Carbamazepine(kar ba maz’ e peen)
Apo-Carbamazepine (CAN), CarbatrolDNC, Epitol, EquetroDNC, Gen-Carbamazepine CRDNC, PMS-Carbamazepine (CAN), Tegretol, Tegretol-XRDNC
PREGNANCY CATEGORY D
Drug class
Antiepileptic
Therapeutic Actions
Mechanism of action not understood; antiepileptic activity may be related to its ability to inhibit polysynaptic responses and block post-tetanic potentiation. Drug is chemically related to the TCAs.
Indications
Refractory seizure disorders: Partial seizures with complex symptoms (psychomotor, temporal lobe epilepsy), generalized tonic-clonic (grand mal) seizures, mixed seizure patterns or other partial or generalized seizures. Reserve for patients unresponsive to other agents with seizures difficult to control or who are experiencing marked side effects, such as excessive sedation
Trigeminal neuralgia (tic douloureux): Treatment of pain associated with true trigeminal neuralgia; also beneficial in glossopharyngeal neuralgia
Treatment of acute manic and mixed episodes associated with bipolar 1 disorder (Equetro)
Unlabeled uses: Certain psychiatric disorders, including schizoaffective illness, resistant schizophrenia, and dyscontrol syndrome associated with limbic system dysfunction; alcohol withdrawal (800–1,000 mg/day); restless leg syndrome (100–300 mg/day at bedtime); non-neuritic pain syndrome (600–1,400 mg/day)
Contraindications and Cautions
Contraindicated with hypersensitivity to carbamazepine or TCAs, history of bone marrow depression, concomitant use of MAOIs, lactation, pregnancy.
Use cautiously with history of adverse hematologic reaction to any drug (increased risk of severe hematologic toxicity), glaucoma or increased IOP; history of cardiac, hepatic, or renal damage; psychiatric patients (may activate latent psychosis).
Available Forms
Tablets—200 mg; chewable tablets—100 mg; ER tabletsDNC—100, 200, 400 mg; ER capsulesDNC—100, 200, 300 mg; suspension—100 mg/5 mL
Dosages
Individualize dosage; a low initial dosage with gradual increase is advised.
Adults
Epilepsy: Initial dose, 200 mg PO bid on the first day; increase gradually by up to 200 mg/day in divided doses every 6–8 hr, until best response is achieved. Suspension: 100 mg PO qid. Do not exceed 1,200 mg/day in patients older than age 15; doses up to 1,600 mg/day have been used in adults (rare). For maintenance, adjust to minimum effective level, usually 800–1,200 mg/day.
Trigeminal neuralgia: Initial dose, 100 mg PO bid on the first day; may increase by up to 200 mg/day, using 100-mg increments every 12 hr as needed. Do not exceed 1,200 mg/day. For maintenance, control of pain can usually be maintained with 400–800 mg/day (range 200–1,200 mg/day). Attempt to reduce the dose to the minimum effective level or to discontinue the drug at least once every 3 mo. Suspension: Start at 50 mg PO qid; increase by 50 mg PO qid as needed to maximum dose.
Combination therapy: When added to existing antiepileptic therapy, do so gradually while other antiepileptics are maintained or discontinued.
Bipolar 1 disorder: 400 mg/day PO in divided doses; may be increased in 200 mg/day increments. Do not exceed 1,600 mg/day (Equetro).
Pediatric patients older than 12 yr
Use adult dosage. Do not exceed 1,000 mg/day in patients 12–15 yr; 1,200 mg/day in patients older than 15 yr.
Pediatric patients 6–12 yr
Initial dose, 100 mg PO bid on the first day. Increase gradually by adding 100 mg/day at 6- to 8-hr intervals until best response is
achieved. Do not exceed 1,000 mg/day. Dosage also may be calculated on the basis of 20–30 mg/kg/day in divided doses tid–qid.
achieved. Do not exceed 1,000 mg/day. Dosage also may be calculated on the basis of 20–30 mg/kg/day in divided doses tid–qid.
Pediatric patients younger than 6 yr
Optimal daily dose, less than 35 mg/kg/day.
Geriatric patients
Use caution; may cause confusion, agitation.
Pharmacokinetics
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