TEGRETOL Novartis
Carbamazepine

Use:
Anticonvulsant, antimanic agent. Epilepsy: Adults and children > 12 years – initially, 100-200 mg once or twice a day; increased in divided doses until best response obtained. Optimal daily dosage: 800-1200 mg. Rarely, some adults may require 1600 mg/day. As soon as disappearance of seizures has been obtained and maintained, reduce dosage very gradually to minimum effective dose. Children 6-12 years: Initially, 100 mg in divided doses on first day; increased by 100mg/day until best response obtained. Maximum daily dosage: 1000mg.

Trigeminal neuralgia: Initially, 100 mg twice daily; increased by 200 mg/day until pain is relieved, usually at 200-800 mg/day (occasionally, 1200 mg/day). Reduce or discontinue Tegretol, if possible, at intervals of not more than 3 months.

Mania and bipolar disorders: Initially, 200-400 mg/day in divided doses (400-600 mg/day may be used in acute mania); increased gradually until symptoms are controlled or a total daily dose of 1600 mg is achieved. Usual dose is 400-1200 mg/day in divided doses.

With lithium, neuroleptics: start with 100-200 mg/day and increase gradually. Daily dose > 800 mg is rarely required.

Tegretol tablets, Chewtabs and suspension: Take in 2-4 divided doses daily, with food. CR tablets may be divided or swallowed unchewed with liquid during or after a meal. Suspension: Start with low doses and increase slowly to avoid adverse reactions. When switching from tablets to suspension, give the same amount of drug daily, but in smaller, more frequent doses (i.e. twice daily tablets could be switched to 3 times daily suspension).

Contraindications:
AV block, hepatic disease, a history of bone marrow depression, acute intermittent porphyria or serious blood disorders. Hypersensitivity to carbamazepine or tricyclics. Not to be given with, or within 14 days of starting or stopping MAOI therapy.

Precautions:
Pregnancy, lactation: Weigh possible risks vs. potential benefits. Elderly patients. Urinary retention, increased intraocular pressure, cardiovascular disorders, activation of behavioral disorders, exacerbation of seizures. Perform periodic ophthalmic examinations, evaluations of renal, hepatic and bone marrow function. Abrupt cessation of Tegretol may precipitate seizures. Cross-hypersensitivity with phenytoin and oxcarbazepine.

Side effects:
Drowsiness, headache, ataxia, vertigo, fatigue, diplopia, dizziness, nausea, vomiting, allergic skin reactions, edema, fluid retention, dry mouth, leucopenia, eosinophilia. Rarely, serious hematologic, hepatic, cardiovascular and dermatologic reactions (stop therapy).

Interactions:
Se Contraindications. Plasma levels of carbamazepine increased by macrolide antibiotics, isoniazid, verapamil, danazol, fluvoxamine, grapefruit juice, azole antifungals, loratadine, ritonavir, diltiazem, fluoxetine, cimetidine. Carbamazepine may lower plasma levels of anticonvulsants, oral contraceptive, oral anticoagulants, digoxin, cyclosporine, levothyroxine, dehydropyridine calcium channel blockers, doxycycline, TCAs, estrogens/progestrogens, corticosteroids, benzodiazepines, haloperidol, protease inhibitors for HIV treatment, olanzapine, risperidone. Plasma levels of carbamazepine may be reduced by phenytoin, Phenobarbital, rifampin, oxcarbazepine, St.John’sWort, valproic acid, phesuximide. Combined use of carbamazepine with lithium or haloperidol may increase risk of neurotoxic side effects.

Patient tips:
Avoid alcoholic beverages. Call physician immediately if seizures worsen. Caution re drowsiness, dizziness (NB driving).

Supplied:
200 mg tablets, 100 mg and 200 mg Chewtabs, 200 mg and 400 mg CR (controlled-release) tablets, 100 mg/5mL oral suspension.

Source: http://www.mentalhealth.com/drug/p30-t01.html

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Antipsychotics can be classified by their structure but can also be distinguished by their pharmacology, their action at receptors, and by their clinical properties. Typical (also called conventional) antipsychotics act primarily at dopamine receptors. Atypical antipsychotics act on other receptors as well as dopamine, and are less likely than typical antipsychotics to cause movement disorders as a side effect. The following are atypical antipsychotics are licensed in the UK: amisulpiride (brand name Solian), aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and zotepine (Zoleptil).

As with all effective medicines antipsychotics can produce side effect in some individuals. The most common side effects include movement disorders that may resemble Parkinson’s disease (referred to as extrapyramidal effects, anticholinergic effects such as dry mouth, feelings of dizziness or light headedness, constipation and blurred vision (so called as they are due to the action of these drugs on cholinergic receptors in the brain and body) and weight gain.

It is important to appreciate that this is not a comprehensive list of the possible side effects of antipsychotics. Full guidance on prescribing and use, including possible side effects, of antipsychotics is provided in the Summary of Product Characteristics (SPC) for health professionals and the patient information leaflet (PIL) that should accompany the medicine.

More recently concerns have arisen that patients receiving risperidone and olanzapine in dementia were at an increased risk of stroke compared with patients receiving placebo (dummy pill) and that the balance of risks and benefits was considered to be unfavourable in the dementia population. Atypical antipsychotics are not authorised for the treatment of dementia related psychosis and/or behaviour disturbances. Prescribers were informed of this risk and advised to review the treatment of all patients receiving atypical antipsychotics in dementia as the risk of stroke for other atypical antipsychotics could not be excluded:
Source: http://www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Antipsychoticdrugs/index.htm

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