What are the primary uses of carbamazepine. How does carbamazepine work in the body. What are the common brand names for carbamazepine. What are the available dosage forms of carbamazepine. What are the potential side effects and drug interactions of carbamazepine.

Understanding Carbamazepine: A Versatile Anticonvulsant Medication

Carbamazepine is a widely prescribed medication that plays a crucial role in treating various neurological and psychiatric conditions. This versatile drug belongs to the anticonvulsant class of medications and has been a mainstay in the management of epilepsy, trigeminal neuralgia, and bipolar disorder for decades.

Primary Uses of Carbamazepine

Carbamazepine is primarily used for:

• Treating certain types of seizures (epilepsy)
• Relieving pain associated with trigeminal neuralgia (tic douloureux)
• Managing bipolar disorder (manic-depressive illness)

Its effectiveness in these conditions has made it an essential medication in the field of neurology and psychiatry.

How Does Carbamazepine Work?

Carbamazepine exerts its therapeutic effects by acting on the brain and nervous system. It helps control seizures, alleviate neuropathic pain, and stabilize mood in bipolar disorder patients. The medication works by modulating sodium channels in neurons, which helps regulate electrical activity in the brain.

Brand Names and Dosage Forms of Carbamazepine

Carbamazepine is available under various brand names in the United States. Some of the common brand names include:

• Carbatrol
• Epitol
• Equetro
• Tegretol
• Tegretol-XR

The medication comes in several dosage forms to accommodate different patient needs and treatment regimens:

1. Tablet
2. Chewable tablet
3. Extended-release tablet
4. Extended-release capsule
5. Oral suspension

The availability of multiple dosage forms allows healthcare providers to tailor the treatment to individual patient requirements, enhancing compliance and efficacy.

Mechanism of Action: How Carbamazepine Affects the Body

Understanding how carbamazepine works in the body is crucial for appreciating its therapeutic effects and potential side effects. The medication’s primary mechanism of action involves:

• Blocking voltage-gated sodium channels in neurons
• Reducing the excitability of nerve cells
• Stabilizing neuronal membranes
• Modulating neurotransmitter release

By influencing these neurological processes, carbamazepine helps control abnormal electrical activity in the brain, which is responsible for seizures and certain types of pain. In bipolar disorder, it helps regulate mood by stabilizing neural circuits involved in emotional processing.

Effects on Neurotransmitters

While the exact mechanism of action in mood stabilization is not fully understood, research suggests that carbamazepine may also influence various neurotransmitter systems, including:

• Serotonin
• Norepinephrine
• Dopamine
• GABA (gamma-aminobutyric acid)

These effects on neurotransmitters may contribute to its mood-stabilizing properties in bipolar disorder.

Proper Use and Administration of Carbamazepine

To ensure optimal therapeutic benefits and minimize the risk of side effects, it’s essential to use carbamazepine as prescribed by a healthcare provider. Here are some key points to consider:

Dosage and Administration

The dosage of carbamazepine varies depending on the condition being treated, the patient’s age, and individual response to the medication. Typically, the treatment starts with a low dose that is gradually increased to achieve the desired therapeutic effect.

• For epilepsy: Initial doses may range from 200 to 400 mg daily, divided into two or three doses
• For trigeminal neuralgia: Starting doses are usually lower, around 100 mg twice daily
• For bipolar disorder: Dosing may begin at 200 mg daily and be adjusted based on clinical response

It’s crucial to take carbamazepine exactly as prescribed and not to adjust the dose without consulting a healthcare provider.

Taking Carbamazepine with Food

Carbamazepine can be taken with or without food. However, taking it with meals may help reduce stomach upset. Consistency in administration (always with food or always without) can help maintain steady blood levels of the medication.

Extended-Release Formulations

For extended-release tablets or capsules:

• Swallow the medication whole; do not crush, chew, or break
• Take with a full glass of water
• Follow a consistent schedule to maintain steady blood levels

Potential Side Effects and Precautions

Like all medications, carbamazepine can cause side effects. While not everyone experiences adverse reactions, it’s important to be aware of potential issues:

Common Side Effects

• Dizziness
• Drowsiness
• Nausea
• Vomiting
• Unsteadiness
• Double vision
• Headache

These side effects often improve as the body adjusts to the medication. If they persist or worsen, it’s important to consult a healthcare provider.

Serious Side Effects

While rare, some serious side effects require immediate medical attention:

• Severe skin reactions (e.g., Stevens-Johnson syndrome)
• Blood disorders
• Liver problems
• Suicidal thoughts or behaviors

Patients should be monitored closely, especially during the initial treatment period, and report any unusual symptoms promptly.

Precautions and Contraindications

Carbamazepine may not be suitable for everyone. It’s contraindicated in patients with:

• A history of bone marrow depression
• Known hypersensitivity to carbamazepine or tricyclic compounds
• Concomitant use of monoamine oxidase inhibitors (MAOIs)

Special caution is needed in patients with liver or kidney disease, heart conditions, or a history of blood disorders.

Drug Interactions: What to Watch Out For

Carbamazepine can interact with numerous medications, potentially altering their effectiveness or increasing the risk of side effects. Some key interactions include:

Medications That May Interact with Carbamazepine

• Certain antifungals (e.g., isavuconazonium, voriconazole)
• Orlistat
• MAO inhibitors
• Macrolide antibiotics (e.g., erythromycin)
• Rifamycins (e.g., rifabutin)
• St. John’s Wort

It’s crucial to inform healthcare providers about all medications, including over-the-counter drugs and herbal supplements, to avoid potential interactions.

Effect on Other Medications

Carbamazepine can affect the metabolism of various drugs, potentially reducing their effectiveness. This includes:

• Certain antibiotics
• Antidepressants
• Anticoagulants
• Oral contraceptives

Patients taking carbamazepine may need dose adjustments of other medications or alternative treatments to ensure optimal therapeutic effects.

Monitoring and Follow-up: Ensuring Safe and Effective Treatment

Regular monitoring is essential for patients taking carbamazepine to ensure its safe and effective use. This typically involves:

Blood Tests

Periodic blood tests are crucial to monitor:

• Carbamazepine levels in the blood
• Liver function
• Complete blood count
• Electrolyte levels

These tests help healthcare providers adjust the dosage and detect any potential adverse effects early.

Clinical Assessments

Regular follow-up appointments allow healthcare providers to:

• Evaluate the medication’s effectiveness
• Assess for side effects
• Make necessary dosage adjustments
• Provide patient education and support

Patients should keep a record of their symptoms, side effects, and any concerns to discuss during these appointments.

Special Considerations: Pregnancy, Breastfeeding, and Elderly Patients

Carbamazepine use requires special consideration in certain populations:

Pregnancy and Breastfeeding

Carbamazepine use during pregnancy carries potential risks, including congenital malformations. However, abrupt discontinuation of the medication in pregnant women with epilepsy can lead to serious complications. The decision to use carbamazepine during pregnancy should be made after careful consideration of the risks and benefits.

Carbamazepine can pass into breast milk, and its use while breastfeeding should be discussed with a healthcare provider.

Elderly Patients

Older adults may be more sensitive to the side effects of carbamazepine, particularly dizziness and unsteadiness. Dosage adjustments may be necessary, and close monitoring is essential to ensure safe and effective treatment in this population.

Long-term Use and Management of Carbamazepine Therapy

For many patients, carbamazepine is a long-term treatment. Effective management of long-term therapy involves:

Adherence to Treatment

Consistent adherence to the prescribed regimen is crucial for maintaining therapeutic effects and preventing complications. Patients should:

• Take the medication as prescribed
• Use pill organizers or reminders if needed
• Avoid abrupt discontinuation without medical supervision

Lifestyle Considerations

Patients on long-term carbamazepine therapy should be aware of certain lifestyle factors:

• Alcohol consumption may increase side effects and should be limited
• Sun sensitivity may occur, necessitating appropriate sun protection
• Driving or operating machinery may be affected, especially when starting treatment or adjusting doses

Regular communication with healthcare providers and adherence to monitoring schedules are essential for successful long-term management of carbamazepine therapy.

In conclusion, carbamazepine is a valuable medication in the treatment of epilepsy, trigeminal neuralgia, and bipolar disorder. Its effectiveness, coupled with the availability of various formulations, makes it a versatile option for many patients. However, like all medications, it requires careful management, regular monitoring, and awareness of potential side effects and interactions. By working closely with healthcare providers and following prescribed guidelines, patients can maximize the benefits of carbamazepine while minimizing risks, leading to improved quality of life and better management of their conditions.

Carbamazepine (Oral Route) Description and Brand Names

Description and Brand Names

Drug information provided by: IBM Micromedex

US Brand Name

1. Carbatrol
2. Epitol
3. Equetro
4. TEGretol
5. TEGretol-XR

Descriptions

Carbamazepine is used to treat certain types of seizures (epilepsy). It is also used to relieve pain due to trigeminal neuralgia (tic douloureux) and in the treatment of bipolar disorder (manic-depressive illness). Carbamazepine works in the brain and nervous system to control seizures, pain, and bipolar disorder. This medicine is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

• Tablet, Chewable
• Capsule, Extended Release
• Tablet
• Tablet, Extended Release
• Suspension

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.

Carbamazepine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

See also How to Use section.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: certain azole antifungals (isavuconazonium, voriconazole), orlistat.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

Other medications can affect the removal of carbamazepine from your body, which may affect how carbamazepine works. Examples include macrolide antibiotics (such as erythromycin), rifamycins (such as rifabutin), St. John’s wort, among others.

Carbamazepine can speed up the removal of other drugs from your body, which may affect how they work. Examples of affected drugs include artemether/lumefantrine, boceprevir, certain drugs used to prevent blood clots (anticoagulants such as apixaban, rivaroxaban), certain calcium channel blockers (such as nifedipine, nimodipine), nefazodone, HIV NNRTIs (such as delavirdine, efavirenz, etravirine, rilpivirine), praziquantel, ranolazine, among others.

This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use reliable backup birth control methods while taking this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and opioid pain relievers (such as codeine, hydrocodone).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This medication may interfere with certain lab tests (such as thyroid function, some pregnancy tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

Generic and branded anti-epileptic drugs

Getting the same version of anti-epileptic drugs (AEDs) with each prescription may contribute to how well the drug works for that person. Switching to a different version of a drug could cause confusion, anxiety, side effects or a breakthrough seizure in some people.

Anti-epileptic drugs (AEDs) aim to prevent seizures from happening. To be most effective, they need to be taken every day, at around the same time. They are often taken for many years, unlike a short course of treatment (such as antibiotics).

What are branded drugs?

‘Branded’ drugs are the original version of a drug produced by the drug (pharmaceutical) company which developed the drug. To start with, only the company that developed the drug can produce it. This is called being ‘on patent’, and the drug will have a brand name that only that company can use. For example, Tegretol is the brand name of the AED carbamazepine.

What are generic drugs?

All drugs have an ‘active ingredient’ (the part of the drug that treats the condition for which you take it). This ingredient is often referred to as the ‘generic’ name.

Once a branded drug has been on the market for a number of years, other companies are allowed to start producing their own version of the drug (after it comes ‘off patent’). These other companies might call their version of the drug by just the generic name, such as ‘carbamazepine’, or they might give their version another name (sometimes called a ‘branded generic’), such as ‘Carbagen’.

Several drug companies might produce their own versions of a generic drug, but they will all contain the same active ingredient.

Different versions of AEDs will look different

Each company’s version of a drug will usually look different, so that you can tell different versions apart, and you can recognise a particular drug from a specific drug company. The differences include the size, colour and any writing on the tablets or capsules themselves. The packaging will also look different.

If two different AEDs have the same generic name, are they exactly the same?

Although AEDs with the same generic name have the same active ingredient, this does not mean that they are exactly the same. This is because drugs contain other ingredients, such as colouring and binding agents (ingredients that hold the tablet together), which can be different from one version to another. In some cases, these other ingredients might affect how the drug is absorbed in the body, which could affect how well the active ingredient works in the brain to stop seizures.

How different are generic drugs with the same name?

When a new generic version of a drug is developed, it has to be shown to be ‘bioequivalent’ (have a similar absorption and distribution) – within a certain range – to the original ‘on patent’ brand. This means they have to be ‘similar enough’ to the original in how they are absorbed and distributed in the body and the amount of active ingredient that gets to the brain. However, a generic version only has to compare in this way to the brand version, not to other generic versions. So, two generic versions might have greater differences between them, in the way they are absorbed and distributed, than the differences between a generic and a brand version.

Which is better, branded or generic?

A ‘brand’ version of an AED is not ‘better’ or ‘worse’ than a generic version of that drug. The important thing is that you and your doctors find a version of a drug which suits you, and you take this version consistently. ‘Consistency of supply’ means getting the same version of a drug with every prescription.

MHRA guidance on prescribing anti-epileptic drugs

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued guidance on prescribing anti-epileptic drugs. They say that certain AEDs must be prescribed with the same version, and that for other AEDs this is less important. This aims to help prescribing doctors decide whether they should prescribe a particular version.

What does the MHRA guidance say?

The guidance divides AEDs into three categories according to the importance of maintaining a consistent supply and depending on whether there is considered to be a risk of problems if switching between different versions.

Category 1  Phenytoin, carbamazepine, phenobarbital and primidone. Specific measures are necessary to ensure consistent supply of a particular product. This means that individuals should not be switched between versions of these AEDs, but should always kept on the same version.                                                    

Category 2  Sodium valproate, lamotrigine, perampanel, retigabine, rufinamide, clobazam, clonazepam, oxcarbazepine, eslicarbazepine acetate, topiramate and zonisamide. The need for continued supply of a particular product should be based on ‘clinical judgement’ (the doctors judgement of the risk of problems) and in consultation with the individual. This means that a doctor should decide, with the individual, whether it is important to always stay on the same version or whether it is ok to switch between different versions.

Category 3  Levetiracetam, lacosamide, tiagabine, gabapentin, pregabalin, ethosuximide, brivaracetam and vigabatrin. No specific measures are normally required and these AEDs can be prescribed generically.This means that individuals can be switched between different versions of their AEDs.

The guidance states that in some cases consistency of supply is important “where the consequence of therapeutic failure or toxicity might have serious clinical consequences”. This means there is a risk that switching between different versions might mean that the drugs don’t work to control seizures, or they cause toxic side effects, and this would have a serious impact on the individual.

The guidance also says that in some cases consistency of supply is important when there are “specific concerns such as patient anxiety, and risk of confusion or dosing errors”. This means that when someone is very worried about switching between AEDs, or switching might cause confusion or result in someone not taking the right dose, their doctor might want to ensure consistency of supply.

The guidance also tells doctor how they can write prescription to ensure consistency of supply. For example, they can put a brand name (if the person is taking a branded AED) or they can put the generic name and the name of the pharmaceutical company (sometimes referred to as the Marketing Authorisation Holder or MAH) to ensure the correct version is dispensed at the pharmacy.

How does the MHRA guidance affect me?

This guidance means that if you are taking certain AEDs you should always have consistency of supply (see category 1). But it also means that if you are taking other AEDs (see categories 2 and 3) you may not receive a consistent supply of medication. However, your doctor should look at your individual circumstances to see what will be best for you.  

Concerns about switching between drugs

There are several reasons why switching between different version of AEDs may be a problem for some people.

• Switching from one version of a drug to another might mean that higher, or lower, amounts of active ingredient reach the brain. If the level is lower in one version than another, seizures could happen. If the level is higher, this could cause side effects.
• People with memory problems or confusion may not remember what their AEDs look like, and so may find it hard to check that they are getting the same medication each time. Or they may get confused about what medication they are taking, especially if it has changed in colour or size. This could lead to errors in prescribing or taking AEDs.
• Being given different versions of AEDs could cause anxiety, which is a common trigger for seizures.

What if my AEDs have been switched?

Talk to your neurologist

If you have a neurologist, you can talk to them about your concerns. If they agree that you need to always have the same version of AEDs, you can ask them to pass this information on to your GP, with instructions on how to prescribe the same version each time.

Talk to your GP

Your GP is usually responsible for your prescriptions. If you are taking a brand version of your AED, you can ask them to write the brand name on your prescription. If you take a generic version, ask them to write the name of the manufacturer, with the generic name.

Talk to your pharmacist

If you use the same pharmacy regularly, your pharmacist may keep a record of what medication you take. They might be able to make a note to get the same version of your AEDs for you each time. If pharmacists don’t have your usual version in stock, you can ask for your prescription back, and take it to another pharmacy. Check that you have your correct AEDs while you are at the pharmacy counter, as they won’t be able to change it after you leave the pharmacy.

Download a letter from our Medical Director to give to your GP, neurologist or pharmacist, supporting your right to ask to be prescribed the same version of your AEDs each time. Or call our helpline for a copy.

Get to know your medication

It can be a good idea to keep a list of your AEDs: the generic name, any brand name, and the name of the manufacturer. You could also make a note of the colour and shape, to help you recognise it. This might help you to check your prescription from the doctor, or from the pharmacy.

You could also use your phone to take pictures of your medication.

Helping you to take your AEDs

Other things that might help you to take your AEDs, and to get the best effect from them include the following:

• A drug wallet (pill box) can help you to keep track of when you have taken your medication.
• A seizure diary can help to keep track of your seizures and see if there is any pattern as to when they happen. Diaries can also help your doctors to see whether your medication is working. Call our helpline for a free seizure diary.
• The patient information leaflet (PIL) that comes with your AEDs explains what to do if you have any problems with your AEDs, such as missing a dose or being sick.
• If you are prescribed other medication, ask your doctor or pharmacist to check whether this medication could affect your AEDs, or vice versa.

Information updated: February 2020

Carbamazepine tablets

What is this medicine?

CARBAMAZEPINE (kar ba MAZ e peen) is used to control seizures caused by certain types of epilepsy. This medicine is also used to treat nerve related pain. It is not for common aches and pains.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Epitol, Tegretol

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• Asian ancestry
• bone marrow disease
• glaucoma
• heart disease or irregular heartbeat
• kidney disease
• liver disease
• low blood counts, like low white cell, platelet, or red cell counts
• porphyria
• psychotic disorders
• suicidal thoughts, plans, or attempt; a previous suicide attempt by you or a family member
• an unusual or allergic reaction to carbamazepine, tricyclic antidepressants, phenytoin, phenobarbital or other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Take this medicine with food. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking this medicine except on the advice of your doctor or health care professional.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:

• certain medicines used to treat HIV infection or AIDS that are given in combination with cobicistat

delavirdine

• MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate

nefazodone

This medicine may also interact with the following medications:

acetazolamide

certain antibiotics like clarithromycin, erythromycin or troleandomycin

cyclosporine

dicumarol

female hormones, including estrogens and birth control pills

isoniazid, INH

lithium and other medicines to treat mood problems or psychotic disturbances

medicines for angina or high blood pressure

medicines for depression or anxiety

medicines to treat fungal infections, like fluconazole, itraconazole or ketoconazole

methadone

praziquantel

rifampin or rifabutin

steroid medicines such as prednisone or cortisone

tramadol

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care provider for a regular check on your progress. Do not change brands or dosage forms of this medicine without discussing the change with your doctor or health care provider. If you are taking this medicine for epilepsy (seizures), do not stop taking it suddenly. This increases the risk of seizures. Wear a Medic Alert bracelet or necklace. Carry an identification card with information about your condition, medications, and doctor or health care provider.

This medicine may cause serious skin reactions. They can happen weeks to months after starting the medicine. Contact your health care provider right away if you notice fevers or flu-like symptoms with a rash. The rash may be red or purple and then turn into blisters or peeling of the skin. Or, you might notice a red rash with swelling of the face, lips or lymph nodes in your neck or under your arms.

You may get drowsy, dizzy, or have blurred vision. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. To reduce dizzy or fainting spells, do not sit or stand up quickly, especially if you are an older patient. Alcohol can increase drowsiness and dizziness. Avoid alcoholic drinks.

Birth control pills may not work properly while you are taking this medicine. Talk to your doctor about using an extra method of birth control.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

The use of this medicine may increase the chance of suicidal thoughts or actions. Pay special attention to how you are responding while on this medicine. Any worsening of mood, or thoughts of suicide or dying should be reported to your health care provider right away.

Women who become pregnant while using this medicine may enroll in the North American Antiepileptic Drug Pregnancy Registry by calling 1-888-233-2334. This registry collects information about the safety of antiepileptic drug use during pregnancy.

This medicine may cause a decrease in vitamin D and folic acid. You should make sure that you get enough vitamins while you are taking this medicine. Discuss the foods you eat and the vitamins you take with your health care provider.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• breathing problems
• changes in vision
• confusion
• dark urine
• fast or irregular heartbeat
• fever or chills, sore throat
• mouth ulcers
• pain or difficulty passing urine
• rash, fever, and swollen lymph nodes
• redness, blistering, peeling or loosening of the skin, including inside the mouth
• ringing in the ears
• seizures
• stomach pain
• swollen joints or muscle/joint aches and pains
• unusual bleeding or bruising
• unusually weak or tired
• vomiting
• worsening of mood, thoughts or actions of suicide or dying
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• clumsiness or unsteadiness
• diarrhea or constipation
• headache
• increased sweating
• nausea

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of reach of children.

Store at room temperature below 30 degrees C (86 degrees F). Keep container tightly closed. Protect from moisture. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Are there potential problems with generic substitution of antiepileptic drugs?: A review of issues

https://doi.org/10.1016/j.seizure.2005.12.010Get rights and content

Summary

In response to increasing cost pressures, healthcare systems are encouraging the use of generic medicines. This review explores potential problems with generic substitution of antiepileptic drugs (AEDs).

A broad search strategy identified approximately 70 relevant articles. Potential problems with generic substitution included:

•

potentially serious consequences of failure of therapy, particularly in well-controlled patients;

•

potential for adverse events and variability of response to AEDs;

•

need for careful titration and dosing of AEDs and susceptibility of some patients to develop problems, even with small changes in drug levels;

•

bioequivalence, as defined by regulatory bodies, may not correspond to therapeutic equivalence for AEDs, because of the permitted range of bioavailability for generics, evaluation methods that use small numbers of relatively young healthy volunteers and individual variation;

•

potential for problems from poor continuity of supply;

•

cost savings may be outweighed by the cost of adverse consequences;

•

potential medico-legal consequences in patients who did not give informed consent to switching of AEDs.

The limited evidence (mainly case reports with some pharmacokinetic studies) appears to support these concerns for older AEDs. As a result, restrictions on use of specific generic AEDs are in place in some countries and recommended by some lay epilepsy organisations.

As more AEDs lose patent protection, it is important to examine the question of whether generic substitution may pose problems for patients with epilepsy, and whether there should be safeguards to ensure that both physician and patient are informed when generic substitution occurs.

Keywords

Antiepileptic drugs

Generic substitution

Bioequivalence

Pharmacokinetics

Review

Recommended articlesCiting articles (0)

Copyright © 2006 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

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List of anticonvulsants uses, brands, and safety recommendations

Anticonvulsants are anti-seizure and antiepileptic drugs (AEDs), but can also treat migraines, neuropathic pain, and mental health disorders

Anticonvulsants are commonly used to treat seizure disorders but may also be used to treat other medical conditions, including chronic nerve pain and mental health disorders. There are many different types of anticonvulsants, and they may work in slightly different ways. However, in general, they work by stabilizing nerve cell impulses. 

Continue reading to learn more about anticonvulsants, their uses, and their side effects.

Other anticonvulsants

• Mebaral (mephobarbital)
• Luminal (phenobarbital)
• Diamox (acetazolamide)
• Carbatrol (carbamazepine)
• Equetro (carbamazepine)
• Oxtellar XR (oxcarbazepine)
• Carnexiv (carbamazepine)
• Depakene (valproic acid)
• Stavzor (valproic acid)
• Depacon (valproic acid)
• Horizant (gabapentin enacarbil)
• Gralise (gabapentin)
• Gaborone (gabapentin)
• Sabril (vigabatrin)
• Fanatrex (gabapentin)
• Diacomit (stiripentol)
• Phenytek (phenytoin)
• Peganone (phenytoin)
• Mesantoin (mephenytoin)
• Cerebyx (fosphenytoin)
• Finetelpla (fenfluramine)
• Epidiolex (cannabidiol)
• Potiga (ezogabine)
• Tridione (trimethadione)
• Briviact (brivaracetam)
• Spritam (levetiracetam)
• Roweepra (levetiracetam)
• Zarontin (ethosuximide)
• Celontin (methsuximide)
• Fycompa (perampanel)
• Klonopin (clonazepam)
• Versed (midazolam)
• Felbatol (felbamate)
• Xcopri (cenobamate)
• Mysoline (primidone)
• Onfi (clobazam)
• Ativan (lorazepam)
• Tranxene-T (clorazepate)
• Banzel (rufinamide)
• Trokendi XR (topiramate)

What are anticonvulsants?

Anticonvulsants, also known as anti-seizure or antiepileptic drugs (AEDs), are medications that calm and regulate nerve impulses and transmission. Because of their nerve-calming actions, anticonvulsants can often be used to treat a variety of medical conditions. Although they are a standard treatment of epilepsy, anticonvulsants can also be used to treat migraines, neuropathic pain, and mental health disorders, such as bipolar disorder. There are many different categories of anticonvulsants that have different mechanisms of action. Not all anticonvulsants work the same, and certain anticonvulsants are prescribed depending on the condition being treated. 

How do anticonvulsants work?

Anticonvulsants differ in how they work; however, in general, anticonvulsants work by decreasing excitation or increasing inhibition of nerve activity. In other words, anticonvulsants help calm nerve impulses and decrease how easily those impulses are activated. Nerve cells that might otherwise fire rapidly during a seizure are kept under control. 

Anticonvulsants can act as mood stabilizers to treat mental health disorders, migraines, and other brain disorders. Anticonvulsants can also reduce the transmission of pain signals from overly sensitive or damaged nerves to help relieve pain from conditions like diabetic neuropathy, trigeminal neuralgia, and postherpetic neuralgia.

What are anticonvulsants used for?

Anticonvulsants are FDA-approved and sometimes used off-label to manage different medical conditions:

Types of anticonvulsants

AMPA receptor antagonists

AMPA receptors are glutamate receptors involved with excitatory nerve activity. AMPA receptor antagonists block these receptors to reduce and stabilize nerve activity. These medicines can be used to treat partial seizures in patients with epilepsy. An example of an AMPA receptor antagonist is Fycompa (perampanel). 

Barbiturate anticonvulsants

Barbiturates work by increasing the activity of a neurotransmitter known as gamma-aminobutyric acid (GABA), which is an inhibitory neurotransmitter responsible for slowing down electrical activity in the brain. Barbiturate anticonvulsants can treat all seizures except for a specific type of seizure known as an absence seizure. Mysoline (primidone), Mebaral (mephobarbital), and Luminal (phenobarbital) are in the barbiturate category.

Benzodiazepine anticonvulsants

Benzodiazepines act on GABA-A receptors and increase the activity of GABA neurotransmitters. Benzodiazepines may be used to treat febrile seizures, partial and generalized seizures, acute repetitive seizures, alcohol withdrawal seizures, and status epilepticus. Benzodiazepines may also be used as anti-anxiety or sedative medicines. Examples of benzodiazepines include Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam).

Carbamate anticonvulsants

The exact way in which carbamate anticonvulsants work is unknown, but they are believed to inhibit NMDA receptors while increasing GABA activity. Because these medications carry a risk of potentially serious side effects, such as aplastic anemia, hepatitis, and liver failure, they are only used after trying other anticonvulsant options first. Examples of carbamate anticonvulsants include Felbatol (felbamate) and Xcopri (cenobamate).

Carbonic anhydrase inhibitor anticonvulsants

Carbonic anhydrase inhibitors work by inhibiting the carbonic anhydrase enzyme. These medications can treat epilepsy, migraines, glaucoma, and mountain sickness. Examples of carbonic anhydrase inhibitors include Diamox (acetazolamide) and Zonegran (zonisamide). 

Dibenzazepine anticonvulsants

Dibenzazepine anticonvulsants work by blocking voltage-gated sodium channels, which are involved in the transmission of nerve signals. These medications can decrease the severity and frequency of seizures. Dibenzazepine anticonvulsants are also used to treat bipolar disorder and schizophrenia. Aptiom (eslicarbazepine) is an anticonvulsant approved as an adjunctive treatment for partial-onset seizures. Other examples of benzodiazepines include Tegretol (carbamazepine) and Trileptal (oxcarbazepine). 

Fatty acid derivative anticonvulsants

Fatty acid derivative anticonvulsants work by increasing the activity of GABA. These medicines also block sodium and calcium channels, which helps slow nerve activity that can otherwise result in seizures. Fatty acid derivatives are useful for most seizure types. They may be given to treat absence seizures, tonic-clonic seizures, juvenile myoclonic epilepsy, and complex partial seizures. Additionally, these medications may be used to treat bipolar disorder, migraines, and schizophrenia. Examples of fatty acid derivatives include Depakote (divalproex) and Depakene (valproic acid).

GABA analogs

GABA analogs are medicines that have a structure very similar to GABA. These medicines can stabilize the nervous system and reduce impulses that could trigger seizure activity. GABA analogs are given for seizures, epilepsy, fibromyalgia, neuropathic pain, and restless leg syndrome. Examples of medications in this category include Lyrica (pregabalin), Neurontin (gabapentin), and Sabril (vigabatrin). 

GABA reuptake inhibitors

GABA reuptake inhibitors are another category of seizure medications that increase the availability of GABA in the brain. These medicines increase GABA activity by binding to and blocking transporters that reabsorb GABA. GABA reuptake inhibitors are used to treat different types of seizures. Examples of GABA reuptake inhibitors include Gabitril (tiagabine) and Diacomit (stiripentol).

Hydantoin anticonvulsants

Hydantoin anticonvulsants work by blocking sodium channels and slowing nerve impulses through these channels. Hydantoin anticonvulsants are used to treat many different types of seizures. Examples of hydantoin anticonvulsants include Dilantin (phenytoin), Peganone (ethotoin), and Sesquient (fosphenytoin).

Neuronal potassium channel openers

Neuronal potassium channel openers help decrease the excitability of nerve cells. They work by activating potassium channels. Potiga (ezogabine) is a neuronal potassium channel opener.

Oxazolidinedione anticonvulsants

The mechanism of action for oxazolidinedione anticonvulsants is unknown, but they are effective in treating absence seizures. An example of an oxazolidinedione anticonvulsant is Tridione (trimethadione).

Pyrrolidine anticonvulsants

Pyrrolidine anticonvulsants work by slowing the transmission of nerve signals. The exact mechanism of action of these anticonvulsants is unknown. They are typically used as adjunctive treatments for tonic-clonic and partial seizures. Examples of pyrrolidine anticonvulsants are Keppra (levetiracetam) and Briviact (brivaracetam).

Succinimide anticonvulsants

Succinimide anticonvulsants inhibit calcium channels and increase the seizure threshold. The seizure threshold refers to the strength of an impulse that will trigger a seizure. The higher the seizure threshold, the less likely a seizure is to occur. Succinimide anticonvulsants are primarily used to treat absence seizures. Examples of succinimide anticonvulsants include Zarontin (ethosuximide) and Celontin (methsuximide).

Triazine anticonvulsants

Triazine anticonvulsants work on sodium channels and inhibit the release of glutamate and aspartate, which are neurotransmitters that excite the nervous system. These medications treat seizures, partial seizures, tonic-clonic seizures, bipolar disorder, and schizophrenia. Lamictal (lamotrigine) is a triazine anticonvulsant. 

Who can take anticonvulsants?

Adults

Adults with epilepsy, bipolar disorder, and other neurological conditions can safely take anticonvulsants. Anticonvulsant agents given as monotherapy may be sufficient to control symptoms, however, multiple anticonvulsants may be needed to achieve the desired effect. 

Doses of anticonvulsants vary and need to be closely monitored or adjusted. Some medications require blood tests to monitor the blood levels of the drug. Doses may need to be adjusted based on liver or kidney function. 

Many seizure medicines must be maintained at a certain blood level. For this reason, it is essential to make sure doses are not missed. Missed doses may cause drug levels to fall, which could result in an increased risk of seizure activity.

Children

The Food and Drug Administration (FDA) has approved anticonvulsants to treat seizure disorders and migraine headaches in children. However, not every drug is approved for every type of pediatric seizure disorder. 

Drug levels of certain medications may need to be monitored. It is critical to avoid missed doses of medication to maintain proper blood levels of medication. The dosing of anticonvulsants in children is usually calculated according to weight. Many anticonvulsant medications are available in liquid form for easier administration in children. 

Seniors

Seniors may safely take anticonvulsants with proper monitoring. Doses may be adjusted if the particular person has decreased kidney or liver function. Some medications may require regular monitoring of drug levels in the blood, and it is important to avoid missed doses. 

Because seniors are often taking other medications with an anticonvulsant, prescribers should consider potential drug interactions. Seniors may be more sensitive to experiencing sedation from anticonvulsants. They may also have an increased fall risk with certain anticonvulsants. Seniors may need to be monitored carefully for any possible adverse effects from anticonvulsants. 

Are anticonvulsants safe?

In general, anticonvulsants, when monitored appropriately, are safe. However, certain groups of people should not take certain anticonvulsants. 

Tell your doctor if you have a history of the following before taking an anticonvulsant: 

• Any drug allergies 
• Kidney disease
• Liver disease
• Use of other medications
• Pregnancy
• Breastfeeding

Black box warnings

Carbamazepine

Carbamazepine carries a black box warning for dermatologic conditions, including toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS). These conditions are rare but potentially fatal skin disorders characterized by blistering and peeling of the skin. 

Carbamazepine also carries a black box warning for aplastic anemia and agranulocytosis. These conditions are characterized by decreased blood cell counts. Lab tests may need to be evaluated before starting carbamazepine and monitored throughout therapy. 

Felbamate

Felbamate carries a black box warning for aplastic anemia and liver failure. Blood testing should be performed before starting therapy and monitored throughout treatment with Felbamate.

Lamotrigine

Serious skin rashes, including SJS, are listed in a black box warning for lamotrigine. Lamotrigine should be discontinued if a rash develops.

Perampanel

Perampanel carries a black box warning for serious psychiatric and behavioral reactions. A patient taking perampanel should be monitored for aggression, hostility, irritability, anger, and homicidal ideation. If these behaviors develop, the medication should be discontinued. 

Valproic acid and divalproex

Valproic acid and divalproex carry a black box warning for hepatotoxicity, teratogenicity, and pancreatitis. Liver function should be checked before and throughout therapy. 

Teratogenicity refers to the effects these medications may have on an unborn child. The potential effects of valproic acid and divalproex include congenital malformations and neural tube defects (spina bifida). Use in pregnancy is not generally recommended, and women are cautioned to avoid becoming pregnant while taking these medications.

Vigabatrin

Vigabatrin carries a black box warning for vision loss. Patients taking this medication should have their vision tested within four weeks of beginning medication and every three months throughout the duration of therapy. 

Anticonvulsant recalls

Anticonvulsant restrictions

Those with a known sensitivity or prior allergic reaction should not take an anticonvulsant. Other contraindications to treatment with an anticonvulsant include liver failure, certain blood disorders, narrow-angle glaucoma, and familial short QT syndrome.  

Kidney failure or dialysis may require dose adjustments and frequent monitoring of anticonvulsant treatment. 

Can you take anticonvulsants while pregnant or breastfeeding?

It is recommended to avoid pregnancy while taking anticonvulsants. However, depending on the drug prescribed, the American Academy of Neurology does not recommend stopping or changing treatment in pregnant women as the risk of breakthrough seizure may be high. Valproic acid should be avoided during pregnancy due to the risk of fetal harm.

Anticonvulsants are found in measurable levels in breastmilk. However, the benefits of continuing medication may outweigh the risk of harm to an infant. Consult a healthcare provider before taking an anticonvulsant while breastfeeding. 

Are anticonvulsants controlled substances

Some anticonvulsants are classified as controlled substances. These include:

• Pregabalin: Schedule V
• Lacosamide: Schedule V
• Perampanel: Schedule III
• Clonazepam: Schedule IV
• Diazepam: Schedule IV
• Lorazepam: Schedule IV
• Phenobarbital: Schedule IV

Common anticonvulsants side effects

The most common side effects of anticonvulsants include:

• Nausea
• Rash
• Diarrhea
• Low sodium levels
• Fluid retention
• Hair loss
• Fatigue
• Dizziness
• Headache
• Weight gain
• Mood changes
• Poor appetite

More severe but rare side effects include:

• Aplastic anemia
• Liver failure
• Stevens-Johnson syndrome
• Pancreatitis
• Thrombocytopenia
• Blood disorders
• Loss of vision

This list of side effects is not comprehensive. Consult a healthcare provider for a complete list of side effects, warnings, and precautions before starting treatment with an anticonvulsant.

How much do anticonvulsants cost?

Anticonvulsants can vary in price. Brand-name medications may cost considerably more than other drugs that are available in generic forms. Most anticonvulsants are available in brand-name and generic formulations. Medicare plans may only cover specific formulations while other insurance plans may cover most types of anticonvulsants. Costs will vary depending on your insurance plan. Without insurance, the price can vary widely depending on the medication and quantity of medication prescribed. However, using a prescription discount card from SingleCare may help reduce the cost of anticonvulsants. 

Tegretol (Carbamazepine) Medicare Coverage

Prescription Drug Coverage

You may be able to find Medicare plan options in your area that cover Carbamazepine (generic Tegretol). Learn more about Tegretol and find Medicare Advantage plans in your area that cover other prescription drugs.

Tegretol is a medication that contains the active ingredient Carbamazepine.

Tegretol is used to treat hypomania, mild to moderate manic episodes, or mixed episodes associated with bipolar disorders. It is also used to treat focal and generalized onset seizures, as well as nerve pain.

This medication produces anticonvulsant effects, anti-nerve pain effects, muscle relaxant and antimanic effects, among others.

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Common side effects of Tegretol include dizziness, drowsiness, upset stomach, dry mouth, constipation and fatigue.

Does Medicare cover Tegretol or Carbamazepine?

While some Medicare plans may not cover Tegretol, some Medicare Advantage plans and Medicare Part D plans may cover generic Carbamazepine.

• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.¹
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Carbamazepine.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Average costs for Carbamazepine with Medicare drug coverage

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in and the Medicare drug plan you have.

Deductible stage	Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs. In the deductible stage, you’re responsible for the full cost of your prescription drugs. Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $480 in 2022.	After you meet your Part D deductible, you enter the initial coverage period. During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.

Additional information

Take your dose of Tegretol with food.

Stopping this medication suddenly can lead to withdrawal symptoms and can increase seizure frequency. It is important to gradually stop taking Tegretol over a period of 2-6 months as directed by your doctor in order to avoid these negative effects.

A specific type of anemia and low white blood cell count can happen while taking Tegretol. Tell your doctor if you experience any fever, chills, shortness of breath, fatigue or any unexplained bleeding or bruising.

Some symptoms such as fever, chills, shortness of breath, sore throat, cough or sinus pain can indicate an infection that you should talk to your doctor about right away.

A bad skin reaction can occur while taking Tegretol. Signs of this skin reaction can include red, blistered or peeling skin, red or irritated eyes, or sores on your mouth and skin.

This skin reaction can become very serious. It is important to talk to your doctor immediately if you notice these signs and symptoms.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.

Carbamazepine-Darnitsa tablets 200 mg No. 50: instructions, prices, analogs, order with delivery

Instruction:

Composition

active substance: carbamazepine;

1 tablet contains 200 mg carbamazepine

Excipients: microcrystalline cellulose, potato starch, povidone, colloidal silicon dioxide, croscarmellose sodium, magnesium stearate.

Indications.

epilepsy:
– complex or simple partial seizures (with or without loss of consciousness) with or without secondary generalization;

– generalized tonic-clonic seizures;

– mixed forms of seizures.

Carbamazepine can be used as monotherapy and in combination therapy.

Acute manic states; supportive therapy for bipolar affective disorders in order to prevent exacerbations or to weaken the clinical manifestations of exacerbations.
Alcohol withdrawal syndrome.
Idiopathic trigeminal neuralgia and trigeminal neuralgia in multiple sclerosis (typical and atypical).
Idiopathic glossopharyngeal neuralgia.

Contraindications.

The drug should not be prescribed:

– with established hypersensitivity to carbamazepine or chemically similar drugs (such as tricyclic antidepressants), or to any other component of the drug

– with atrioventricular block;

– to patients with a history of bone marrow suppression

– for patients with hepatic porphyria (for example, acute intermittent porphyria, mixed porphyria, tardive porphyria of the skin) in anamnesis

– in combination with MAO inhibitors (MAO).

Method of administration and dosage.

Carbamazepine should be administered orally; the daily dose of the drug is divided into 2-3 doses. The medicine can be taken with or without food, with a small amount of liquid, such as a glass of water.

Before starting treatment, patients who are potentially carriers of the HLA-A * 3101 allele in origin should, if possible, be tested for the presence of the allele, since in this case, the use of the drug can provoke the development of severe adverse reactions from the skin.

epilepsy

Treatment should be started with the use of a low daily dose with a gradual increase in the dose of the drug, which must be adjusted according to the needs of each patient.

For the selection of the optimal dose of the drug, it may be useful to determine the level of carbamazepine in the blood plasma. Especially in the case of combination therapy, therapeutic doses should be calculated based on the determination of the plasma level of carbamazepine and efficacy.

Adults: the recommended initial dose of the drug is 100-200 mg 1-2 times a day. Then slowly increase the dose until the optimal effect is achieved. The daily dose is often 800-1200 mg. Some patients may require a dosage of up to 1600 mg or even 2000 mg per day.

Elderly patients Elderly patients due to possible drug interactions, the dose of the drug should be selected carefully.

Children: you can start with 100 mg per day, increase the dose gradually – every week by 100 mg.

The usual dose of the drug is 10-20 mg / kg of body weight per day (in divided doses).

Lamotrigine, drug monitoring (Lamotrigine) – find out the prices for the analysis and pass it in Moscow

Method of determination
Gas chromatography / mass spectrometry (GC-MS).

Study material
Blood serum

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Synonyms : Convulsan; Lamictal; Lameptil; Lamitor; Lamolep; Lamotrix; Seizar; Triginet.

Convulsan; Lamotriginum; Lamictal; Lamolep; Lamitor; Lamotrix; Sazar; Triginet

Brief characteristics of the analyte Lamotrigine

Lamotrigine is an antiepileptic drug used in the treatment of epilepsy and bipolar disorders. In epilepsy, it is used in the treatment of partial epileptic seizures, primary and secondary tonic-clonic seizures and seizures associated with Lennox-Gastaut syndrome. May have an anticonvulsant effect if other antiepileptic drugs are ineffective.Lamotrigine has relatively few side effects.

After oral administration, lamotrigine is rapidly and completely absorbed from the gastrointestinal tract.

The maximum plasma concentration is reached after about 2.5 hours. Plasma protein binding is 55%. Undergoes intensive metabolism with the formation of the main metabolite of N-glucuronide. The half-life of the drug from the blood (T1 / 2) in adults is an average of 29 hours. It is excreted by the kidneys mainly in the form of a metabolite; about 8% of the active substance is excreted unchanged.T1 / 2 in children is less than in adults. The pharmacokinetics of lamotrigine varies widely, especially depending on the combination of therapy with other drugs and the state of renal function. With the simultaneous use of lamotrigine and carbamazepine or phenytoin, the T1 / 2 of lamotrigine decreases. Due to the inhibition of microsomal liver enzymes under the influence of sodium valproate, with simultaneous use, the metabolism of lamotrigine slows down, the T1 / 2 of lamotrigine increases.

What is the purpose of determining the level of lamotrigine in serum

Evaluation of the level of lamotrigine in the blood is used for the purpose of individual selection of the dose and periodic monitoring of therapy (incl.including when adding other drugs, changing the form of the drug and other indications).

Side effects of the substance Lamotrigine

The concentration of the drug exceeding 15 μg / ml may cause side effects.

From the side of the central nervous system: headache, dizziness, drowsiness, sleep disturbances, fatigue, aggressiveness, confusion.

From the digestive system: nausea, liver dysfunction.

From the hematopoietic system: leukopenia, thrombocytopenia.Allergic reactions: skin rash (usually maculo-papular), angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, lymphadenopathy.

instructions for use, reviews, indications and what helps?

A seizure of epilepsy can overtake the patient at the most inopportune moment, so it is important to take medications that prevent the risk of seizures.

One of these is Carbamazepine .

Contents

• 1 Properties and preparation
• 2 History
• 3 Pharmacology 3.1 Pharmacodynamics
• 3.2 Pharmacokinetics
• 3.3 Interaction with other medicinal products