Carbamazepine

DEA Class;  Rx

Common Brand Names; Tegretol, Equetro, Epitol, Tegretol XR, Carbamazepine Chewtabs, Carbamazepine CR, Carbatrol, Teril, Carnexiv

Documented hypersensitivity

History of bone marrow suppression

Administration of MAO inhibitors within last 14 days

Coadministration with nefazodone; carbamazepine decreases plasma levels of nefazodone and its active metabolite

Coadministration with NNRTIs (eg, delavirdine, efavirenz, etravirine, nevirapine, rilpivirine); carbamazepine induces CYP3A4 and may substantially reduce NNRTI serum concentration

Jaundice, hepatitis

Pregnancy (especially first trimester: risk of fetal carbamazepine syndrome)

• Orthostatic hypotension
• Dizziness
• Headache
• Drowsiness
• Sleep disturbance
• Fatigue
• Weakness
• Tremor
• Hyperreflexia
• Constipation
• Dry mouth
• Confusion
• Decr memory
• Nystagmus
• Paresthesia
• Anorexia
• N/V
• Impotence
• Urinary frequency or retention
• Anxiety
• Irritation
• Hypomania
• “Hypermetabolic syndrome” (hyperpyrexia, tachycardia, tachypnea, incr CPK, acidosis)
• Arthralgia
• Edema
• SIADH (rare)
• Risk of hypertensive crisis (rare,usu d/t drug interaction)
• Ataxia (rare)
• Seizure (rare)
• Jaundice (rare)
• Visual disturbance (rare)

Monitor for notable changes in behavior that might indicate suicidal thoughts or depression and notify healthcare provider immediately if behavioral changes observed

Discontinue if significant bone marrow depression occurs

Withdraw gradually

Increased risk of agranulocytosis and aplastic anemia

May cause ECG abnormalities; use caution in patients with conduction abnormalities; AV heart block, including second and third degree block, reported following carbamazepine treatment; effect occurred generally, but not solely, in patients with underlying EKG abnormalities or risk factors for conduction disturbances

May exacerbate absence seizures; in the event of allergic or hypersensitivity reaction, more rapid substitution of alternative therapy may be necessary

Bipolar mania: Efficacy inconsistent; APA recommends use after failure of or if there is resistance to lithium and valproate

May cause psychosis/confusion/agitation; elderly patients are at greater risk

May render oral contraceptives ineffective

Higher risk of potentially fatal skin reactions (SJS/TEN) in patients of Asian ancestry (genetic testing recommended); increased risk of developing hypersensitivity reactions with presence of HLAA*3101 or HLA-B*1502, inherited allelic variants of the HLA-A and HLA-B gene (see Pharmacogenomics in the Pharmacology section);

Hyponatremia may occur and appears to be a result of SIADH; may be dose-related and elderly individuals are at greater risk

Associated with hypotension, bradycardia, AV block, and signs and symptoms of HF

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antiepileptic drugs (AEDs), during pregnancy

Drug and its epoxide metabolite are excreted in human milk; there are no data to assess effects of drug or its metabolites on milk production, or on breastfed infant, of mothers taking drug