CARBAMAZEPINE oral

Prescription under medical supervision

Therapeutic action

– Antiepileptic

Indications

– Epilepsy (except absence seizures)
– Neuropathic pain (alone or combined with amitriptyline)
– Prevention of recurrence of bipolar disorder 

Forms and strengths

– 200 mg tablet

Dosage

– Epilepsy
Child 1 month and over:  start with 5 mg/kg once daily or 2.5 mg/kg 2 times daily, then increase the dose every week by 2.5 to 5 mg/kg, up to 5 mg/kg 2 or 3 times daily (max. 20 mg/kg daily)
Adult: start with 100 to 200 mg once daily or 2 times daily, then increase the dose every week by 100 to 200 mg, up to 400 mg 2 to 3 times daily (max. 1600 mg daily)

– Neuropathic pain
Adult: 200 mg once daily at bedtime for one week, then 200 mg 2 times daily (morning and bedtime) for one week, then 200 mg 3 times daily

– Prevention of recurrence of bipolar disorder 
Adult: start with 100 mg 2 times daily, then increase the dose every week by 200 mg if necessary up to 200 mg 2 or 3 times daily (max. 1200 mg daily).

Duration

– Epilepsy, prevention of recurrence of bipolar disorder: lifetime treatment. Do not stop treatment abruptly, even if changing treatment to another antiepileptic.
– Neuropathic pain: continue several months after pain relief is obtained, then attempt to stop treatment.

Contra-indications, adverse effects, precautions

– Do not administer to patients with atrioventricular block, history of bone marrow depression.
– Administer with caution to patients with glaucoma, urinary retention, hepatic or renal impairment, heart failure or blood disorders and to elderly patients.
– May cause:
• headache, dizziness, gastrointestinal and visual disturbances, rash, leucopenia, confusion and agitation in elderly patients, drowsiness (use with caution when driving or operating machinery);
• rarely: severe allergic reactions (Lyell's and Stevens-Johnson syndromes), agranulocytosis, anaemia, bone marrow depression, pancreatitis, hepatitis, cardiac conduction defect. In these cases, stop treatment.
– Do not drink alcohol during treatment.
– Do not combine or monitor the combination with:
• erythromycin, isoniazid, fluoxetine, valproic acid, etc. (increased carbamazepine plasma concentrations);
• rifampicin (reduced efficacy of carbamazepine);
• oral anticoagulants, contraceptives (oral and implants), corticosteroids, tricyclic antidepressants, neuroleptics, protease inhibitors, rifampicin, itraconazole, doxycycline, tramadol, etc. (reduced efficacy of these drugs).
– Pregnancy:
• Epilepsy and bipolar disorder: do not start treatment during the first trimester, except if vital and there is no alternative (risk of neural tube defects, facial and cardiac malformations, hypospadias). However, if treatment has been started before the pregnancy, do not stop treatment and use the minimal effective dose. Due to the risk of haemorrhagic disease of the newborn, administer vitamin K to the mother and the neonate. The administration of folic acid during the first trimester may reduce the risk of neural tube defects.
• Neuropathic pain: not recommended
– Breast-feeding: avoid

Remarks

– Also comes in 100 mg/5 ml oral solution, 100 mg tablet and 100 mg and 200 mg chewable tablets.
 Storage: below 25 °C -  -