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Table Reference Number

Note. CNS = central nervous system; FDA = U.S. Food and Drug Administration; TCAs = tricyclic antidepressants; XR = extended-release.

Carbamazepine therapy: overview

Efficacy

Acute mania (FDA approved for Equetro only)

Mixed, rapid-cycling bipolar (not FDA approved)

Seizure disorders (FDA approved)

Side effects

Sedation

Dizziness

Fatigue and nausea

Ataxia

Safety in overdose

Serious symptoms may occur at 10–20 times normal serum levels. Symptoms include nausea, vomiting, CNS depression, respiratory depression, and seizures. Management includes gastric lavage, forced emesis, assisted ventilation.

Dosage and administration

For the XR form: 200 mg bid, to therapeutic range of 800–1,200 mg/day. Follow serum levels to 6–10 g/mL.

Discontinuation

Carbamazepine has not been associated with a withdrawal syndrome with rapid discontinuation. However, as with other mood stabilizers, rapid discontinuation is associated with an increased risk of rapid relapse. In bipolar patients, decrease dose over 6 months. In nonbipolar patients, dose may be decreased by 25% every 3 days.

Drug interactions

Drugs that may carbamazepine levels include: cimetidine, ciprofloxacin, diltiazem, fluoxetine, fluvoxamine, doxycycline, erythromycin, fluconazole, grapefruit juice, INH (isoniazid), ketoconazole, macrolide antibiotics (erythromycin, clarithromycin, troleandomycin), nefazodone, norfloxacin, prednisolone, propoxyphene, protease inhibitors (e.g., ritonavir), TCAs, valproate, verapamil, and warfarin

Drugs whose blood levels are by coadministration with carbamazepine include: atypical antipsychotics, benzodiazepines, doxycycline, ethosuximide, fentanyl, glucocorticoids, haloperidol, methadone, oral contraceptives, phenothiazines, phenytoin, sertraline, TCAs, and theophylline

References

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