Primidone-carbamazepine interaction: clinical consequences.

A 15-year old boy, suffering from partial complex seizures, was treated with primidone (PR) and carbamazepine (CBZ). In spite of daily doses in the usual range (PR = 12 mg/kg, CBZ = 30 mg/kg), he was not free from seizures and serum levels of CBZ were remarkably low (4.8 micrograms/ml). A good control of seizures was obtained after gradually stopping treatment with PR. This lead to a substantial increase of CBZ serum levels to a decrease of carbamazepine-10, 11-epoxide levels and a 60% reduction in total CBZ clearance.