Drug-Drug Interactions and Hot Flashes with This Medication Regimen
Direct Answer
Among these medications, Depo-Provera (medroxyprogesterone) can directly cause hot flashes as a known adverse effect, while gabapentin is actually used to treat hot flashes rather than cause them. Regarding drug-drug interactions, the most clinically significant concern is between Keppra (levetiracetam) and Depo-Provera, though this interaction is minimal compared to older antiepileptic drugs 1.
Hot Flashes Analysis
Medications That Cause Hot Flashes
- Depo-Provera (medroxyprogesterone acetate) is the primary culprit for hot flashes in this regimen, as hormonal contraceptives can cause vasomotor symptoms including hot flashes as a direct pharmacological effect 2.
Medications That Treat Hot Flashes
- Gabapentin is actually prescribed to reduce hot flashes, not cause them, and has established efficacy for vasomotor symptoms 3.
- Trazodone has no established association with causing hot flashes 4.
Medications Unlikely to Cause Hot Flashes
- Cimzia (certolizumab pegol) does not list hot flashes as a recognized adverse effect 5.
- Keppra (levetiracetam) does not cause hot flashes 6, 7.
Drug-Drug Interaction Analysis
Minimal Interaction Risk Profile
The good news is that this specific combination has a relatively low risk of significant drug-drug interactions because levetiracetam (Keppra) is one of the newer antiepileptic drugs that does not induce or inhibit cytochrome P450 enzymes 6, 7.
Specific Interaction Assessments
Keppra (Levetiracetam) with Other Medications
- Levetiracetam does not interact with hormonal contraceptives like Depo-Provera, unlike older antiepileptic drugs such as carbamazepine, phenytoin, and phenobarbital 1.
- Levetiracetam has no clinically significant interactions with gabapentin 7.
- No documented interactions exist between levetiracetam and trazodone 7.
Gabapentin Interactions
- Gabapentin and trazodone have been studied together and show no pharmacokinetic interaction at therapeutic doses 3.
- Gabapentin does not interact with hormonal contraceptives 1.
- Gabapentin has minimal interaction potential with other medications in this regimen 7.
Trazodone Interactions
- Trazodone does not significantly interact with gabapentin, as demonstrated in controlled pharmacokinetic studies 3.
- No clinically significant interactions between trazodone and levetiracetam have been documented 4.
Cimzia (Certolizumab Pegol) Interactions
- The primary concern with Cimzia is avoiding concurrent use with other biological disease-modifying antirheumatic drugs (DMARDs), not the medications listed in this regimen 5.
- Cimzia should not be used with live vaccines, but this does not apply to the other medications in this regimen 5.
Depo-Provera Interactions
- Depo-Provera does not interact with levetiracetam, gabapentin, or trazodone 1.
- The recommendation for more frequent dosing (every 10 weeks instead of 12) only applies when using enzyme-inducing antiepileptic drugs like carbamazepine, phenytoin, or phenobarbital—not levetiracetam 1.
Clinical Monitoring Recommendations
For Hot Flashes
- If hot flashes are problematic, consider that Depo-Provera is the likely cause and discuss alternative contraceptive options 2.
- The gabapentin in this regimen may actually provide some relief from hot flashes 3.
For Drug Interactions
- No dose adjustments are needed for any of these medications when used together 3, 7, 1.
- Standard dosing intervals for Depo-Provera (every 12 weeks) are appropriate with levetiracetam, unlike with enzyme-inducing antiepileptics 1.
- Monitor for additive CNS effects (sedation, dizziness) from the combination of gabapentin and trazodone, though pharmacokinetic interaction is absent 3.
Important Caveats
Immunosuppression Considerations
- Cimzia suppresses immune function and increases infection risk, which is independent of drug-drug interactions but clinically important 5.
- Avoid live vaccines while on Cimzia 5.
- Monitor for signs of infection, tuberculosis reactivation, and hepatitis B reactivation 5.