Carbamazepine

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Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Carbamazepine.jpg

[edit] MECHANISM OF ACTION

Carbamazepine major anticonvulsant mechanism consist on the blockade of conductance at the neuronal voltage-dependent sodium channel.

[edit] INDICATIONS

  • Anticonvulsant for the following seizure types:
    • Partial seizures
    • Tonic-clonic seizures (grand mal)
  • Carbamazepine is a mood stabilizer indicated for the treatment of acute manic or mixed episodes associated with bipolar I disorder
  • Treatment of the pain associated true trigeminal neuralgia

[edit] DOSAGE

[edit] CONTRAINDICATIONS

[edit] WARNINGS AND PRECAUTIONS

Serious Dermatologic Reactions
(Skin rashes)
  • Serious and sometimes fatal dermatologic reactions, including toxic  epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS), have occurred with Carbamazepine.
  • Patients of Asian ancestry have a 10-fold greater risk of TEN/SJS, compared to other populations. (Across Asian populations, notable variation exists in the prevalence of HLA-B*1502. Greater than 15% of the population is reported positive in Hong Kong, Thailand, Malaysia, and parts of the Philippines, compared to about 10% in Taiwan and 4% in North China. South Asians, including Indians, appear to have intermediate prevalence of HLA-B*1502, averaging 2 to 4%, but higher in some groups. HLA-B*1502 is present in <1% of the population in Japan and Korea. HLA-B*1502 is largely absent in individuals not of Asian origin (e.g., Caucasians, African-Americans, Hispanics, and Native Americans).
  • In genetically at-risk patients, test for the HLA-B*1502 allele prior to initiating Carbamazepine
  • Discontinue the drug if these reactions occur

Decreased bone marrow function: Aplastic Anemia and Agranulocytosis (lowered white blood cell count)
  • Aplastic anemia (deficiency of red blood cells, white blood cells, and platelets) and agranulocytosis occurred with  carbamazepine
  • Obtain complete pretreatment hematological testing.
  • Consider discontinuing the drug if significant bone marrow depression develops


  • Drug Reaction with Eosinophilia and Systemic Symptoms also known as Multiorgan hypersensitivity, has occurred with Carbamazepine. Monitor for hypersensitivity (signs or symptoms include fever, rash, and/or lymphadenopathy, in association with other organ system involvement, such as hepatitis, nephritis, hematologic abnormalities, myocarditis, or myositis sometimes resembling an acute viral infection. Eosinophilia is often present)
  • Suicidal Behavior and Ideation: Antiepileptic drugs, including Carbamazepine, increase the risk of suicidal thoughts or behavior. Monitor for depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.
  • Embryofetal Toxicity: Advise women of child-bearing potential of possible risks to the fetus.
  • Abrupt Discontinuation and Risk of Seizure: Antiepileptic drugs should not be discontinued abruptly. Taper the dose when discontinuing treatment.
  • Hyponatremia: Hyponatremia has been reported in association with Carbamazepine use, either alone or in combination with some diuretics (Hydrochlorothiazide, Furosemide). Signs and symptoms of hyponatremia include headache, new or increased seizure frequency, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which can lead to fall.
  • Hepatic Porphyria: Avoid Carbamazepine use in patients with hepatic porphyria. Carbamazepine can cause acute episodes of porphyria

[edit] INTERACTIONS

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category D (US). Carbamazepine can cause fetal harm (congenital malformations, including spina bifida) when administered to a pregnant woman. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Use in pregnancy only if the potential benefits of treatment outweigh the risks.
  • Nursing Mothers: Discontinue drug or discontinue nursing, taking into consideration importance of drug to mother

[edit] SIDE EFFECTS

The most frequently observed adverse reactions are: Drowsiness, dizziness,, nausea, vomiting, ataxia, constipation, pruritus, dry mouth, asthenia, rash, blurred vision, unsteadiness, and speech disorder.

For serious adverse reactions (See WARNINGS AND PRECAUTIONS)

[edit] RELATED LINKS

www.equetro.com

Pharmacology of Antiepileptic Drugs

[edit] BIBLIOGRAPHY

[edit] REFERENCES