Brand name: Tegretol

Generic name: Carbamazepine

Indications: alone or concomitantly with other anticonvulsants in treatment of grand mal
and psychomotor or temporal lobe epilepsy and mixed seizures in patients who
have not responded satisfactorily to other agents. Also used for symptomatic
treatment of trigeminal and glossopharyngeal neuralgias and for pain and
paroxysmal symptoms associated with multiple sclerosis and other neurologic
disorders.
Drug classification: central nervous system agent; anticonvulsant
Mechanism of action: structurally related to tricyclic antidepressants but lacks
antidepressant properties. Anticonvulsant actions appear qualitatively similar to
those of phenytoin. Like phenytoin, provides relief in trigeminal neuralgia by
reducing synaptic transmission within trigeminal nucleus. Also has
sedative,anticholinergic, antidepressant, and muscle relaxant (by inhibition of
neuromuscular transmission) effects and slight analgesic actions.
Dosage: Epilepsy
Adult: PO 200mg bid, gradually increased to 800-1200mg/d in 3-4 divided
doses. Tegretol XR dosed bid
 Child: PO <6y: 10-20mg/kg/d, may gradually increased weekly, recommended
max 35mg/kg/d in 3-4 divided doses; 6-12y: 100mg bid, gradually increased to
400-800mg/d in 3-4 divided doses (max 1g/d); <6y: 20-30mg/kg/d in 3-4
divided doses
Trigeminal neuroglia
Adult: PO 100mg bid, gradually increased by 100mg increments q12h until
relief; usual dose 200-800mg/d in 3-4 divided doses (max 1.2g/d) Tegretol XR
dosed bid.
Special precaution: the older adults; history of cardiac disease
Pregnancy risk category: D
Adverse reaction: Body as a whole: myalgia, arthralgia, leg cramps, carbamazepine-
induced SLE.CV: edema, syncope, arrhythmias, heart block. GI: nausea,
vomittting, anorexia, abdominal pain, diarrhea, constipation, dry mouth and
pharynx, abnormal liver function test, hepatitis, cholestatic and hepatocellular
jaundice,pancreatitis. Endocrine: hypothyroidism, SIADH. Hematologic:
aplastic anemia, leukopenia, leukocytosis, agranulocytosis, eosinophilia,
thrombocytopenia. CNS: dizziness, vertigo, drowsiness, disturbances of
coordination, ataxia, confusion, headache, fatigue, listlessness, speech
(continuation Tegretol)
difficulty, development of minor motor seizures, hyperreflexia, akathisia,
involuntary movements, tremors, visual hallucinations, activation of latent
psychosis, aggression; agitation, respiratory depression. Skin: skin rashes,
urticaria, petechiae, erythema multiforme, Stevens-Johnson syndrome,
photosensitivity reaction, altered skin pigmentation, exfoliative dermatitis,
alopecia. Special Senses: abnormal hearing acuity, scotomas, conjunctivitis,
blurred vision, transient diplopia, aculomotor disturbances, oscillopsia,
nystagmus. Urogenital: urinary frequency or retention, oliguria, impotence.
Contraindication: hypersensitivity to carbamazepine and to TCA’s; history of
myelosuppression or hematologic reaction to other drugs; increased IOP; SLE;
cardiac, hepatic or renal disease; coronary artery disease; hypertension;
pregnancy, lactation. Safe use in children <6 months not established.
Form: 100 mg chewable tablets; 200 mg tablets; 100 mg, 200 mg, 400 mg sustained-
release tablets; 200 mg, 300 mg sustained-release capsules; 100 mg/5ml
suspension.
Nursing responsibility: Monitor for the following reactions which commonly occur
during early therapy: drowsiness, dizziness, light headedness, ataxia, gastric
upset. If these symptoms does not subside within a few days, dosage adjustment
may be indicated. Monitor for toxicity, which can develop when serum
concentrations are even slightly above the therapeutic range. Monitor I&O ratio
and vital signs during period of dosage adjustment. Report oliguria, signs of
fluid retention, changes in I&O ratio, and changes in BP or pulse pattern.
Confusion and agitation may be aggravated in the older adults; therefore, side
rails and supervision of ambulation may be indicated. Cardiac syncope may
resemble epileptic seizures. Therefore, it is recommended that patients who
experience an apparent increase in frequency of seizures or a change in their
character should be checked by continuous ECG monitoring for 24h. Doses
higher than 600mg/d may precipitate arrhythmias in patients with heart disease.