on the drugs metabolic pathways. Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as barbiturates. Alprazolam is a CYP3A4 substrate and barbiturates are strong CYP3A4 inducers. [29], Anticonvulsants affect the bones in many ways. Quetiapine: (Major) Coadministration of barbiturates, potent CYP3A4 inducers, with quetiapine, a CYP3A4 substrate, may result in decreased exposure to quetiapine. Additionally, concurrent use of meperidine with a barbiturate may decrease meperidine plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to opioid agonists. Educate patients about the risks and symptoms of respiratory depression and sedation. Monitor for reduced efficacy of codeine and signs of opioid withdrawal. Coadministration with another strong CYP3A inducer decreased belumosudil exposure by 72% in healthy subjects. An enhanced effect of the displaced drug may occur. Atorvastatin; Ezetimibe: (Minor) CYP3A4 inducers like the barbiturates may decrease the efficacy of atorvastatin, a CYP3A4 substrate. There is a possibility of interaction with valerian at normal prescription dosages of sedatives and hypnotics. (Major) Do not administer tezacaftor; ivacaftor and primidone together; coadministration may reduce the efficacy of tezacaftor; ivacaftor. Palbociclib: (Major) Avoid coadministration of primidone with palbociclib due to decreased plasma concentrations of palbociclib, which may result in decreased efficacy. 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