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Carbamazepine (Tegretol)
Carbamazepine (Tegretol)
- First line agent for acute mania and mania prophylaxis
- Indicated for rapid cyclers and mixed patients
How to use it
- Before med is started: baseline liver function tests, CBC and an EKG
- Monitoring: Steady state achieved after 5 days -check 12 hours after last dose and repeat CBC and lfts
- Goal: Target levels 4-12mcg/ml
- Need to check level and adjust dosing after around a month because induces own metabolism.
Side effects
Carbamazepine side effects
- Rash- most common SE seen
- Nausea, vomiting, diarrhea, transaminitis
- Sedation, dizziness, ataxia, confusion
- AV conduction delays
- Aplastic anemia and agranulocytosis (<0.002%)
- Water retention due to vasopressin-like effect which can result in hyponatremia
- Drug-drug interactions!
Drug interactions
Drug interactions
- Drugs that increase carbamazepine levels and/or toxicity: acetazolamide, cimetidine (both can cause rapid toxic reactions), clozapine (may act synergistically to suppress BM), diltiazem, INH, fluvoxamine, occasionally fluoxetine, erythromycin, clarithromycin, fluconazole, itraconazole, ketoconazole, metronidazole, propoxyphene, verapamil, diltiazem.
- Drugs that decrease carbamazepine levels: neuroleptics, barbiturates, phenytoin, TCA’s.
- VPA may increase or decrease carbamazepine levels.
- Carbamazepine is a heteroinducer, increasing its own metabolism and that of many other drugs, including estrogen and progesterone (contraceptives), warfarin, methadone, many psychotropics including antidepressants, antipsychotics, BZD’s, in addition to cyclosporine (and other immunosuppressants), theophylline, etc.