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).
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.
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.
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).
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.
Avoid alcoholic beverages. Call physician immediately if seizures worsen. Caution re drowsiness, dizziness (NB driving).
200 mg tablets, 100 mg and 200 mg Chewtabs, 200 mg and 400 mg CR (controlled-release) tablets, 100 mg/5mL oral suspension.
Tags: allergic skin reactions, Anticonvulsant, antimanic agent, ataxia, bipolar disorders, cardiovascular, dermatologic reactions, diplopia, dizziness, Drowsiness, dry mouth, edema, eosinophilia. Rarely, fatigue, fluid retention, headache, hepatic, leucopenia, lithium, mania, nausea, neuroleptics, serious hematologic, Tegretol, vertigo, vomiting