MODERATE — Monitor Closely
CAUTION — bidirectional interaction, monitor both
Evidence level: STRONG
Tegretol and Paxil have a complex two-way interaction.
Carbamazepine induces CYP enzymes reducing paroxetine levels. Paroxetine may inhibit CYP2D6 affecting carbamazepine metabolism.
Monitor carbamazepine levels and mood. Both may need dose adjustments.
Some SSRIs inhibit CYP enzymes that metabolize antiepileptics — fluoxetine and fluvoxamine are the biggest offenders, potentially raising levels of phenytoin or carbamazepine. Take each at their prescribed times. Monitor for signs of antiepileptic toxicity (dizziness, double vision, nausea) when adding an SSRI.
Active psychiatric illness
Depression breakthrough or carbamazepine toxicity
Monitor carbamazepine levels when adding/changing SSRIs.
Discuss this combination with your prescriber. They may adjust timing, dosing, or switch to an alternative with fewer interaction risks. Never stop an antidepressant abruptly — taper under medical guidance.
Tegretol and Paxil have a complex two-way interaction.
Some SSRIs inhibit CYP enzymes that metabolize antiepileptics — fluoxetine and fluvoxamine are the biggest offenders, potentially raising levels of phenytoin or carbamazepine. Take each at their prescribed times. Monitor for signs of antiepileptic toxicity (dizziness, double vision, nausea) when adding an SSRI.
Depression breakthrough or carbamazepine toxicity
Discuss this combination with your prescriber. They may adjust timing, dosing, or switch to an alternative with fewer interaction risks. Never stop an antidepressant abruptly — taper under medical guidance.
Monitor carbamazepine levels when adding/changing SSRIs.
Or browse the full interaction database (121,000+ pairs).