lMONITORING REQUIREMENTS
▶Plasma concentration for optimum response 4 – 12 mg/litre
( 20 – 50 micromol/litre) measured after 1 – 2 weeks.
▶Manufacturer recommends blood counts and hepatic and
renal function tests (but evidence of practical value
uncertain).
lTREATMENT CESSATIONWhen stopping treatment with
carbamazepine for bipolar disorder, reduce the dose
gradually over a period of at least 4 weeks.
lDIRECTIONS FOR ADMINISTRATIONOral liquid has been
used rectally—should be retained for at least 2 hours (but
may have laxative effect).
TEGRETOL®PROLONGED RELEASETegretol®Prolonged
Releasetablets can be halved but should not be chewed.
lPRESCRIBING AND DISPENSING INFORMATION
Switching between formulationsDifferent formulations of oral
preparations may vary in bioavailability. Patients being
treated for epilepsy should be maintained on a specific
manufacturer’s product.
lPATIENT AND CARER ADVICE
Blood, hepatic, or skin disordersPatients or their carers
should be told how to recognise signs of blood, liver, or
skin disorders, and advised to seek immediate medical
attention if symptoms such as fever, rash, mouth ulcers,
bruising, or bleeding develop.
Medicines for Children leaflet: Carbamazepine (oral) for preventing
seizureswww.medicinesforchildren.org.uk/carbamazepine-
oral-preventing-seizures- 0
lPROFESSION SPECIFIC INFORMATION
Dental practitioners’formulary
Carbamazepine Tablets may be prescribed.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Modified-release tablet
CAUTIONARY AND ADVISORY LABELS3, 8, 25
▶Carbagen SR(Mylan)
Carbamazepine 200 mgCarbagen SR 200 mg tablets|
56 tabletP£ 4. 16 DT = £ 5. 20
Carbamazepine 400 mgCarbagen SR 400 mg tablets|
56 tabletP£ 8. 20 DT = £ 10. 24
▶Tegretol Retard(Novartis Pharmaceuticals UK Ltd)
Carbamazepine 200 mgTegretol Prolonged Release 200 mg tablets
| 56 tabletP£ 5. 20 DT = £ 5. 20
Carbamazepine 400 mgTegretol Prolonged Release 400 mg tablets
| 56 tabletP£ 10. 24 DT = £ 10. 24
Tablet
CAUTIONARY AND ADVISORY LABELS3, 8
▶Carbamazepine (Non-proprietary)
Carbamazepine 100 mgCarbamazepine 100 mg tablets|
84 tabletPsDT = £ 2. 07
Carbamazepine 200 mgCarbamazepine 200 mg tablets|
84 tabletPsDT = £ 3. 83
Carbamazepine 400 mgCarbamazepine 400 mg tablets|
56 tabletPsDT = £ 5. 02
▶Carbagen(Mylan)
Carbamazepine 100 mgCarbagen 100 mg tablets| 28 tabletP
£ 5. 74 | 84 tabletPsDT = £ 2. 07 (Hospital only)
Carbamazepine 200 mgCarbagen 200 mg tablets| 28 tabletP
£ 4. 99 | 84 tabletPsDT = £ 3. 83 (Hospital only)
Carbamazepine 400 mgCarbagen 400 mg tablets| 28 tabletP
£ 4. 27 | 56 tabletPsDT = £ 5. 02 (Hospital only)
▶Tegretol(Novartis Pharmaceuticals UK Ltd)
Carbamazepine 100 mgTegretol 100 mg tablets| 84 tabletP
£ 2. 07 DT = £ 2. 07
Carbamazepine 200 mgTegretol 200 mg tablets| 84 tabletP
£ 3. 83 DT = £ 3. 83
Carbamazepine 400 mgTegretol 400 mg tablets| 56 tabletP
£ 5. 02 DT = £ 5. 02Suppository
CAUTIONARY AND ADVISORY LABELS3, 8
▶Carbamazepine (Non-proprietary)
Carbamazepine 125 mgCarbamazepine 125 mg suppositories|
5 suppositoryP£ 120. 00 DT = £ 120. 00
Carbamazepine 250 mgCarbamazepine 250 mg suppositories|
5 suppositoryP£ 140. 00 DT = £ 140. 00
Oral suspension
CAUTIONARY AND ADVISORY LABELS3, 8
▶Carbamazepine (Non-proprietary)
Carbamazepine 20 mg per 1 mlCarbamazepine 100 mg/ 5 ml oral
suspension sugar free sugar-free| 300 mlP£ 7. 35 DT = £ 6. 94
▶Tegretol(Novartis Pharmaceuticals UK Ltd)
Carbamazepine 20 mg per 1 mlTegretol 100 mg/ 5 ml liquid sugar-
free| 300 mlP£ 6. 12 DT = £ 6. 94Ethosuximide
lINDICATIONS AND DOSE
Absence seizures|Atypical absence seizures (adjunct)|
Myoclonic seizures
▶BY MOUTH
▶Child 1 month–5 years:Initially 5 mg/kg twice daily
(max. per dose 125 mg), dose to be increased every
5 – 7 days; maintenance 10 – 20 mg/kg twice daily (max.
per dose 500 mg), total daily dose may rarely be given
in 3 divided doses
▶Child 6–17 years:Initially 250 mg twice daily, then
increased in steps of 250 mg every 5 – 7 days; usual dose
500 – 750 mg twice daily, increased if necessary up to
1 g twice dailylCAUTIONSAvoid in Acute porphyrias p. 603
lINTERACTIONS→Appendix 1 : antiepileptics
lSIDE-EFFECTSAggression.agranulocytosis.appetite
decreased.blood disorder.bone marrow disorders.
concentration impaired.depression.diarrhoea.dizziness
.drowsiness.erythema nodosum.fatigue.
gastrointestinal discomfort.generalised tonic-clonic
seizure.headache.hiccups.leucopenia.libido increased.
lupus-like syndrome.mood altered.movement disorders.
nausea.nephrotic syndrome.oral disorders.psychosis.
rash.sleep disorders.Stevens-Johnson syndrome.vaginal
haemorrhage.vision disorders.vomiting.weight
decreased
SIDE-EFFECTS, FURTHER INFORMATIONBlood counts
required if features of fever, sore throat, mouth ulcers,
bruising or bleeding.
lPREGNANCY
MonitoringThe dose should be monitored carefully during
pregnancy and after birth, and adjustments made on a
clinical basis.
lBREAST FEEDINGPresent in milk. Hyperexcitability and
sedation reported.
lHEPATIC IMPAIRMENTUse with caution.
lRENAL IMPAIRMENTUse with caution.
lPATIENT AND CARER ADVICE
Blood disordersPatients or their carers should be told how
to recognise signs of blood disorders, and advised to seek
immediate medical attention if symptoms such as fever,
mouth ulcers, bruising, or bleeding develop.
Medicines for Children leaflet: Ethosuximide for preventing
seizureswww.medicinesforchildren.org.uk/ethosuximide-for-
preventing-seizures198 Epilepsy and other seizure disorders BNFC 2018 – 2019
Nervous system4