Class: AED/Mood Stabilizer FDA Indications: Bipolar Disorder, Epilepsy, Trigeminal Neuralgia Off-Label Use: Restless Leg Syndrome, Neuropathic Pain, Agitation And Aggression In Dementia
Forms: 100, 200mg tablet; 100, 200, 400 mg Extended-Release Capsules (Equetro®); 100 mg/5 mL po soln Dose Range: 200-1600 mg/day Starting: Usual starting dose is 200 mg BID, gradually increasing up to an average effective dose of 400 mg BID. The maximum recommended dose is 1600 mg QD (split BID). Monitoring: Every 6 to 12 months: CBZ levels (therapeutic range 4-12 μg/mL), LFTs, CBC w/ diff & retics, serum Na+
Contraindications: H/o bone marrow depression, known sensitivity to any of the TCAs, concomitant use of MAOIs Serious Side Effects:Stevens-Johnson syndrome/TEN (1-6:10,000, 10x higher in some Asian countries), aplastic anemia (2:1,000,000), agranulocytosis (6:1,000,000), ↑'d suicidality, DRESS Side Effects: ataxia, visual changes, weakness/asthenia, constipation, xerostomia, hyperhidrosis, hyponatremia, rash, pruritus, speech disturbance, anemia, leukopenia, dizziness (44%), sedation/somnolence (32%), nausea (29%), vomiting (18%)
1° MOA: Binds to α subunit of voltage sensitive Na+ channels & possibly actions at other ion channels (Ca2+ & K+). Interference with these channels may enhance the inhibitory actions of GABA. Target: SCN5A
- pan-inducer of nearly all major metabolic pathways
induces its own metabolism — autoinduction may start within 24° of 1st dose & seems to be complete within 20-30 days
autoinduction of CBZ is dose dependent, so each dose ↑ will result in further autoinduction
combining with Li+ can ↑ neurotoxic side effects
DO NOT CO-PRESCRIBE WITH MAOIs (need a 14-day washout period)
- t½ after a single dose varies between 28-65°, however after autoinduction is completed t½'s are in the range of 10-20°
HLA Genetic Testing recommened patients of East Asian descent who are at an ↑'d risk of carbamazepine-induced SJS
Rational for Patients of Asian Descent Having HLA Genetic Testing Before Using Carbamazepine
This recommendation was added to the product packaging label based on research showing that patients of East Asian descent were at an increased risk of developing
Stevens-Johnson syndrome when taking carbamazepine. At least 5 % of this risk was attributed to carrying a particular variant of the human leukocyte antigen allele: HLA-B*1502. This allele is present at a much greater frequency in East Asians (10-15%), as compared to those of Japanese or Korean (<1%) descent.
∅ clinically significant weight gain
has most robust evidence, among mood-stabilizers, for use in treating non-cognitive symptoms of dementia
Category D—CBZ can cause fetal harm (spina bifida) when administered to a pregnant woman. Fetal plasma concentrations range between 50-80% of maternal levels. CBZ is cleared more rapidly in the 3rd trimester
RID 1.1-7.3%; some AEs reported, suggest discontinue or bottle feed
Clearance is age dependent, with higher clearance reported in younger children and lower clearances reported in older patients
Renal disease and dialysis do not alter clearance
Patients with significant liver disease may have a decreased clearance of carbamazepine
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Last updated December 05 2018 19:19:12. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.
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