<p>Carbamazepine is largely metabolized in the liver. CYP3A4 hepatic enzyme is the major enzyme that metabolizes carbamazepine to its active metabolite, carbamazepine-10,11-epoxide<sup class="text-reference-group"><a class="reference-popover-link" data-content="Yoshimura R, Yanagihara N, Terao T, Minami K, Toyohira Y, Ueno S, Uezono Y, Abe K, Izumi F: An active metabolite of carbamazepine, carbamazepine-10,11-epoxide, inhibits ion channel-mediated catecholamine secretion in cultured bovine adrenal medullary cells. Psychopharmacology (Berl). 1998 Feb;135(4):368-73. (PubMed ID 9539261)" href="#reference-A180427">12</a></sup>, which is further metabolized to its trans-diol form by the enzyme epoxide hydrolase.<sup class="text-reference-group"><a class="reference-popover-link" data-content="FDA Approved Drug Products: EQUETRO (carbamazepine) extended-release capsules" href="#reference-L1335">16</a></sup> Other hepatic cytochrome enzymes that contribute to the metabolism of carbamazepine are CYP2C8, CYP3A5, and CYP2B6.<sup class="text-reference-group"><a class="reference-popover-link" data-content="Pharm KGB, carbamazepine pathway, pharmacokinetics" href="#reference-L7195">17</a></sup> Carbamazepine also undergoes hepatic glucuronidation by UGT2B7 enzyme and several other metabolic reactions occur, resulting in the formation of minor hydroxy metabolites and quinone metabolites.<sup class="text-reference-group"><a class="reference-popover-link" data-content="Pharm KGB, carbamazepine pathway, pharmacokinetics" href="#reference-L7195">17</a></sup> Interestingly, carbamazepine induces its own metabolism.<sup class="text-reference-group"><a class="reference-popover-link" data-content="FDA Approved Drug Products: EQUETRO (carbamazepine) extended-release capsules" href="#reference-L1335">16</a></sup> This leads to enhanced clearance, reduced half-life, and a reduction in serum levels of carbamazepine.<sup class="text-reference-group"><a class="reference-popover-link" data-content="Tolou-Ghamari Z, Zare M, Habibabadi JM, Najafi MR: A quick review of carbamazepine pharmacokinetics in epilepsy from 1953 to 2012. J Res Med Sci. 2013 Mar;18(Suppl 1):S81-5. (PubMed ID 23961295)" href="#reference-A180301">3</a>,<a class="reference-popover-link" data-content="FDA Approved Drug Products: EQUETRO (carbamazepine) extended-release capsules" href="#reference-L1335">16</a></sup></p><p class="d-none d-sm-block"><strong>Hover over products below to view reaction partners</strong></p>