Information on level of drugs into breastmilk
Wendy Jones in Breastfeeding and Medication, 2013
Carbamazepine is also used to treat manic depression and trigeminal neuralgia. It reaches measurably detectable levels in infant serum but below the therapeutic range. The infant should be monitored for jaundice, drowsiness and adequate weight gain as sedation, poor sucking and hepatic dysfunction have been reported although rarely. In case of concern monitoring infant serum levels may reassure (see below). It is 75% bound to plasma proteins and has active metabolites. It induces its own metabolism and metabolism is induced by other hepatic enzyme inducers so the plasma half-life is variable. It is widely used in children. Most studies of levels in breastmilk include other drugs as well which may interact with carbamazepine. Drowsiness, poor sucking and elevated liver enzymes have been reported. No absolute causality to carbamazepine has been shown but the risk should not be disregarded. Relative infant dose quoted as 3.8 to 5.9% (Hale 2012 online access). BNF safety of breastmilk as above but licensed in children up to a year at dose of 100 to 200 mg daily. Amount probably too small to be harmful but monitor infant for possible adverse reactions (BNFC). Compatible with use during breastfeeding. Observe for sedation.
Cranial Neuropathies I, V, and VII–XII
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in 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.
Psychopharmacology and mental health
Chambers Mary in Psychiatric and mental health nursing, 2017
Carbamazepine is mainly used to treat bipolar disorder,13 aggression and behavioural and psychological symptoms in depression. There is a paucity of evidence to support their use, and some clinicians believe the best thing you can do with carbamazepine is stop it and let the other medicines used to treat the illness work, due to the extensive interactions seen with this medicine. Carbamazepine exerts its effect through numerous pharmacological mechanisms: adenylate cyclases, phosphoinositol turnover and calcium influx into nerve cells through numerous mechanisms (including through inhibition of the N-methyl-D-aspartate (NMDA) receptor). Carbamazepine also decreases the release of glutamate, the excitatory neurochemical in the brain.14
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.
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].
Pharmacotherapeutic management of acute alcohol withdrawal syndrome in critically Ill patients
Published in Expert Opinion on Pharmacotherapy, 2020
A. Glahn, P. J. Proskynitopoulos, S. Bleich, T. Hillemacher
Although carbamazepine and valproic acids are not recommended as first-line therapy, there is promising data on the use of these drugs including evidence for carbamazepine, valproic acid, gabapentin, pregabalin, tiagabine and vigabatrin [57]. In Europe carbamazepine use in the management of AWS has a long tradition. Side effects of carbamazepine, including pruritus, somnolence, nausea, and agranulocytosis, have to be cared for. Carbamazepine is superior to placebo and non-BDZ agents in suppressing AWS. Nine randomized, controlled studies (n = 800) have shown that carbamazepine has an effect in the treatment of AWS [57]. No significant cardiovascular or hepatotoxic effects could be shown in this review and the metabolism of carbamazepine is mainly unaffected by liver damage [57]. In contrast Dixit et al. refer to a Cochrane review on anticonvulsants for alcohol dependence that concluded that routine clinical use of these drugs in the management of AWS is not recommended [18]. Maldonado found in her review six randomized controlled studies (n = 900), which showed effectiveness of valproic acid in alcohol detoxification. Because if teratogenic potential, thrombocytopenia, and idiosyncratic liver toxicity the use of valproic acid should always be considered carefully, especially in critically ill patients [57].
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