China
Africa
Explore chapters and articles related to this topic
Prescribing for a first episode of affective psychosis
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
The common side-effects of carbamazepine are: nausea, +/- appetite loss and abdominal painataxia, clumsinessdizziness or lightheadednesstransient diplopia
Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Most patients can be managed medically. The most effective first-line treatment is carbamazepine, followed by oxcarbazepine, both of which reduce the excitability of neurons by blocking sodium channels. Carbamazepine 400–1200 mg daily in divided doses is effective in about three-quarters of patients.25 A small dose of 50–100 mg nightly is the usual starting dose (to avoid drowsiness), escalating the dose as tolerated until pain relief is achieved (or adverse effects occur). A slow-release preparation can also be used. The dose is continued for weeks to months, and can then be tapered slowly, with reloading if the pain recurs. Most responders will experience about 6–12 months of respite before recurrence. Up to one-third of patients cannot tolerate carbamazepine in the doses required to alleviate the pain due to adverse effects such as rash, nausea, drowsiness, and ataxia. Carbamazepine may also cause hyponatremia, megaloblastic anemia (folate interaction), aplastic anemia, agranulocytosis, hepatotoxicity, and hypersensitivity reactions. Oxcarbazepine (900 mg/day to 1800 mg/day) is generally better tolerated.
Antiepileptic Actions of Carbamazepine
Published in Carl L. Faingold, Gerhard H. Fromm, Drugs for Control of Epilepsy:, 2019
Alternatively, it has been proposed that carbamazepine decreases neuronal firing in the CNS by potentiating dopaminergic effects.41,42 However, these experiments also employed very high doses, so that their relevance to the therapeutic action of carbamazepine is not clear. There is also no conclusive evidence that carbamazepine’s action involves effects on cholinergic mechanisms.1
National assessment of anti-epileptic drug exposures among pre-teens and adolescents, 2000–2020
Published in Clinical Toxicology, 2022
Michael S. Toce, Joel D. Hudgins, Christopher J. Yuskaitis, Michael C. Monuteaux, Florence T. Bourgeois
The population-adjusted rate of epilepsy diagnoses remains relatively unchanged, indicating that the rise in AED exposure cases may be related to increased prescribing of AEDs for psychiatric indications as opposed to epilepsy [25]. This is consistent with known increases in the use of AEDs for psychiatric conditions [16,26,27]. AEDs have been shown to be effective in treating a variety of psychiatric conditions, including major depressive disorder, generalized anxiety disorder, and bipolar disorder [10–14]. For example, lamotrigine’s primary psychiatric indication is the treatment of bipolar disorder, which is FDA-approved for this indication in adults and supported by strong evidence for efficacy in the treatment of the depressive phase of bipolar disorder [28]. Carbamazepine has a number of well-established psychiatric uses, including for bipolar disorder, mania, post-traumatic stress disorder, and behavioral dysregulation [10,29]. Tiagabine, the AED with the highest risk of adverse outcomes in our analysis, does not have any FDA-approved psychiatric indications, but is used off-label in the treatment of anxiety [30,31]. However, in 2005, the FDA added a boxed warning to the label stating that use of tiagabine in non-epileptic patients has been associated with seizures [32].
Impact of chronic medications in the perioperative period: mechanisms of action and adverse drug effects (Part I)
Published in Postgraduate Medicine, 2021
Ofelia Loani Elvir-Lazo, Paul F White, Hillenn Cruz Eng, Firuz Yumul, Raissa Chua, Roya Yumul
Carbamazepine is primarily used as an anticonvulsant, but it is considered as a second-line agent for treating bipolar affective disorders. Aside from its anticonvulsant properties, carbamazepine has also been shown to exhibit anticholinergic, antineuralgic, antidiuretic, muscle relaxant, antimanic, antidepressant, and antiarrhythmic properties. Carbamazepine depresses activity in the nucleus ventralis of the thalamus decreasing synaptic transmission (or summation of temporal stimulation) and leading to neuronal discharge by limiting the influx of sodium ions across cell membranes [96]. Carbamazepine has also been shown to stimulate the release of ADH and potentiate reabsorption of water by the renal tubules. Due to its similar chemical structure, it has been shown to have similar effects to tricyclic antidepressants. Carbamazepine is often used as monotherapy for the acute treatment of hypomania and mild-to-moderate mania or mixed episodes associated with bipolar disorder. It can also be used as monotherapy or adjunct treatment for focal onset seizures and generalized onset seizures. Lastly, a unique clinical indication that carbamazepine has been shown to be helpful in is the treatment of trigeminal or glossopharyngeal neuralgia [91]. Carbamazepine elimination depends on hepatic biotransformation and can undergo autoinduction and increase clearance by up to 300% over time.
Interactions of antiepileptic drugs with drugs approved for the treatment of indications other than epilepsy
Published in Expert Review of Clinical Pharmacology, 2020
Kinga K. Borowicz-Reutt, Stanisław J. Czuczwar, Marta Rusek
Out of calcium channel inhibitors, some of them were tried as adjunctive drugs (for instance, nifedipine and nimodipine) in controlled clinical studies. Generally, the results were not encouraging, probably due to the low plasma concentrations of the adjunctive drugs, resulting from the interactions with AEDs. It is thus not surprising that experimental data based on acute administration of AEDs and calcium channel inhibitors were more positive [for review, 126]. The only antiarrhythmic drug showing an antagonistic interaction with valproate, mexiletine, should not be probably recommended to epilepsy patients prescribed this AED. However, mexiletine was an anticonvulsant in seizure models and offered anticonvulsant activity in clinical conditions so its co-administration with other than valproate AEDs should be safe. Also, verapamil needs to be administered with caution in epilepsy patients receiving carbamazepine as this calcium channel inhibitor may induce neurotoxicity associated with increased plasma concentration of this AED. Actually, data from six patients confirmed significant elevations of the plasma carbamazepine concentration. Withdrawal of verapamil resulted in breakthrough seizures in one patient who was receiving both drugs for a long period of time [183]. Further case report study confirmed this negative interaction in two patients. A significant reduction in the dosage of carbamazepine was suggested [184]. On the other hand, a possibility of using verapamil in cases of drug-resistant epilepsy has to be considered.