carbamazepine

Carbamazepine is an anti-seizure medication. Recurrent seizures (epilepsy) are divided into two main categories according to how much of the brain is involved, either partial or 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 by nerves in the brain. It also is used for treating trigeminal neuralgia. One dosage form, Equetro, has been approved for treating bipolar disorder. The FDA approved carbamazepine in March 1968.

What brand names are available for carbamazepine?

Tegretol, Tegretol XR , Equetro, Carbatrol, Epitol, Teril

Is carbamazepine available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for carbamazepine?

Yes

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.

Rarely, patients with Asian ancestry 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 patients who are Asian before starting therapy.

Antiepileptic medications have been associated with an 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.

Carbamazepine may be taken with or without food. Carbamazepine is excreted by the kidney and eliminated by the liver, and dosages may need to be lowered in patients with liver or kidney dysfunction.  Blood levels of carbamazepine are used for adjusting dosing. The dose for seizures is 800 to 1600 mg daily in divided doses. Trigeminal neuralgia is treated with 400-1200 mg daily in divided doses. The dose for treating bipolar disorder using Equetro is begun at 200 mg every 12 hours initially, and then increased by 200 mg a day up to a maximum dose of 1600 mg per day.

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 eliminated with carbamazepine, while carbamazepine levels are elevated when taken with erythromycin, cimetidine (Tagamet), propoxyphene (Darvon), and calcium channel blockers. Carbamazepine also increases the elimination 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.

If possible, carbamazepine should not be used in pregnancy or while breastfeeding.

What preparations of carbamazepine are available?

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

How should I keep carbamazepine stored?

Carbamazepine should be stored in a tight, light resistant container at room temperature.