There have been two recently published randomized, double-blind,
placebo-controlled studies of the extended-release formulation of
the anticonvulsant carbamazepine for the acute treatment of manic
or mixed episodes (27, 28). In both studies, carbamazepine extended-release
was initiated at 400 mg in divided doses on day 1 and increased
as tolerated up to 1,600 mg/day. The mean final dosages
were 756 mg/day (27) and 643 mg/day (28), respectively.
An onset of action was seen at day 14 in the first trial and at
day 7 in the second trial, and both trials found carbamazepine extended-release
to be superior to placebo at endpoint. Side effects included dizziness,
somnolence, nausea, vomiting, ataxia, blurred vision, dyspepsia,
dry mouth, pruritus, and speech disorder.