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Carbamazepine information from DrugsUpdate  

See Available Brands of Carbamazepine in India

P - Contraindicated in pregnancy
L - Contraindicated in lactation
LI - Lab*

Carbamazepine (CBZ) is an anticonvulsant and mood stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder, as well as trigeminal neuralgia. It is also used off-label for a variety of indications, including attention-deficit hyperactivity disorder (ADHD), schizophrenia, phantom limb syndrome, paroxysmal extreme pain disorder, and post-traumatic stress disorder.

Pharmacodynamics

Pharmacokinetics

Carbamazepine reduces polysynaptic responses and blocks post-tetanic potentiation. It is effective in partial and generalised convulsions as well as in mixed types but not in petit mal seizures. It reduces or abolishes pain in trigeminal and glossopharyngeal neuralgia.
Absorption: Slowly and irregularly absorbed from the GI tract (oral).
Distribution: Crosses the placenta; enters breast milk. Protein-binding: 75%. Well distributed in the body.
Metabolism: Hepatic; converted to its metabolites.
Excretion: Urine (as metabolites), faeces; 5-26 hr (elimination half-life).

Carbamazepine Indications / Carbamazepine Uses

Information Not Available

Carbamazepine Adverse Reactions / Carbamazepine Side Effects

Dizziness, drowsiness, ataxia; dry mouth, abdominal pain, nausea, vomiting, anorexia; leucopenia, proteinuria, renal failure, heart failure and hyponatraemia.
Potentially Fatal: Agranulocytosis, aplastic anaemia, hepatic failure, severe exfoliative dermatitis and Stevens-Johnson syndrome.

Precautions

General:
Before initiating therapy, a detailed history and physical examination should be made.
Carbamazepine should be used with caution in patients with a mixed seizure disorder that includes atypical absence seizures, since in these patients Carbamazepine has been associated with increased frequency of generalized convulsions (see INDICATIONS AND USAGE).
Therapy should be prescribed only after critical benefit-to-risk appraisal in patients with a history of cardiac conduction disturbance, including second and third degree AV heart block; cardiac, hepatic or renal damage; adverse hematologic or hypersensitivity reaction to other drugs, including reactions to other anticonvulsants; or interrupted courses of therapy with Carbamazepine.
AV heart block, including second and third degree block, have been reported following Carbamazepine treatment. This occurred generally, but not solely, in patients with underling EKG abnormalities or risk factors for conduction disturbances.
Hepatic effects, ranging from slight elevations in liver enzymes to rare cases of hepatic failure have been reported. In some cases, hepatic effects may progress despite discontinuation of the drug.
Multiorgan hypersensitivity reactions occurring days to weeks or months after initiating treatment have been reported in rare cases.
Discontinuation of Carbamazepine should be considered if any evidence of hypersensitivity develops.
Hypersensitivity reactions to Carbamazepine have been reported in patients who previously experienced this reaction to anticonvulsants including phenytoin and phenobarbital. A history of hypersensitivity reactions should be obtained for a patient and the immediate family members. If positive, caution should be used in prescribing Carbamazepine.
Since a given dose of Carbamazepine suspension will produce higher peak levels than the same dose given as the tablet, it is recommended that patients given the suspension be started on lower doses and increased slowly to avoid unwanted side effects

Special Precautions

Lactation; CV disease, hepatic or renal disorders, history of blood disorders or haematological reactions to other drugs; glaucoma; skin disorders; elderly, patients on MAO inhibitors; abrupt withdrawal of treatment.

Other Drug Interactions

Reduces tolerance to alcohol; shortens T1/2 of doxycycline. Decreased efficacy of oral contraceptives when used with carbamazepine. Increased plasma concentrations of carbamazepine by propoxyphene. Serum level decreases with phenytoin, phenobarbital, primidone.
Potentially Fatal: Neurotoxic reactions when combined with lithium.

Other Interactions

Information Not Available

Dosage

Oral
Epilepsy
Adult: Initially, 100-200 mg once or bid gradually increased by increments of 100-200 mg every 2 wk. Maintenance: 0.8-1.2 g daily in divided doses. Max dose: 2 g daily.
Child: ≤1 yr: 100-200 mg daily, 1-5 yr: 200-400 mg daily, 5-10 yr: 400-600 mg daily, 10-15 yr: 0.6-1 g daily. Alternatively, 10-20 mg/kg daily in divided doses.
Oral
Trigeminal neuralgia
Adult: Initially, 100 mg once or bid gradually increased as necessary. Maintenance: 400-800 mg daily in 2-4 divided doses. Max: 1.2 g daily.
Oral
Prophylaxis of bipolar disorder
Adult: Initially, 400 mg daily in divided doses gradually increased if necessary. Maintenance: 400-600 mg daily. Max: 1.6 g daily.
Rectal
Epilepsy
Adult: 250 mg every 6 hr for patients incapable of oral treatment.


 

Food(before/after)

Should be taken with food. (Avoid grapefruit juice.)

List of Contraindications

Carbamazepine and Pregnancy

Contraindicated in pregnancy.
Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective). 

Carbamazepine and Lactation

Caution when used during lactation.
Carbamazepine and its epoxide metabolite are transferred to breast milk. The ratio of the concentration in breast milk to that in maternal plasma is about 0.4 for Carbamazepine and about 0.5 for the epoxide. The estimated doses given to the newborn during breast feeding are in the range of 2 to 5 mg daily for Carbamazepine and 1 to 2 mg daily for the epoxide.
Because of the potential for serious adverse reactions in nursing infants from Carbamazepine, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Carbamazepine and Children

Substantial evidence of Carbamazepine’s effectiveness for use in the management of children with epilepsy  is derived from clinical investigations performed in adults and from studies in several in vitro systems which support the conclusion that (1) the pathogenetic mechanisms underlying seizure propagation are essentially identical in adults and children, and (2) the mechanism of action of Carbamazepine in treating seizures is essentially identical in adults and children.
Taken as a whole, this information supports a conclusion that the generally accepted therapeutic range of total Carbamazepine in plasma (i.e., 4 to 12 mcg/mL) is the same in children and adults.
The evidence assembled was primarily obtained from short-term use of Carbamazepine. The safety of Carbamazepine in children has been systematically studied up to 6 months. No longer-term data from clinical trials is available.

Carbamazepine and Geriatic

No systematic studies in geriatric patients have been conducted

Carbamazepine and Other Contraindications

Hypersensitivity; bone marrow depression; porphyria, pregnancy.

Storage

Oral: Store below 30°C
Rectal: Store below 30°C

Lab interference

Oral: Store below 30°C
Rectal: Store below 30°C

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