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Interactions between prim done, carbamazepine, and nicotinamide

Division of Clinical Neuropharmacology (Drs. Bourgeois, Dodson, and Ferrendelli), the Department of Neurology and Neurological Surgery (Neurology) (Drs. Bourgeois, Dodson, and Ferrendelli), the Edward Mallinckrodt Department of Pediatrics (Drs. Bourgeois and Dodson), and the Department of Pharmacology (Dr. Ferrendelli), Washington University School of Medicine, and the Division of Pediatric Neurology (Drs. Bourgeois and Dodson), St. Louis Children's Hospital, St. Louis, MO.

The effect of nicotinamide on the conversion of primidone to phenobarbital was0 studied in mice and in three epileptic patients. In mice, 200 mg per kilogram of nicotinamide increased the half-life of primidone by 47.6%, and the conversion to phenobarbital and phenylethylmalonamide was decreased by 32.4% and 14.5%, respectively. Nicotinamide also decreased the conversion of primidone to phenobarbital in patients. The dose of nicotinamide correlated directly with the primidone:phenobarbital ratio (r = 0.861, p < 0.01). Nicotinamide also increased carbamazepine levels in two patients treated with this drug. The data demonstrate that nicotinamide inhibits metabolism of primidone in mice and metabolism of primidone and carbamazepine in humans. This probably occurs by inhibition of cytochrome P-450 by nicotinamide.

Address correspondence and reprint requests to Dr. Bourgeois. Schweizerische Epilepsie-Klinik, Bleulerstrasse 60. CH-8008 Zurich, Switzerland.

Supported in part by NIH Grants Nos. RR-00954 and NS-14834. Dr. Bourgeois is the recipient of a Merritt-Putnam Clinical Research Fellowship of the Epilepsy Foundation of America.

Presented at the thirty-fourth annual meeling of the American Academy of Neurology. Washington, DC, April 1982.

Accepted for publication March 10. 1982.