|•||Treatment of tonic-clonic, mixed, and complex-partial seizures.|
|•||Management of pain in trigeminal neuralgia or diabetic neuropathy.|
|•||Acute mania and mixed mania.|
|•||Other forms of neurogenic pain.|
Adults and Children older than 12 yr of age:
Initial dosage: PO 200 mg twice daily (tablets) or 100 mg (1 tsp) 4 times daily (suspension). Increase weekly by up to 200 mg/day in 2 divided doses for extended-release or 3 to 4 divided doses for other formulations to reach minimum effective dose (max, 1,000 mg/day in children 12 to 15 yr of age; 1,200 mg/day in children older than 15 yr of age; 1,600 mg/day in adults).
Maintenance: 800 to 1,200 mg/day.
Adults and Children older than 12 yr of age (extended-release):
Initial dosage: PO 200 mg twice daily.
Children 6 to 12 yr of age:
Initial dosage: PO 100 mg twice daily (tablets) or 50 mg 4 times daily (suspension). Increase weekly by 100 mg/day in 3 to 4 divided doses (extended-release formulations use a twice-daily regimen) to reach minimum effective dose (max, 1,000 mg/day).
Maintenance: 400 to 800 mg/day in 3 to 4 divided doses.
Children younger than 6 yr of age:
Initial dosage: PO 10 to 20 mg/kg/day in 2 or 3 divided doses (tablet) or 10 to 20 mg/kg/day in 4 divided doses (suspension). Increase weekly to achieve optimal clinical response when administered in 3 or 4 divided daily doses (max, 35 mg/kg/day).
Maintenance: Less than 35 mg/kg/day.
Initial dosage: PO 100 mg twice daily (tablets) or 50 mg 4 times daily (suspension). May increase by up to 200 mg/day (tablets, 100 mg increments every 12 h; suspension, 50 mg 4 times daily) as needed (max, 1,200 mg/day).
Maintenance: Usually 400 to 800 mg/day. Attempt to reduce the dosage or discontinue the drug once every 3 mo.
Initial dosage: PO 100 mg twice daily (tablets) or 200 mg once daily (capsules) (max, 1,200 mg/day).
Bipolar Disorder ( Equetro only)
Initial dosage: PO 200 mg twice daily. Increase in 200 mg/day increments to optimal clinical response (max, 1,600 mg/day).
May be used alone or in combination with other antiepileptic drugs (AEDs) for treatment of seizures or with analgesics for treatment of trigeminal neuralgia.
Appears to provide anticonvulsant effects by reducing polysynaptic responses and blocking posttetanic potentiation. Mechanism of action for other effects is unknown.
Hypersensitivity to tricyclic antidepressants or carbamazepine; history of bone marrow depression; concomitant use of MAOIs. Discontinue MAOIs at least 14 days before administration of carbamazepine.
Use Cautiously in:
|•||Cardiac or hepatic disease.|
|•||renal failure (dosing adjustment required for ClCr < 10 ml/min.|
|•||Increased intraocular pressure.|
|•||Geri: Older men with prostatic hyperplasia may be at increased risk for acute urinary retention or difficulty initiating stream.|
CV: Aggravation of coronary artery disease, aggravation of hypertension, arrhythmias, AV block, CHF, fainting, hypotension, syncope, thrombophlebitis.
CNS: Dizziness (44%); somnolence (32%); headache (22%); ataxia (15%); amnesia, asthenia (8%); anxiety, depression, manic depressive reaction (7%); speech disorder (6%); ataxia (5%); depersonalization, extrapyramidal syndrome, insomnia, nervousness, suicide attempts (less than 5%); aseptic meningitis with myoclonus, cerebral artery insufficiency, confusion, depression with agitation, disturbances in coordination, drowsiness, fatigue, hyperacusis, involuntary movements, neuroleptic malignant syndrome, paralysis, paresthesias, peripheral neuritis, talkativeness, visual hallucinations.
DERM: Rash (13%); pruritus (8%); alopecia, photosensitivity (less than 5%); aggravation of disseminated systemic lupus erythematosus, altered skin pigmentation, diaphoresis, erythema multiforme and nodosum, erythematous rash, exfoliative dermatitis, hirsutism, pruritic rash, purpura, Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), urticaria.
EENT: Amblyopia (6%); diplopia, ear pain, pharyngitis, rhinitis (less than 5%); blurred vision, conjunctivitis, dry pharynx, nystagmus, oculomotor disturbances, scattered punctuate cortical lens opacities, tinnitus.
GI: Nausea (29%); vomiting (18%); diarrhea, dyspepsia (10%); dry mouth (8%); constipation (5%); abdominal pain, anorexia, gastric distress, glossitis, pancreatitis, stomatitis.
GU: UTI (less than 5%); acute urinary retention, albuminuria, azotemia, elevated BUN, glucosuria, impotence, microscopic urine deposits, oliguria with elevated blood pressure, renal failure, urinary frequency.
HEMA/LYMPH: Leukopenia, lymphadenopathy (less than 5%); acute intermittent porphyria, adenopathy, agranulocytosis, aplastic anemia, bone marrow suppression, eosinophilia, leukocytosis, pancytopenia, thrombocytopenia.
HEPA: Abnormal LFTs (less than 5%); cholestatic jaundice, hepatic failure, hepatitis, hepatocellular jaundice.
M/N: Decreased plasma calcium; elevated cholesterol, HDL cholesterol, and triglycerides; hyponatremia; SIADH; water intoxication.
MUSC: Back pain (5%); aching joints and muscles, leg cramps.
RESP: Bronchitis, sinusitis (less than 5%); dyspnea, pneumonia, pneumonitis, pulmonary hypersensitivity.
OTHER: Infection, pain (12%); accidental injury (7%); chest pain (5%); edema, peripheral edema (less than 5%); chills, fever, lupus erythematosus–like syndrome, multi-organ hypersensitivity.
Acetaminophen, aripiprazole, benzodiazepines (eg, midazolam), bupropion, citalopram, clozapine, corticosteroids (eg, dexamethasone), cyclosporine, dicumarol, itraconazole, lapatinib, levothyroxine, methadone, olanzapine, oxcarbazine, praziquantel, risperidone, sertraline, simvastatin, succinimides (eg, ethosuximide), tiagabine, topiramate, tramadol, ziprasidone, zonisamide
Levels may be reduced by carbamazepine.
Acetazolamide, azole antifungal agents, danazol, diltiazem, grapefruit juice, loratadine, macrolide antibiotics (except azithromycin), niacinamide, nicotinamide, propoxyphene, quinine, terfenadine, verapamil
May increase carbamazepine levels and result in toxicity.
Increased risk of CNS adverse reactions.
May decrease anticoagulant effects.
May result in decreased carbamazepine serum concentrations, possibly leading to decreased effectiveness.
May reduce absorption of carbamazepine.
May result in carbamazepine toxicity.
Cisplatin, doxorubicin, methsuximide, rifamycins (eg, rifampin)
May increase carbamazepine metabolism, reducing plasma levels and the therapeutic effect.
Levels may be increased by carbamazepine.
Causes breakthrough bleeding and reduces effectiveness of contraceptives.
Coadministration may lead to loss of virologic response and possible resistance. May decrease delavirdine levels and increase carbamazepine levels.
May decrease doxycycline hyclate levels.
May decrease concentrations of felbamate or carbamazepine.
May decrease effects of felodipine.
May decrease effects of haloperidol.
Hydantoins (eg, phenytoin)
May decrease carbamazepine levels; may alter hydantoin levels.
May result in toxicity of isoniazid, carbamazepine, or both.
Lamotrigine levels may be decreased, while levels of the active metabolite of carbamazepine may be increased.
Liquid medicinals or diluents
May result in the formation of an insoluble precipitate in the GI tract.
May cause adverse CNS effects regardless of drug levels.
Coadministration with carbamazepine is contraindicated.
Coadministration is contraindicated. Elevated carbamazepine levels and lower nefazodone levels may result.
Nondepolarizing muscle relaxants
May make these agents less effective.
Decreased carbamazepine levels. Primidone’s active metabolite (phenobarbital) may be increased.
Protease inhibitors (eg, indinavir)
Carbamazepine levels may be elevated and protease inhibitor levels may be decreased, resulting in antiretroviral treatment failure.
Quetiapine levels may be reduced; concentrations of the active carbamazepine metabolite may be increased.
SSRIs (eg, fluoxetine, fluvoxamine)
Increased carbamazepine levels with possible toxicity.
May reduce effects of theophylline and carbamazepine. Theophylline levels may be increased or decreased.
May increase carbamazepine levels; may decrease tricyclic antidepressant levels.
May decrease valproic acid levels; may alter carbamazepine levels.
Therapeutic Classification: anticonvulsants
Absorption: Absorption is slow but complete. Suspension produces earlier, higher peak and lower trough levels.
Distribution: Widely distributed. Crosses the blood-brain barrier. Crosses the placenta rapidly and enters breast milk in high concentrations.
Protein Binding: Carbamazepine-75–90%; epoxide — 50%.
Metabolism/Excretion: Extensively metabolized in the liver by cytochrome P450 3A4 to active epoxide metabolite; epoxide metabolite has anticonvulsant and antineuralgic activity.
Half-life: Carbamazapine — single dose — 25–65 hr, chronic dosing — Children — 8–14 hr; Adults —12–17 hr; epoxide —349hr.
|ORAL||UPTO 1 MONTH||4-5 HOUR||6-12 HOUR|
|ORAL-ER||UPTO 1 MONTH||3-12 HOUR||12 HOUR|