II. Indication
- Simple Partial Seizures
- Complex Partial Seizures
- Generalized Tonic Clonic Seizures
- Trigeminal Neuralgia
-
Bipolar Disorder
- Frequently reserved for use as a second agent
- Resistant Schizophrenia
- Restless Leg Syndrome
- Psychosis in Dementia
- Post-Traumatic Stress Disorder
III. Contraindications
- MAO inhibitor use within last 14 days
- Bone Marrow suppression
- Pregnancy
- Tricyclic compound sensitivity
- Asian patients who are positive for HLA-B1502
- Risk of Steven's Johnson: 5% if HLA-B1502 positive
- Also associated with Toxic Epidermal Necrolysis
- FDA has issued a black box warning
- Man (2007) Epilepsia 48(5):1015-8 [PubMed]
IV. Adverse Effects: Dose related
V. Adverse Effects: Other
- Morbilliform rash
- Gingival Hyperplasia
- Blood dyscrasias
- Cardiac conduction abnormality (increases A-V delay)
-
Hyponatremia
- Occurs in up to 40% of patients
- Elderly are at higher risk of SIADH
- Liver failure
- Osteoporosis
- Serum Sickness
- Stevens-Johnson Syndrome
- Toxic Epidermal Necrolysis
VI. Drug Interactions (Numerous)
- Substrate of Cytochrome P450 2C8/9
- Substrate of Cytochrome P450 3A4
- Induces Cytochrome P450 1A2
- Induces Cytochrome P450 2B6
- Induces Cytochrome P450 2C8/9
- Induces Cytochrome P450 2C19
- Induces Cytochrome P450 3A4
VII. Dose: General
- Titrate dose to serum concentration and effect
- Target serum concentration: 4-12 mcg/ml
- Observe closely for concentration 8 mcg/ml or higher
- Toxic serum concentration: >15 mcg/ml
VIII. Dose: Adults
-
Seizure Disorder
- Initial: 200 mg orally twice daily
- Increase by 200 mg/day increments weekly
- Typically up to 800-1200 mg/day (max: 2400 mg/day) in divided dosing
- Target concentration: 4 to 12 mcg/ml
-
Trigeminal Neuralgia
- Initial: 100 mg orally twice daily
- Increase by 100 mg/day increments weekly
- Target: 400-800 mg/day divided twice daily
-
Bipolar Disorder
- Initial: 200 mg twice daily
- Increase by 200 mg as often as daily in acute mania as tolerated
- Slower titration results in fewer side effects
- Target: 200-1600 mg per day
- Target serum level: 4 to 12 mcg/ml
IX. Dose: Elderly
- Initial: 100 mg orally twice daily
- Increase by 100 mg/day increments weekly
- Target: 400-1000 mg/day divided three to four times daily
X. Monitoring
- Routine labs
- Obtain monthly for first 2 months, then every 3 to 12 months
- Complete Blood Count with Platelet Count
- Liver Function Tests
- HLA-B1502
- Indicated before starting in asian patients
- See contraindications above
- Serum Carbamazepine level
- Initial: Every 1-2 weeks
- Later: Every 3-6 months
- Also check before and after dose changes
- Other tests previously monitored with Carbamazepine use
Images: Related links to external sites (from Bing)
Related Studies
carbamazepine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
CARBAMAZEPINE 100 MG TAB CHEW | Generic | $0.39 each |
CARBAMAZEPINE 100 MG/5 ML SUSP | Generic | $0.13 per ml |
CARBAMAZEPINE 200 MG TABLET | Generic | $0.58 each |
CARBAMAZEPINE ER 100 MG CAP | Generic | $0.80 each |
CARBAMAZEPINE ER 100 MG TABLET | Generic | $0.76 each |
CARBAMAZEPINE ER 200 MG CAP | Generic | $0.74 each |
CARBAMAZEPINE ER 200 MG TABLET | Generic | $1.42 each |
CARBAMAZEPINE ER 300 MG CAP | Generic | $0.96 each |
CARBAMAZEPINE ER 400 MG TABLET | Generic | $2.73 each |
tegretol (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
TEGRETOL 100 MG/5 ML SUSP | Generic | $0.13 per ml |
TEGRETOL 200 MG TABLET | Generic | $0.58 each |
TEGRETOL XR 100 MG TABLET | Generic | $0.76 each |
TEGRETOL XR 200 MG TABLET | Generic | $1.42 each |
TEGRETOL XR 400 MG TABLET | Generic | $2.73 each |
Ontology: Carbamazepine (C0006949)
Definition (CHV) | a kind of epilepsy treatment drug |
Definition (CHV) | a kind of epilepsy treatment drug |
Definition (NCI) | A tricyclic compound chemically related to tricyclic antidepressants (TCA) with anticonvulsant and analgesic properties. Carbamazepine exerts its anticonvulsant activity by reducing polysynaptic responses and blocking post-tetanic potentiation. Its analgesic activity is not understood; however, carbamazepine is commonly used to treat pain associated with trigeminal neuralgia. |
Definition (MSH) | An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of PHENYTOIN; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. |
Definition (CSP) | anticonvulsant and antineuralgic used in the treatment of pain associated with trigeminal neuralgia and in epilepsy manifested by tonic-clonic and partial seizures. |
Definition (PDQ) | A tricyclic compound chemically related to tricyclic antidepressants (TCA) with anticonvulsant and analgesic properties. Carbamazepine exerts its anticonvulsant activity by reducing polysynaptic responses and blocking post-tetanic potentiation. Its analgesic activity is not understood; however, carbamazepine is commonly used to treat pain associated with trigeminal neuralgia. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42418&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42418&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C341" NCI Thesaurus) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D002220 |
SnomedCT | 255643003, 387222003, 40820003 |
CPT | 1011157 |
LNC | LP16061-1, MTHU003352 |
English | Carbamazepine, 5H-Dibenz(b,f)azepine-5-carboxamide, carbamazepine, carbamazepine (medication), Carbamazepine - chemical, CARBAMAZEPINE, Carbamazepine [Chemical/Ingredient], carbamazepines, carBAMazepine, CarBAMazepine, Carbamazepine - chemical (substance), Carbamazepine Anhydrous, Carbamazepine product, Carbamazepine (product), Carbamazepine (substance) |
Swedish | Karbamazepin |
Czech | karbamazepin |
Finnish | Karbamatsepiini |
Russian | FINLEPSIN, TEGRETOL, KARBAMAZEPIN, DIFENILMOCHEVINY SOEDINENIIA, ДИФЕНИЛМОЧЕВИНЫ СОЕДИНЕНИЯ, КАРБАМАЗЕПИН, ТЕГРЕТОЛ, ФИНЛЕПСИН |
Japanese | カルバマゼピン |
Croatian | KARBAMAZEPIN |
Polish | Amizepin, Karbamazepina |
Spanish | carbamacepina - químico, carbamezepina - químico, carbamezepina - químico (sustancia), Carbamacepina, carbamacepina, carbamazepina (producto), carbamazepina (sustancia), carbamazepina, Carbamazepina |
French | Carbamazépine |
German | Carbamazepin |
Italian | Carbamazepina |
Portuguese | Carbamazepina |
Ontology: Tegretol (C0700087)
Definition (CHV) | a kind of epilepsy treatment drug |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D002220 |
English | tegretol, TEGretol, Tegretol |