Final answer:
Carbamazepine is contraindicated with drugs that strongly affect hepatic enzymes like CYP3A4, MAOIs, and other highly protein-bound drugs with narrow therapeutic ranges. It is also contraindicated in patients with bone marrow suppression, those with the HLA-B*1502 allele, and those with hypersensitivity to the drug.
Step-by-step explanation:
Carbamazepine is an anticonvulsant and mood-stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder. It can also be used for neuropathic pain. Carbamazepine has several contraindications due to its effect on the liver enzymes and potential interaction with other drugs. First, it is contraindicated with drugs that are strong inducers or inhibitors of hepatic enzymes, particularly cytochrome P450 isozymes such as CYP3A4, because carbamazepine is primarily metabolized by this enzyme. Drugs that inhibit CYP3A4 can lead to significantly increased plasma levels of carbamazepine and an increased risk of toxicity, while inducers can decrease its plasma levels and effectiveness.
Additionally, carbamazepine is contraindicated with monoamine oxidase inhibitors (MAOIs), as concurrent use may lead to severe hypertensive reactions.
Because carbamazepine can cause plasma protein binding changes for itself and other drugs, it is contraindicated with drugs that have a narrow therapeutic range and are highly protein-bound, as these medications' plasma concentrations may be unpredictably altered, resulting in either subtherapeutic effects or toxicity.
It is also contraindicated in patients with a history of bone marrow suppression, in those who carry the HLA-B*1502 allele due to the increased risk of serious dermatological reactions, and in patients with known hypersensitivity to the drug.