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Name: Carbamazepine

Pregnancy Category C

Drug classes

  • Antiepileptic

Therapeutic actions

Mechanism of action not understood; antiepileptic activity may be related to its ability to inhibit polysynaptic responses and block post-tetanic potentiation. Drug is chemically related to the tricyclic antidepressants (TCAs).

Indications

Refractory seizure disorders: partial seizures with complex symptoms (psychomotor, temporal lobe epilepsy), generalized tonic-clonic (grand mal) seizures, mixed seizure patterns or other partial or generalized seizures (carbamazepine should be reserved for patients who have not
responded satisfactorily to other agents, whose seizures are difficult to control, or who are experiencing marked side effects, such as excessive sedation)

Trigeminal neuralgia (tic douloureux): treatment of pain associated with true trigeminal neuralgia; also beneficial in glossopharyngeal neuralgia

Unlabeled uses: neurogenic diabetes insipidus; certain psychiatric disorders, including bipolar disorders, schizoaffective illness, resistant schizophrenia, and dyscontrol syndrome associated with limbic system dysfunction; alcohol withdrawal

Contraindications/cautions

Contraindicated in the presence of hypersensitivity to carbamazepine or tricyclic antidepressants; history of bone marrow depression; concomitant use of monoamine oxidase inhibitors (MAOIs), lactation.

Use caution with history of adverse hematologic reaction to any drug (may be at increased risk of severe hematologic toxicity); glaucoma or increased intraocular pressure; history of cardiac, hepatic, or renal damage; psychiatric patients (may activate latent psychosis).

Adverse effects

  • CNS: Dizziness, drowsiness, unsteadiness, disturbance of coordination, confusion, headache, fatigue, visual hallu-cinations, depression with agitation, behavioral changes in children, talkativeness, speech disturbances, abnormal involuntary movements, paralysis and other symptoms of cerebral arterial insufficiency, peripheral neuritis and paresthesias, tinnitus, hyperacusis, blurred vision, transient diplopia and oculomotor disturbances, nystagmus, scattered punctate cortical lens opacities, conjunctivitis, ophthalmoplegia, fever, chills; syndrome of inappropriate antidiuretic hormone (SIADH)
  • GI: Nausea, vomiting, gastric distress, abdominal pain, diarrhea, constipation, anorexia, dryness of mouth or pharynx, glossitis, stomatitis; abnormal liver function tests, cholestatic and hepatocellular jaundice, fatal hepatitis, fatal massive hepatic cellular necrosis with total loss of intact liver tissue
  • CV: Congestive heart faliure, aggravation of hypertension, hypotension, syncope and collapse, edema, primary thrombophlebitis, recurrence of thrombophlebitis, aggravation of coronary artery disease, arrhythmias and AV block; fatal cardiovascular complications
  • Respiratory: Pulmonary hypersensitivity characterized by fever, dyspnea, pneumonitis or pneumonia
  • Hematologic: Potentially fatal hematologic disorders
  • GU: Urinary frequency, acute urinary retention, oliguria with hypertension, renal failure, azotemia, impotence, proteinuria, gluycosuria, elevated BUN, microscopic deposits in urine
    Dermatologic: Pruritic and erythematous rashes, urticaria, Stevens-Johnson syndrome, photosensitivity reactions, alterations in pigmentation, exfoliative dermatitis, alopecia, diaphoresis, erythema multiforme and nodosum, purpura, aggravation of lupus erythematosus
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