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Carbamazepine is one of the most important agents in seizure disorders (epilepsy). It has long been known as an active ingredient and is often prescribed because of the many years of experience. However, Carbamazepine can interact with many other medications. Therefore, patients must be very well looked after during treatment by doctors and pharmacists. Here you can read everything about Carbamazepine.
How Carbamazepine works
Mechanism of Action
The human nervous system is activated or inhibited by certain chemical messengers (neurotransmitters). Normally, these messengers are released according to the external circumstances and ensure an adequate reaction of the body to various situations such as injuries, stress or rest.
Nervous system this controlled balance is disturbed. Through a genetic predisposition or by injuries to the brain, the excitement intensified or inhibition may be reduced. The result: The nervous system of the brain is hyperexcitable, and can lead to seizures
Carbamazepine lowers as an antiepileptic the hyperexcitability of neurons by blocking certain ion channels, and so reduces the risk of an epileptic seizure.
Pharmacokinetics and metabolism of Carbamazepine
Carbamazepine is relatively slow, but completely absorbed from the intestine into the blood. The effect occurs after four to 16 hours. Thereupon, the degradation in the liver and renal excretion take place (in the urine) and the gut (the chair).
When is Carbamazepine used?
The fields of application (indications) of Carbamazepine are:
- Seizures ()
- nerve pain in the facial area (trigeminal neuralgia)
- nerve damage in diabetes (diabetic neuropathy)
- attack prevention in alcohol withdrawal
How Carbamazepine is used
Carbamazepine is used in the form of tablets, sustained release (sustained release tablets) and juices. The drug is usually (preferably a glass of water) taken with plenty of liquid or after eating. The Carbamazepine dosage is determined individually for each patient. Usually you start with 200 milligrams daily; the dose may be slowly increased to up to 1200 milligrams. The doctor should check just in the early stages of treatment success intensively, in order to find the patient the appropriate dose.
children, adolescents, the elderly, patients with cardiovascular disease and those with kidney or liver dysfunction receive a lower dose.
Patients should can be performed prior to Carbamazepine treatment a genetic testing, there are numerous indications that certain side effects frequently occur with certain genetic changes. If these were previously excluded, the risk of some side effects is significantly lower.
What are the side effects of Carbamazepine?
Very often, that is at more than ten percent of the treated patients, can produce side effects such as Carbamazepine and confusion. Even rarer develop vision problems and speech disorders.
What to watch for while taking this medicine?
restrictions on use
Carbamazepine may only be used after strict benefit-risk assessment when hematopoiesis disorders, a disturbed sodium metabolism or cardiac, renal or hepatic impairment are available.
Carbamazepine may not be taken if patients have bone marrow damage, heart failure or certain blood disorder (acute intermittent porphyria).
Furthermore, by a simultaneous intake with voriconazole (to treat fungal infections) and MAO inhibitors strongly discouraged (or against depression).
For children under six years of drug Carbamazepine may only be used after strict benefit-risk assessment.
The active ingredient Carbamazepine is highly susceptible to interactions with other drugs.
It reduces the effect of the following medications:
- other antiepileptics
- remedy for psychosis (called neuroleptics like haloperidol, clozapine, Olanzapine, Risperidone, Quetiapine)
- benzodiazepines (for insomnia)
- antidepressants (eg., Imipramine, Amitriptyline)
- Tetracyclines (antibiotics)
- Certain medicines for fungal infections (voriconazole, itraconazole)
- indinavir (for HIV infection)
- Immunosuppressive agents such as corticosteroids (cortisone, Prednisolone, Dexamethasone), cyclosporin and Tacrolimus
- certain blood-thinning agents (warfarin, phenprocoumon)
- Oral contraceptives (the “pill”)
- Theophylline (for asthma)
- quinidine (for arrhythmia)
- Digoxin (in case of malfunctions of the heart)
- Propranolol, Felodipine (at)
- thyroid hormone (levothyroxine)
The following drugs reduce the effect of Carbamazepine:
- other antiepileptics
- Theophylline (for asthma)
- rifampicin (antibiotic)
- doxorubicin and cisplatin (in cancer)
- St. John’s Wort (for depression mild)
effects and side effects of Carbamazepine are amplified by the following substances:
- certain antibiotics (Erythromycin, Clarithromycin)
- Certain medicines for fungal infections (itraconazole, ketoconazole)
- isoniazid (for treating tuberculosis)
- Fluoxetine (for depression)
- Verapamil, Diltiazem (for heart rhythm disturbances)
- Loratadine (for allergies)
- cimetidine (to treat heartburn etc.)
Pregnancy and lactation
The active ingredient Carbamazepine may harm the unborn child, which is why pregnant women with epilepsy as possible to another antiepileptic drug (Lamotrigine) should be changed. If a secure conversion is not possible, the Carbamazepine dosage should be chosen as low as possible during pregnancy.
In the lactation period the application is possible.
Driving and using machines
By Carbamazepine can cause side effects such as dizziness, drowsiness and tiredness. Therefore, experts do not recommend during Carbamazepine therapy to drive or operate heavy machinery on the road.
This is especially true when combined with alcohol, as Carbamazepine reduces alcohol tolerance.
How to obtain drugs Carbamazepine
Carbamazepine belongs to the potent drugs. The effects and side effects must be regularly recorded and monitored by a physician. Therefore medications obtained with Carbamazepine only with a doctor’s prescription in the pharmacy.
Since when Carbamazepine is known?
Carbamazepine has been known for a very long time. Meanwhile, the drug was chemically optimized; the new drug Oxcarbazepine should have fewer side effects and interactions have as the “older” Carbamazepine. However, this is not yet available a lot of data, which is why Carbamzepin is prescribed frequently continue. Whether the “improved” drug penetrated, remains to be seen.