Dr. Saltiel received his Pharm.D. from the University of California, San Francisco, in 1980, following undergraduate work at UCLA. At UCSF, he was the recipient of the Outstanding Service Award and the Bowl of Hygeia Award. He completed a residency in clinical pharmacy practice at the University of Illinois, in Chicago.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Carbamazepine is an
anti-seizure
medication. Recurrent seizures (epilepsy) are divided
into two main categories according to how much of the brain is involved, partial
and generalized epilepsy (which includes petit mal,
grand
mal, and myoclonic epilepsy). Seizures are called "simple" if there
is no
loss of consciousness and "complex" if there is. Medicines
that
inhibit seizures are called anti-convulsants. Carbamazepine works as
an anti-convulsant for
partial and grand mal seizures by reducing
or blocking
certain responses in the brain. It is also
used for treating trigeminal neuralgia. One dosage form, Equetro,
has been
approved for treating bipolar disorder.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Tablets: 200
mg. Chewable tablets; 100 mg. Extended release tablets; 100, 200,
and 400 mg. Suspension; 100 mg/5 ml. Equetro is available in 100,
200, and 300 mg extended
release
tablets
STORAGE: Carbamazepine should be stored in a tight,
light
resistant container at room temperature.
PRESCRIBED FOR: Carbamazepine
is used in the treatment of simple and complex partial seizures and
in generalized
seizures of the grand mal type. It is not used
to treat
petit mal seizures. Carbamazepine also is used to treat a painful
nerve condition
of the face called trigeminal neuralgia. Equetrol is used to treat
bipolar
disorder.
DOSING: Carbamazepine may be taken with or without
food.
Carbamazepine is excreted by the kidney and metabolized by the
liver and
dosages may need to be lowered in patients with liver or kidney
dysfunction. Drug blood levels of carbamazepine can be
followed.
DRUG INTERACTIONS: Carbamazepine interacts with
multiple drugs
and caution should be used in combining other medicines with
it. Lower
levels of carbamazepine are seen when administrated with
phenobarbital,
phenytoin (Dilantin), or
primidone (Mysoline). Warfarin
(Coumadin), phenytoin (Dilantin), theophylline, and
valproic
acid (Depakote, Depakote ER, Depakene, Depacon) are more rapidly metabolized with carbamazepine, while
carbamazepine
levels are elevated when taken with erythromycin, cimetidine
(Tagamet),
propoxyphene (Darvon), and calcium channel blockers. Carbamazepine also
increases the metabolism (destruction) of the hormones in birth
control pills and can reduce the effectiveness of
birth control
pills. Unexpected pregnancies have occurred in patients taking both
carbamazepine and birth control pills.
PREGNANCY: If possible,
carbamazepine should not be used in
pregnancy or while
breastfeeding.
NURSING MOTHERS: If possible, carbamazepine should not
be used
in pregnancy or while breast feeding.
SIDE EFFECTS: Serious side effects include dangerously
low red
and white blood cell counts. Severe skin reactions can occur as
well as
serious liver abnormalities, such as hepatitis, resulting in
jaundice. Low
sodium levels and thyroid abnormalities have been described.
Minor more
common side effects include dizziness,
unsteadiness, nausea, and
vomiting. Rare
patients with Asian ancestry rarely may develop severe skin reactions to
carbamazepine (Stevens-Johnson syndrome and toxic epidermal necrolysis). These patients can be
identified by genetic testing, and such testing is recommended for all Asian patients before
starting therapy.
Antiepileptic medications have been associated
with increased risk of suicidal thinking and behavior. Anyone
considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are
started on therapy should be closely observed for clinical worsening, suicidal
thoughts, or unusual changes in behavior.
Shingles (herpes zoster) is a skin rash caused by the same virus that causes chickenpox. Under certain circumstances, such as emotional stress, immune deficiency, or with cancer, the virus re-activates causing shingles. Shingles are catching and can spread from an infected person to others who have not had chickenpox. There are a variety of treatments for shingles.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Dystonia disorders cause involuntary movements and prolonged muscle contraction, resulting in twisting body motions, tremor, and abnormal posture. There are many forms of dystonia. Some types of dystonia respond to dopamine, or can be controlled with dedative-type medications, or surgery.
Compulsive gambling is a disorder that affects millions in the U.S. Symptoms and signs include a preoccupation with gambling, lying to family or loved ones to hide gambling, committing crimes to finance gambling, and risking importance relationships and employment due to gambling. Treatment may incorporate participation in Gamblers' Anonymous, psychotherapy, and medications like carbamazepine, topiramate, lithium, naltrexone, antidepressants, clomipramine, and fluvoxamine.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Pain that originates in the face is referred to as trigeminal neuralgia. This pain may be caused by an injury, and infection in the face, a nerve disorder, or it can occur for no known reason. Trigeminal neuralgia can be treated with antiseizure medications. Some antidepressant drugs also have significant pain relieving effects.
Fabry disease (Fabry's disease, alpha-galactosidase-A) is a genetic disorder with symptoms such as burning sensations in the hands, small-raised reddish-purplish blemishes on the skin, fever, decreases sweating, and GI difficulties. Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication.
Cysticercosis is an infection caused by Taenia solium, the pork tapeworm. Symptoms include seizures, lethargy, nausea and vomiting, headache, vision changes, weakness, and confusion. Treatment depends upon the individual's symptoms and the stage of the infection. Treatment may incorporate anthelmintics, corticosteroids, anticonvulsants, and/or surgery.
Kleine-Levin syndrome is a rare sleep condition, primarily affecting adolescent males. Symptoms of Kleine-Levin syndrome include recurring but reversible periods "episodes" of excessive sleep. There is no definitive treatment for Kleine-Levin syndrome. Medication can be prescribed to treat sleepiness and episodes.
Bipolar disorder, also called manic depression, is a mental illness that is characterized by severe mood swings, repeated episodes of depression, and at least one episode of mania. Bipolar disorder is one kind of mood disorder that afflicts more than
1% of adults in the United States, up to as many as 4 million people. Here are
some additional statistics about bipolar disorder:
Bipolar disorder is the fifth leading cause of disability worldwide.
Bipolar disorder is the ninth leading cause of years lost to death or disability worldwide.
The number of individuals with bipolar disorder who commit suicide is 60 times higher than that of the general population.
People who have bipolar disorder are at a higher risk of also suffering from substance abuse and other mental health problems.
Males may develop bipolar disorder earlier in life compared to females.
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