Known brand names include Tegretol and Epitol.
An antiepileptic (anticonvulsant) taken by mouth as tablets, extended-release tablets, or a liquid suspension. It treats several seizure types and the facial nerve pain of trigeminal neuralgia. Its boxed warning covers severe skin reactions, linked to the inherited HLA-B*1502 gene variant, and rare but serious drops in blood cells.
Narrow therapeutic index. The label gives a usual adult therapeutic level of 4 to 12 mcg/mL and directs measuring plasma levels to see whether they are in the therapeutic range when response is unsatisfactory or interacting drugs are added or stopped.
Serious, sometimes fatal skin reactions (SJS and TEN), about 10 times more common in some Asian countries and strongly linked to HLA-B*1502. Screen patients with at-risk ancestry before starting, and do not treat allele-positive patients unless the benefit clearly outweighs the risk. Aplastic anemia and agranulocytosis occur 5 to 8 times more often than in the general population; get complete baseline blood counts, monitor closely if counts fall, and consider stopping for significant bone marrow depression.
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No specific antidote. Signs begin 1 to 3 hours after ingestion and are mainly neuromuscular: impaired consciousness up to coma, convulsions (especially in small children), twitching, tremor, ataxia, nystagmus, and dilated pupils, with irregular or depressed breathing, tachycardia, blood pressure changes, and conduction disorders. Remove the drug early (gastric lavage, activated charcoal), protect the airway, treat shock with fluids and vasopressors if needed, and treat seizures with diazepam or barbiturates while watching for worse respiratory depression. Monitor breathing, ECG, blood pressure, temperature, and kidney and bladder function for several days; dialysis is for severe poisoning with renal failure.
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Sources: [1]
Doses come from the FDA label. Study tool, not for clinical decisions.
No dose table. Use only after a careful benefit-to-risk appraisal in renal damage. Renal problems including oliguria, azotemia, and renal failure have been reported, so baseline and periodic urinalysis and BUN are recommended.
No dose table. It is metabolized in the liver; use only after a careful benefit-to-risk appraisal in hepatic damage. Check liver function at baseline and periodically, especially with a history of liver disease, and stop for new or worsening liver dysfunction or active liver disease.
Mechanism unknown. In animals it reduces polysynaptic responses and blocks post-tetanic potentiation, and it is chemically related to the tricyclic compounds. It is metabolized in the liver, mainly by CYP3A4, to carbamazepine-10,11-epoxide, which is also anticonvulsant in animals. It induces its own metabolism (autoinduction complete in 3 to 5 weeks), so half-life falls from 25 to 65 hours to 12 to 17 hours. It is a potent CYP3A4 inducer and also induces CYP1A2, 2B6, and 2C8/9/19. About 76% is protein bound.