Brand Name: Tegretol (available in generic)

Manufacturer: Norartis

Description: Carbamazepine USP is an anticonvulsant and specific analgesic for trigeminal neuralgia. It is chemically unrelated to other medications designated for these purposes. Its specific mechanism of action is unknown. Because Carbamazepine USP may induce its own metabolism, the half-life is variable (from 25-65 hours). It is metabolized in the liver.

Indications and Uses: Carbamazepine USP is indicated for use as an anticonvulsant to treat partial complex seizure disorder, generalized clonic-tonic seizures (grand mal), and mixed seizure patterns. Absence seizures (petit mal) do not generally respond to treatment with carbamazepine. It is also indicated to treat the pain associated with true trigeminal neuralgia. It has also been used to treat glossopharyngeal neuralgia. Psychiatrically, it is sometimes used as a mood stabilizer in the treatment of Bipolar disorder ( Manic-Depression), although the FDA has not yet approved this use.

Contraindications, Warnings, and Precautions: Carbamazepine is contraindicated in patients with a history of previous bone marrow depression, hypersensitivity to the drug, or known sensitivity to any of the tricyclic compounds (e.g., amitriptyline, imipramine, etc.).  Aplastic anemia and agranulocytosis have been reported in association with the use Tegretol.  It should not be given with MAOIs (monoamine oxidase inhibitors). Rare cases of severe dermatologic reactions (toxic epidermal necrolysis and Stevens-Johnson Syndrome) have occurred. It should be used with caution in patients with glaucoma. Taking carbamazepine with phenobarbital, phenytoin, or primidone produces a marked lowering of blood levels or carbamazepine. Mixing it with lithium increases the risk of neurotoxic side effects. Regular monitoring of blood counts including platelets and possible reticulocytes and serum iron should be done. Carbamazepine should be discontinued if there is any evidence of significant bone marrow depression. Periodic liver function tests should also be done. Carbamazepine should not be used in pregnant or nursing mothers.

Adverse Reactions: Possible common observed adverse reactions, particularly during the starting phases of therapy, are dizziness, drowsiness, unsteadiness, nausea, and vomiting. Patients may also experience edema, skin rash, cardiovascular complications (worsening of pre-existing arrhythmia's), and hematologic changes.

Dosing Range: In adults and children over twelve years the usual starting dose is 200 mg twice an day. Doses generally should not exceed 1000 mg per day in children twelve to fifteen years old and 1200 mg per day in patients over fifteen years of age. A therapeutic blood level ranges from 4 to 12 micrograms per ml of blood.  Blood levels and effects should be closely monitored.

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© 2000 Red Oak Psychiatry Associates, P.A.    Updated 11/26/2007