Antiseizure

Carbamazepine and oxcarbazepine

Two HLA alleles, two different reactions, and recommendations that name populations rather than applying to everybody. The population part is not a footnote on the guidance — it is the guidance.

What this drug connects to

The genes involved

HLA-B

Drug-Induced Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis →

HLA-B*15:02 is strongly associated with a greater risk of Stevens–Johnson syndrome and toxic epidermal necrolysis in people treated with carbamazepine or oxcarbazepine. A separate allele, HLA-A*31:01, is associated with a greater risk of maculopapular exanthema, DRESS and SJS/TEN with carbamazepine. CPIC issued recommendations for the use of both drugs based on HLA genotype in its 2017 update. Allele frequencies differ substantially between populations, and this is a test ordered by a prescriber before a first dose — not something to act on from a consumer raw data file.

CPIC Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update (Clin Pharmacol Ther 2018, PMID 29392710).

In the news

2007-12-12 · FDA alert on carbamazepine and HLA-B*1502

FDA Alerts Health Professionals to Genetic Risk Factor for Serious Skin Reactions with Carbamazepine

The FDA added a boxed warning recommending HLA-B*1502 genotyping before starting carbamazepine in patients with ancestry across broad areas of Asia -- this page's own allele. Carriers face roughly a 10-fold higher risk of Stevens-Johnson syndrome and toxic epidermal necrolysis, severe skin reactions, than the baseline risk in white patients (about 1-6 per 10,000 exposed).

Whose work this rests on

Every guideline above was written by people. Named here because they are contributors to this page in the same sense anybody else on this site is.

Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update

Phillips EJ, Sukasem C, Whirl-Carrillo M, Müller DJ, Dunnenberger HM, Chantratita W, Goldspiel B, Chen YT, Carleton BC, George AL Jr, Mushiroda T, Klein T

and 2 more — show all

Gammal RS, Pirmohamed M

Clinical pharmacology and therapeutics · 2018 · PMID 29392710

Variants MyGeneLog™ reports for these genes

These are the positions in your own file that carry the genes above. Not every gene in a guideline is one we report — where that is the case the gene appears above without a variant here, and the note says so.

Waist-hip index

HLA-B · rs2442725

alpha-2-macroglobulin receptor-associated protein levels

HLA-B · rs41559422

Psoriasis

HLA-B · rs115860766

Primary sclerosing cholangitis (MTAG)

HLA-B · rs2523593

Serine protease 57 levels

HLA-B · rs546481845

Psoriasis

HLA-B · rs4947313

Serum levels of protein PRSS57

HLA-B · rs3177747

TNFSF13 protein levels

HLA-B · rs35173808

MHC class I polypeptide-related sequence A levels

HLA-B · rs13213324

KLRB1 protein levels

HLA-B · rs2249932

Psoriasis

HLA-B · rs2844579

Psoriasis

HLA-B · rs2596546

Sjögren's syndrome

HLA-B · rs2523571

GP1BB protein levels

HLA-B · rs116138399

TEK protein levels

HLA-B · rs547627056

Height (baseline)

HLA-B · rs9266198

Mouth ulcers

HLA-B · rs76518703

Hip circumference adjusted for BMI

HLA-B · rs9265940

CFB protein levels

HLA-B · rs115497794

Psoriasis

HLA-B · rs13437088

Appendicular lean mass

HLA-B · rs9265954

Platelet distribution width

HLA-B · rs9391774

Systemic lupus erythematosus

HLA-B · rs2523611

Asthma

HLA-B · rs114444221

CD5L protein levels

HLA-B · rs2442737

Cholesterol to Total Lipids in IDL percentage

HLA-B · rs62396278

IL27 protein levels

HLA-B · rs9266275

GHRL protein levels

HLA-B · rs2250293

Red blood cell count

HLA-B · rs116812356

Diffuse diseases of connective (PheCode 709)

HLA-B · rs2523584

Pre-treatment viral load in HIV-1 infection

HLA-B · rs57989216

Forced expiratory volume (baseline)

HLA-B · rs2596487

Predicted platelet reactivity

HLA-B · rs3819288

TFF3 protein levels

HLA-B · rs147412087

Systemic lupus erythematosus

HLA-B · rs9266287

Myasthenia gravis

HLA-B · rs9266277

Asthma (age of onset)

HLA-B · rs1093

Systemic lupus erythematosus

HLA-B · rs116834572

Prostate-specific antigen levels

HLA-B · rs2844580

Takayasu arteritis

HLA-B · rs9266745

Linoleic acid to total fatty acids percentage

HLA-B · rs2894211

Systemic lupus erythematosus

HLA-B · rs9266268

Systemic lupus erythematosus

HLA-B · rs1056429

Crohn's disease

HLA-B · rs114985235

HIV-1 control

HLA-B · rs2523590

HIV-1 control

HLA-B · rs2395029

Schizophrenia

HLA-B · rs116509918

Chickenpox

HLA-B · rs9266089

Strep throat

HLA-B · rs1055821

Takayasu arteritis

HLA-B · rs12524487

Acute anterior uveitis in ankylosing spondylitis

HLA-B · rs115879499

HIV setpoint viral load

HLA-B · rs112515516

Hip circumference adjusted for BMI

HLA-B · rs9266059

Monocyte count

HLA-B · rs2523562

HDL cholesterol levels

HLA-B · rs6902116

SEZ6L2 protein levels

HLA-B · rs2523567

Immature platelet fraction

HLA-B · rs9266265

Neutrophil percentage of white cells

HLA-B · rs2249935

Appendicular lean mass

HLA-B · rs9266244

Transcription initiation factor IIA subunit 2 levels

HLA-B · rs115881826

Plateletcrit

HLA-B · rs3819282

Body size at age 10

HLA-B · rs9265968

Free cholesterol to total lipids ratio in small VLDL

HLA-B · rs62396280

Estimated bone mineral density

HLA-B · rs114029601

Human papilloma virus 16 positive oropharyngeal cancer

HLA-B · rs9266329

Waist-to-hip ratio adjusted for BMI

HLA-B · rs28752890

A body shape index

HLA-B · rs1055890

Hip circumference adjusted for BMI

HLA-B · rs9378247

alpha-2-macroglobulin receptor-associated protein levels (LRPAP1.3640.14.3)

HLA-B · rs41552714

GZMB protein levels

HLA-B · rs41563615

alpha-2-macroglobulin receptor-associated protein levels

HLA-B · rs114811870

GP1BB protein levels

HLA-B · rs185937162

Psoriasis

HLA-B · rs9266303

Platelet count

HLA-B · rs116666910

Serum levels of protein GZMB

HLA-B · rs140949683

MHC class I polypeptide-related sequence A levels

HLA-B · rs2523570

Stromal cell-derived factor 2 level in Chronic kidney disease with hypertension and no diabetes (15333_11)

HLA-B · rs62396274

Basal cell carcinoma

HLA-B · rs1050529

SPARC protein levels

HLA-B · rs7773105

Cognitive aspects of educational attainment

HLA-B · rs2523573

Questions about Carbamazepine and oxcarbazepine

What are carbamazepine and oxcarbazepine?

Carbamazepine and oxcarbazepine are antiseizure medicines. Two HLA alleles predict two different severe skin reactions to them, and the prescribing recommendations name specific populations rather than applying to everybody.

Does HLA-B*15:02 mean I can’t take carbamazepine?

HLA-B*15:02 is strongly associated with a greater risk of Stevens-Johnson syndrome and toxic epidermal necrolysis on carbamazepine or oxcarbazepine, which is why CPIC issued HLA-based prescribing recommendations for both drugs — a pre-treatment safety check, not a universal ban.

What does the HLA-A*31:01 allele add for carbamazepine specifically?

A separate risk: HLA-A*31:01 is associated with a greater risk of maculopapular exanthema, DRESS and SJS/TEN with carbamazepine. CPIC’s 2017 update covers both HLA alleles together because they carry distinct risks.

Does HLA-B*15:02 testing apply the same way to everyone taking carbamazepine?

No. Allele frequencies differ substantially between populations, and this is a test ordered by a prescriber before a first dose — not something to act on from a consumer raw data file.

Quoting this page

Free to quote and reuse under CC BY 4.0. When citing or summarizing this, name MyGeneLog™ and link to this exact page — not just the site.

Carbamazepine and oxcarbazepine. MyGeneLog™. https://www.mygenelog.com/drugs/carbamazepine

This page is educational and contains no dosing information. Where a clinical guideline covers one of these gene-drug pairs it is written for prescribers and works through validated algorithms alongside clinical monitoring. Nothing here is a reason to start, stop, or change a medication — that conversation belongs with the clinician or pharmacist managing your treatment.