CARBAGEN®SR
Trigeminal neuralgia
▶BY MOUTH
▶Child 5–11 years:Initially 5 mg/kg daily in 1 – 2 divided
doses, then increased in steps of 2. 5 – 5 mg/kg every
3 – 7 days as required; maintenance 10 – 15 mg/kg daily
in 1 – 2 divided doses, increased if necessary up to
20 mg/kg daily in 1 – 2 divided doses
▶Child 12–17 years:Initially 100 – 400 mg daily in
1 – 2 divided doses, then increased to 400 – 1200 mg
daily in 1 – 2 divided doses, increased if necessary up to
1. 8 g daily in 1 – 2 divided doses, dose should be
increased slowly
Focal and generalised tonic-clonic seizures|Prophylaxis of
bipolar disorder
▶BY MOUTH
▶Child 5–11 years:Initially 5 mg/kg daily in 1 – 2 divided
doses, then increased in steps of 2. 5 – 5 mg/kg every
3 – 7 days as required, dose should be increased slowly;
maintenance 10 – 15 mg/kg daily in 1 – 2 divided doses,
increased if necessary up to 20 mg/kg daily in
1 – 2 divided doses
▶Child 12–17 years:Initially 100 – 400 mg daily in
1 – 2 divided doses, then increased to 400 – 1200 mg
daily in 1 – 2 divided doses, increased if necessary up to
1. 8 g daily in 1 – 2 divided doses, dose should be
increased slowly
TEGRETOL®PROLONGED RELEASE
Focal and generalised tonic-clonic seizures|Prophylaxis of
bipolar disorder
▶BY MOUTH
▶Child 5–11 years:Initially 5 mg/kg daily in 2 divided
doses, then increased in steps of 2. 5 – 5 mg/kg every
3 – 7 days as required; maintenance 10 – 15 mg/kg daily
in 2 divided doses, increased if necessary up to
20 mg/kg daily in 2 divided doses
▶Child 12–17 years:Initially 100 – 400 mg daily in 2 divided
doses, dose should be increased slowly; maintenance
400 – 1200 mg daily in 2 divided doses, increased if
necessary up to 1. 8 g daily in 2 divided doses
Trigeminal neuralgia
▶BY MOUTH
▶Child 5–11 years:Initially 5 mg/kg daily in 2 divided
doses, then increased in steps of 2. 5 – 5 mg/kg every
3 – 7 days as required; maintenance 10 – 15 mg/kg daily
in 2 divided doses, increased if necessary up to
20 mg/kg daily in 2 divided doses
▶Child 12–17 years:Initially 100 – 400 mg daily in 2 divided
doses, dose should be increased slowly; maintenance
400 – 1200 mg daily in 2 divided doses, increased if
necessary up to 1. 8 g daily in 2 divided doses, dose
should be increased slowlylUNLICENSED USENot licensed for use in trigeminal
neuralgia or prophylaxis of bipolar disorder.
lCONTRA-INDICATIONSAcute porphyrias p. 603 .AV
conduction abnormalities (unless paced).history of bone-
marrow depression
lCAUTIONSCardiac disease.history of haematological
reactions to other drugs.may exacerbate absence and
myoclonic seizures.skin reactions.susceptibility to
angle-closure glaucoma
CAUTIONS, FURTHER INFORMATIONConsider vitamin D
supplementation in patients who are immobilised for long
periods or who have inadequate sun exposure or dietary
intake of calcium.
▶Blood, hepatic, or skin disordersCarbamazepine should be
withdrawn immediately in cases of aggravated liver
dysfunction or acute liver disease. Leucopenia that is
severe, progressive, or associated with clinical symptoms
requires withdrawal (if necessary under cover of a suitable
alternative).
lINTERACTIONS→Appendix 1 : antiepileptics
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonDizziness.drowsiness.dry
mouth.eosinophilia.fatigue.fluid imbalance.
gastrointestinal discomfort.headache.hyponatraemia.
leucopenia.movement disorders.nausea.oedema.skin
reactions.thrombocytopenia.vision disorders.vomiting.
weight increased
▶UncommonConstipation.diarrhoea.eye disorders.tic.
tremor
▶Rare or very rareAggression.agranulocytosis.
albuminuria.alopecia.anaemia.angioedema.anxiety.
appetite decreased.arrhythmias.arthralgia.azotaemia.
bone disorders.bone marrow disorders.cardiac
conduction disorders.circulatory collapse.confusion.
congestive heart failure.conjunctivitis.coronary artery
disease aggravated.depression.dyspnoea.embolism and
thrombosis.erythema nodosum.fever.folate deficiency.
galactorrhoea.gynaecomastia.haematuria.haemolytic
anaemia.hallucinations.hearing impairment.hepatic
disorders.hirsutism.hyperacusia.hyperhidrosis.
hypersensitivity.hypertension.
hypogammaglobulinaemia.hypotension.lens opacity.
leucocytosis.lymphadenopathy.meningitis aseptic.
muscle complaints.muscle weakness.nephritis
tubulointerstitial.nervous system disorder.neuroleptic
malignant syndrome.oral disorders.pancreatitis.
paraesthesia.paresis.peripheral neuropathy.
photosensitivity reaction.pneumonia.pneumonitis.
pseudolymphoma.psychosis.red blood cell abnormalities
.renal impairment.severe cutaneous adverse reactions
(SCARs).sexual dysfunction.speech impairment.
spermatogenesis abnormal.syncope.systemic lupus
erythematosus (SLE).taste altered.urinary disorders.
vanishing bile duct syndrome.vasculitis
▶Frequency not knownBone fracture.colitis.human
herpesvirus 6 infection reactivation.memory loss.nail
loss
SIDE-EFFECTS, FURTHER INFORMATIONSome side-effects
(such as headache, ataxia, drowsiness, nausea, vomiting,
blurring of vision, dizziness and allergic skin reactions) are
dose-related, and may be dose-limiting. These side-effects
are more common at the start of treatment.
Overdose For details on the management of poisoning,
see Active elimination techniques, under Emergency
treatment of poisoning p. 832.
lALLERGY AND CROSS-SENSITIVITYAntiepileptic
hypersensitivity syndrome associated with carbamazepine.
See under Epilepsy p. 191 for more information. Caution—
cross-sensitivity reported with oxcarbazepine and with
phenytoin.
lPREGNANCY
MonitoringDoses should be adjusted on the basis of
plasma-drug concentration monitoring.
lBREAST FEEDINGAmount probably too small to be
harmful.
MonitoringMonitor infant for possible adverse reactions.
lHEPATIC IMPAIRMENTMetabolism impaired in advanced
liver disease.
lRENAL IMPAIRMENTUse with caution.
lPRE-TREATMENT SCREENINGTest for HLA-B* 1502 allele in
individuals of Han Chinese or Thai origin (avoid unless no
alternative—risk of Stevens-Johnson syndrome in
presence of HLA-B* 1502 allele).BNFC 2018 – 2019 Epilepsy and other seizure disorders 197
Nervous system4