Stahl's Essential Psychopharmacology Online
In Collaboration With
Carbamazepine
Therapeutics
Brands
• Tegretol, Carbatrol, Tegretol XR, Equetro, Teril, Timonil, Carbagen, Arbil, Epimaz, Mazepine, Novo-Carbamaz
Generic?
Yes
Class
• Antiepileptic drug (AED)
Commonly Prescribed for
(FDA approved in bold)
• Complex partial seizures with or without secondary generalization (adults and children, monotherapy and adjunctive)
• Generalized tonic-clonic seizures
• Mixed seizure patterns
• Trigeminal neuralgia
• Glossopharyngeal neuralgia
• Lennox-Gastaut syndrome
• Temporal lobe epilepsy (children and adults)
• Neuropathic pain
• Alcohol withdrawal
• Restless legs syndrome
• Bipolar I Disorder (acute manic and mixed episodes)
• Psychosis/Schizophrenia (adjunctive)
How the Drug Works
• Blocks voltage-dependent sodium channels
• Modulates sodium and calcium channels and GABA and glutamate transmission
How Long Until It Works
• Seizures - 2 weeks or less
• Trigeminal neuralgia or neuropathic pain - hours to weeks
• Mania - weeks
If It Works
• Seizures - goal is the remission of seizures. Continue as long as effective and well-tolerated. Consider tapering and slowly
stopping after 2 years without seizures, depending on the type of epilepsy
• Trigeminal neuralgia - should dramatically reduce or eliminate attacks, pain may recur. Periodically attempt to reduce to
lowest effective dose or discontinue
If It Doesn't Work
• Increase to highest tolerated dose. Subject to autoinduction, meaning that dose requirements can change over time
• Epilepsy: consider changing to another agent, adding a second agent or referral for epilepsy surgery evaluation. Check level
if compliance is in question. When adding a second agent, keep drug interactions in mind
• Trigeminal neuralgia: Try an alternative agent. For truly refractory patients referral to tertiary headache center, consider
surgical or other procedures
Best Augmenting Combos for Partial Response or Treatment-Resistance
• Epilepsy: drug interactions can complicate multi-drug therapy
• Pain: Can combine with other AEDs (gabapentin or pregabalin) or tricyclic antidepressants
Tests
• Baseline CBC, liver, kidney, and thyroid tests
• Check CBC biweekly for 2 months then every 3 months
• Liver, kidney, and thyroid tests every 6-12 months
• Check sodium levels for symptoms of hyponatremia