{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:26:32Z","timestamp":1777418792008,"version":"3.51.4"},"reference-count":40,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2006,6,1]],"date-time":"2006-06-01T00:00:00Z","timestamp":1149120000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2006,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To present a case of carbamazepine toxicity induced by lopinavir\/ritonavir and nelfinavir.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary:<\/jats:title>\n                    <jats:p>A 50-year-old HIV-positive male developed excessive drowsiness secondary to carbamazepine when an antiretroviral regimen containing lopinavir\/ritonavir was introduced. The carbamazepine serum concentration increased 46%. Subsequently, the patient developed a possible adverse skin reaction to his antiretrovirals and was hospitalized. The protease inhibitor was changed to nelfinavir. Within 3 days, the patient again developed excessive drowsiness and became unsteady on his feet. This time, the carbamazepine serum concentration had increased by 53%. In both instances, the carbamazepine dosage was decreased by 33%, which resulted in resolution of symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Carbamazepine undergoes extensive hepatic metabolism. The major metabolic pathway involves oxidation of carbamazepine via CYP3A4 to an active metabolite, carbamazepine-10,11-epoxide. Protease inhibitors are well-known CYP3A4 inhibitors. Other cases of carbamazepine toxicity secondary to protease inhibitors are reviewed. A MEDLINE search (1966\u2013May 2006) revealed 4 cases of carbamazepine toxicity secondary to antiretrovirals. Carbamazepine serum concentrations increased two- to threefold from baseline. Vertigo, drowsiness, disorientation, ataxia, and vomiting occurred within 12 hours to 2 months, which resolved with reduction of the carbamazepine dosage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>An objective causality assessment suggests that our patient became drowsy and unsteady on his feet secondary to a carbamazepine\u2013protease inhibitor interaction. Lopinavir\/ritonavir and nelfinavir may decrease carbamazepine metabolism, causing an elevation in carbamazepine serum concentrations. Carbamazepine toxicity may be prevented by reducing the carbamazepine dosage by 25\u201350% when protease inhibitors are introduced. A carbamazepine serum concentration should be repeated 3\u20135 days after the protease inhibitors are started.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1345\/aph.1g630","type":"journal-article","created":{"date-parts":[[2006,5,23]],"date-time":"2006-05-23T23:55:03Z","timestamp":1148428503000},"page":"1190-1195","source":"Crossref","is-referenced-by-count":27,"title":["Carbamazepine Toxicity Induced by Lopinavir\/Ritonavir and Nelfinavir"],"prefix":"10.1177","volume":"40","author":[{"given":"Duane E","family":"Bates","sequence":"first","affiliation":[{"name":"Internal Medicine, Department of Pharmacy, Foothills Medical Centre, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J","family":"Herman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Calgary; Chief, Division of General Internal Medicine, Calgary Health Region; Head, Division of General Internal Medicine, University of Calgary, Calgary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2006,6,1]]},"reference":[{"key":"bibr1-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1D309"},{"key":"bibr2-aph.1G630","volume-title":"Carbamazepine","author":"McEvoy GK","year":"2003"},{"key":"bibr3-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1345\/aph.19211"},{"key":"bibr4-aph.1G630","volume-title":"Cytochrome P450 drug interaction table","author":"Flockhart D."},{"key":"bibr5-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1002\/j.1875-9114.1998.tb03830.x"},{"key":"bibr6-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1345\/aph.17332"},{"key":"bibr7-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1177\/096032719801701204"},{"key":"bibr8-aph.1G630","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-198510010-00004"},{"key":"bibr9-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1A363"},{"key":"bibr10-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200103293441307"},{"key":"bibr11-aph.1G630","first-page":"208","volume":"6","author":"Jackson A","year":"2004","journal-title":"AIDS Rev"},{"key":"bibr12-aph.1G630","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200363160-00003"},{"key":"bibr13-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"bibr14-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1345\/aph.10039"},{"key":"bibr15-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1097\/00002826-200007000-00009"},{"key":"bibr16-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1592\/phco.20.9.851.35206"},{"key":"bibr17-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200012010-00022"},{"key":"bibr18-aph.1G630","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200363080-00004"},{"key":"bibr19-aph.1G630","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200059030-00014"},{"key":"bibr20-aph.1G630","volume-title":"Viracept (nelfinavir)","author":"Product information.","year":"2004"},{"key":"bibr21-aph.1G630","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200342030-00002"},{"key":"bibr22-aph.1G630","volume-title":"Kaletra (lopinavir\/ritonavir)","author":"Product information.","year":"2005"},{"key":"bibr23-aph.1G630","volume-title":"DRUGDEX system","author":"Scott SA"},{"key":"bibr24-aph.1G630","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199631030-00004"},{"key":"bibr25-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.2001.01359.x"},{"key":"bibr26-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1046\/j.1528-1157.2002.41701.x"},{"key":"bibr27-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1111\/j.0013-9580.2003.06203.x"},{"key":"bibr28-aph.1G630","first-page":"645","volume":"30","author":"Wilensky AJ","year":"1989","journal-title":"Epilepsia"},{"key":"bibr29-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1996.tb00651.x"},{"key":"bibr30-aph.1G630","volume-title":"Topamax (topiramate)","author":"Product information","year":"2006"},{"key":"bibr31-aph.1G630","volume-title":"Topamax (topiramate)","author":"Product information","year":"2005"},{"key":"bibr32-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1053\/seiz.2001.0633"},{"key":"bibr33-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-200110000-00007"},{"key":"bibr34-aph.1G630","volume-title":"3TC (lamivudine)","author":"Product information","year":"2005"},{"key":"bibr35-aph.1G630","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200443090-00003"},{"key":"bibr36-aph.1G630","volume-title":"Viread (tenofovir)","author":"Product information","year":"2005"},{"key":"bibr37-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2000.110215"},{"key":"bibr38-aph.1G630","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.54.7.1404"},{"key":"bibr39-aph.1G630","unstructured":"Bartlett JG, Lane HC. 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