Podcast
Questions and Answers
Carbamazepine should be administered with monoamine oxidase inhibitors (MAOIs) without any waiting period.
Carbamazepine should be administered with monoamine oxidase inhibitors (MAOIs) without any waiting period.
False
Carbamazepine is primarily used as a first-line treatment for mania.
Carbamazepine is primarily used as a first-line treatment for mania.
False
The modified release formulation of carbamazepine, known as Tegretol Retard, is associated with greater serum level fluctuation than the standard formulation.
The modified release formulation of carbamazepine, known as Tegretol Retard, is associated with greater serum level fluctuation than the standard formulation.
False
Carbamazepine can increase the risk of neutropenia when combined with clozapine.
Carbamazepine can increase the risk of neutropenia when combined with clozapine.
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Patients on carbamazepine must have their plasma levels checked immediately after taking their next dose.
Patients on carbamazepine must have their plasma levels checked immediately after taking their next dose.
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Neurotoxicity is a common interaction seen when carbamazepine is used with lithium.
Neurotoxicity is a common interaction seen when carbamazepine is used with lithium.
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Before starting carbamazepine, a baseline weight measurement is necessary.
Before starting carbamazepine, a baseline weight measurement is necessary.
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Carbamazepine can potentially lower the seizure threshold when taken with antidepressants.
Carbamazepine can potentially lower the seizure threshold when taken with antidepressants.
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Carbamazepine increases potassium conductance while blocking voltage-dependent sodium channels.
Carbamazepine increases potassium conductance while blocking voltage-dependent sodium channels.
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Carbamazepine is primarily indicated for treating grand mal and focal seizures.
Carbamazepine is primarily indicated for treating grand mal and focal seizures.
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Controlled-release formulations of carbamazepine can be administered up to four times a day.
Controlled-release formulations of carbamazepine can be administered up to four times a day.
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NICE recommends carbamazepine as a first-line treatment for mania.
NICE recommends carbamazepine as a first-line treatment for mania.
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The therapeutic range of carbamazepine is considered to be 5-15mg/L.
The therapeutic range of carbamazepine is considered to be 5-15mg/L.
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Carbamazepine has shown comparable effectiveness to lithium in bipolar disorder prophylaxis.
Carbamazepine has shown comparable effectiveness to lithium in bipolar disorder prophylaxis.
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Carbamazepine can initially have a half-life of approximately 30 hours.
Carbamazepine can initially have a half-life of approximately 30 hours.
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Oxcarbazepine has established evidence for its efficacy in treating acute bipolar disorder.
Oxcarbazepine has established evidence for its efficacy in treating acute bipolar disorder.
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Higher doses of carbamazepine typically prescribed in the UK range between 600-800mg/day.
Higher doses of carbamazepine typically prescribed in the UK range between 600-800mg/day.
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Carbamazepine shows a higher likelihood of patients discontinuing treatment due to side effects when compared to lithium.
Carbamazepine shows a higher likelihood of patients discontinuing treatment due to side effects when compared to lithium.
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Carbamazepine monotherapy has been indicated for bipolar depression with strong evidence.
Carbamazepine monotherapy has been indicated for bipolar depression with strong evidence.
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Patients with affective illness may not require a specific plasma level for treatment.
Patients with affective illness may not require a specific plasma level for treatment.
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Carbamazepine is an effective medication for managing aggressive behavior in all patients with schizophrenia.
Carbamazepine is an effective medication for managing aggressive behavior in all patients with schizophrenia.
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Genetic testing is advisable for individuals of European descent before administering carbamazepine.
Genetic testing is advisable for individuals of European descent before administering carbamazepine.
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Common adverse effects of carbamazepine include dizziness and sexual dysfunction.
Common adverse effects of carbamazepine include dizziness and sexual dysfunction.
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Cochrane considers the evidence for using carbamazepine for alcohol withdrawal strong.
Cochrane considers the evidence for using carbamazepine for alcohol withdrawal strong.
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Carbamazepine is exclusively safe for all women in child-bearing age without any concerns.
Carbamazepine is exclusively safe for all women in child-bearing age without any concerns.
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Monitoring the liver function tests (LFTs) is unnecessary after starting treatment with carbamazepine.
Monitoring the liver function tests (LFTs) is unnecessary after starting treatment with carbamazepine.
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A value that is 2-3 times the normal range for carbamazepine is typically a major cause for concern.
A value that is 2-3 times the normal range for carbamazepine is typically a major cause for concern.
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Carbamazepine can interact with drugs in a way that either reduces or increases their plasma levels.
Carbamazepine can interact with drugs in a way that either reduces or increases their plasma levels.
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Patients are advised to stop taking carbamazepine abruptly to prevent mood disorder recurrences.
Patients are advised to stop taking carbamazepine abruptly to prevent mood disorder recurrences.
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Carbamazepine has been linked to an increased risk of suicidal behavior in individuals without bipolar disorder.
Carbamazepine has been linked to an increased risk of suicidal behavior in individuals without bipolar disorder.
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Adequate contraception is not necessary if carbamazepine is prescribed to women of child-bearing age.
Adequate contraception is not necessary if carbamazepine is prescribed to women of child-bearing age.
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Fluconazole is an example of a drug that may increase plasma levels of carbamazepine.
Fluconazole is an example of a drug that may increase plasma levels of carbamazepine.
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Weight measurement is not considered important before starting treatment with carbamazepine.
Weight measurement is not considered important before starting treatment with carbamazepine.
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Patients on carbamazepine require regular monitoring of their white blood cell count (WBC) and liver function tests (LFTs).
Patients on carbamazepine require regular monitoring of their white blood cell count (WBC) and liver function tests (LFTs).
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Study Notes
Pharmacodynamic Interactions
- Carbamazepine's anticonvulsant activity can be reduced by drugs that lower the seizure threshold (e.g., antipsychotics and antidepressants)
- Carbamazepine can cause neutropenia, which may be increased by other drugs that depress the bone marrow (e.g., clozapine)
- The risk of hyponatremia may increase due to the depletion of sodium (e.g., diuretics)
- Neurotoxicity has been reported when carbamazepine is used in combination with lithium. This is rare.
Plasma Levels
- When used as an antiseizure medication, the therapeutic range is generally considered to be 4–12 mg/L.
- Patients with affective illness, a dose of at least 600mg/day and a plasma level of at least 7mg/L may be required.
- Levels above 12mg/L are associated with higher side effects
- Carbamazepine serum levels vary markedly within a dosage interval.
- To ensure reproducibility, taking a trough level before the first dose of the day is the most appropriate way of monitoring.
Adverse Effects
- Common side effects include dizziness, diplopia, drowsiness, ataxia, nausea, and headaches.
- Avoiding high peak blood levels by splitting the dose throughout the day or using a controlled-release formulation may help.
- Dry mouth, edema, and hyponatremia are also common.
- Sexual dysfunction can occur.
- Reduced testosterone levels are probably the cause of sexual dysfunction.
- Around 3% of patients develop a generalized erythematous rash.
- Serious exfoliative dermatological reactions can rarely occur.
- Carbamazepine can cause a chronic low white blood cell (WBC) count.
- Raised alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) are also common.
Pre-carbamazepine workup
- Baseline measurement of weight is desirable
- U&Es, FBC and LFTs
Prescribing
- Start with 100–200mg BD and titrate upwards
- The target dose is 400mg BD
- Some patients may need higher doses
- Modified release (Tegretol Retard) can be given once daily (if tolerated)
Monitoring
- Regular monitoring of U&Es, FBC and LFTs
- Weight (or BMI)
Stopping
- Reduce the dose slowly over at least 1 month
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Description
Explore the essential pharmacological aspects of carbamazepine, a widely used medication in the treatment of bipolar disorder and seizures. This quiz covers its interactions, dosage considerations, and formulations. Test your knowledge on how carbamazepine functions and its clinical implications.
