Indications & Dose:
Focal and secondary generalised tonic-clonic seizures
Primary generalised tonic-clonic seizures
Adult: Initially 100–200 mg 1–2 times a day, increased in steps of 100–200 mg every 2 weeks; usual dose 0.8–1.2 g daily in divided doses; increased if necessary up to 1.6–2 g daily in divided doses Elderly: Reduce initial dose
Adult: Up to 1 g daily in 4 divided doses for up to 7 days, for short-term use when oral therapy temporarily not possible
Adult: Initially 100 mg 1–2 times a day, some patients may require higher initial dose, increase gradually according to response; usual dose 200 mg 3–4 times a day, increased if necessary up to 1.6 g daily
Prophylaxis of bipolar disorder unresponsive to lithium
Adult: Initially 400 mg daily in divided doses, increased until symptoms controlled; usual dose 400–600 mg daily; maximum 1.6 g per day
Adjunct in acute alcohol withdrawal
BY MOUTH
Adult: Initially 800 mg daily in divided doses, then reduced to 200 mg daily for usual treatment duration of 7–10 days, dose to be reduced gradually over 5 days Diabetic neuropathy
Adult: Initially 100 mg 1–2 times a day, increased gradually according to response; usual dose 200 mg 3–4 times a day, increased if necessary up to 1.6 g daily.
Focal and generalised tonic-clonic seizures
Child 1 month–11 years: Initially 5 mg/kg once daily, dose to be taken at night, alternatively initially 2.5 mg/kg twice daily, then increased in steps of 2.5–5 mg/kg every 3–7 days as required; maintenance 5 mg/kg 2–3 times a day, increased if necessary up to 20 mg/kg daily Child 12–17 years: Initially 100–200 mg 1–2 times a day, then increased to 200–400 mg 2–3 times a day, increased if necessary up to 1.8 g daily, dose should be increased slowly
Focal and secondary generalised tonic-clonic seizures
Primary generalised tonic-clonic seizures
Adult: Initially 100–400 mg daily in 1–2 divided doses, increased in steps of 100–200 mg every 2 weeks, dose should be increased slowly; usual dose 0.8–1.2 g daily in 1–2 divided doses, increased if necessary up to 1.6–2 g daily in 1–2 divided doses
Elderly: Reduce initial dose
Trigeminal neuralgia
Adult: Initially 100–200 mg daily in 1–2 divided doses, some patients may require higher initial dose, increase gradually according to response; usual dose 600–800 mg daily in 1–2 divided doses, increased if necessary up to 1.6 g daily in 1–2 divided doses
Prophylaxis of bipolar disorder unresponsive to lithium
Adult: Initially 400 mg daily in 1–2 divided doses, increased until symptoms controlled; usual dose 400–600 mg daily in 1–2 divided doses; maximum 1.6 g per day
Focal and generalised tonic-clonic seizures Prophylaxis of bipolar disorder
Child 5–11 years: Initially 5 mg/kg daily in 1–2 divided doses, then increased in steps of 2.5–5 mg/kg every 3–7 days as required, dose should be increased slowly; maintenance 10–15 mg/kg daily in continued 1–2 divided doses, increased if necessary up to 20 mg/kg daily in 1–2 divided doses
Child 12–17 years: Initially 100–400 mg daily in 1–2 divided doses, then increased to 400–1200 mg daily in 1–2 divided doses, increased if necessary up to 1.8 g daily in 1–2 divided doses, dose should be increased slowly
Focal and secondary generalised tonic-clonic seizures
Primary generalised tonic-clonic seizures
Adult: Initially 100–400 mg daily in 2 divided doses, increased in steps of 100–200 mg every 2 weeks, dose should be increased slowly; usual dose 0.8–1.2 g daily in 2 divided doses, increased if necessary up to 1.6–2 g daily in 2 divided doses
Elderly: Reduce initial dose
Focal and generalised tonic-clonic seizures Prophylaxis of bipolar disorder
Child 5–11 years: Initially 5 mg/kg daily in 2 divided doses, then increased in steps of 2.5–5 mg/kg every 3–7 days as required; maintenance 10–15 mg/kg daily in 2 divided doses, increased if necessary up to 20 mg/kg daily in 2 divided doses
Child 12–17 years: Initially 100–400 mg daily in 2 divided doses, dose should be increased slowly; maintenance 400–1200 mg daily in 2 divided doses, increased if necessary up to 1.8 g daily in 2 divided doses
Trigeminal neuralgia
Adult: Initially 100–200 mg daily in 2 divided doses, some patients may require higher initial dose. After initial dose, increase according to response; usual dose 600–800 mg daily in 2 divided doses, increased if necessary up to 1.6 g daily in 2 divided doses, dose should be increased slowly
Prophylaxis of bipolar disorder unresponsive to lithium
Adult: Initially 400 mg daily in 2 divided doses, increased until symptoms controlled; usual dose 400–600 mg daily in 2 divided doses; maximum 1.6 g per day
Contraindications:
Hypersensitivity to tricyclic antidepressants, bone marrow depression, concomitant use of MAO inhibitor
Side Effects:
Cautions:
Precautions:
Glaucoma, hepatic disease, renal disease, cardiac disease, psychosis, child <6 yr
Interaction:
Drugs
Acetaminopen: Enhanced hepatotoxic potential; reduced acetaminophen response
Antidepressants, tricyclic: Carbamazepine (educes serum concentrations of imipramine and probably other cyclic antidepressants
Benzodiazepines (alprazolam, diazepam, midazolam, triazolam): Metabolized by CYP3A4; enzyme induced by carbamazepine; reduced benzo effect
Calcium channel blockers: Verapamil and diltiazem reduce the metabolism of carbamazepine leading to increased carbamazepine toxicity when these CCBs are added to chronic carbamazepine therapy; enzyme induction by carbamazepine can reduce the bioBrands Available with Cost of CCBs that undergo extensive 1 stpasa hepatic clearance, like felodipine (94% reduction)
Cimetidine: Transient (1 week) increases in carbsmazepine levels
Corticosteroids: Carbamazepine reduces levels and therapeutic effect
Cyclasporine: Carbamazepine reduces cyclosporine blood levels
Danazol: Increases carbamazepine levels with toxicity expected
Doxycycline: Carbamazepine reduces doxycycline levels and antibiotic effects
Erythromycin, clarithromycin:Increased carbarnazepine levels
Ethinyl Estradiol, Oral contraceptives: Carbamazepineinduced metabolic induction may lead to menstrual irregularities and unplanned pregnancies
Felbamate: Reductions in carbamazepine levels and increases in 10,11-epoxide metabolite, along with decreased felbarnate concentrations
Fluoxetine, fluvoxamine:Inhibits carbamazepine metabolism, increased levels and risk of toxicity
Isoniazid: Increases carbamazepine levels with increased risk of toxicity
Isotretinoin: Reduced carbamazepine bioBrands Available with Cost
Lamotrigine: Increased carbamazepine metab and risk of toxicity; carbamazepine reduces lamotrigine levels
Lithium: Increased potential for neurotoxicity with normal lithium concentrations; reverses carbamazepine induced leukopenia; additive antithyroidal effects
Mebendazole: Carbamazepine decreases mebendazole levels, significant only when large doses given
Methadone: Carbamazepine reduces levels and therapeutic effect
Metronidazole: Increases carbamazepine concentrations with toxicity
Neuroleptics: Reduced concentration of and therapeutic response to these agents when used with carbamazepine
Omeprazole: May increase carbamazepine concentrations
Oral anticoagulants: Decreased prothrombin time
Phenytoin: Concurrent use reduces serum concentrations of both
Propoxyphene: Increases carbamazepine levels
Theophylline: Carbamazepine reduces levels and therapeutic effect
Thyroid: Cxrbamazepine reduces levels and therapeutic effect
Valproic acid: Valproic acid can increase, decrease, or have no effect on carbamazepine, monitor serum levels; carbamazepine decreases levels of valproic acid
Warnings:
Adverse Effects:
Lactations:
Concentration in milk approximately 60% of maternal plasma concentration; compatible with breast feeding
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
CN: Ataxia, confusion, dizziness, drowsiness, fatigue, hallucinations, headache, paralysis
CV: Aggravation of coronary artery disease, CHF, hypertension, hypotension
EENT: Blurred vision, conjunctivitis, diplopia, dry mouth, nystagmus, tinnitus
GI: Abdominal pain, anorexia, constipation, diarrhea, enzymes, glossitis, hepatitis, increased liver enzymes, nausea, stomatitis, vomiting
GU: Albuminuria, frequency, glycosuria, impotence, urinary retention
HEME: Agranulocytosis, aplastic anemia, eosinophilia, leukocytosis, neutropenia, thrombocytopenia
RESP: Pulmonary hypersensitivity (fever, dyspnea, pneumonitis)
SKIN: Rash, Stevens-Johnson syndrome, urticaria
Patient And Carer Advice:
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