CARBAMAZEPINE

(use suspension or chewable tabs)
Initial: 1.7-3.3 mg/kg/dose PO TID (5-10 mg/kg/24 hr)
Increment: 0.8-1.7 mg/kg/dose every 5-7 days (2.5-5 mg/kg/24 hr)
Maintenance: 5-6.7 mg/kg/dose PO TID (15-20 mg/kg/24 hr)
Maximum: 11.7 mg/kg/dose PO TID (35 mg/kg/24 hr or 1000 mg/24 hr, whichever is less)
(use regular, chewable or CR tabs)
Initial: 100 mg/dose PO BID*
Increment: 50 mg/dose BID every 5-7 days*
Maintenance: 200-400 mg PO BID*
Maximum: 500 mg/dose BID*
Initial: 200 mg/dose PO BID
Increment: 100 mg/dose PO BID every 5-7 days
Maintenance: 400-600 mg/dose PO BID
Maximum: 800 mg/dose PO BID (max dose depends on clinical response, side effects and serum level monitoring)
< 6 yrs: initial 2-5 mg/kg/dose PO BID (max 100 mg/dose);  titrate dose weekly (maximum 35 mg/kg/24 hr)
6-12 yrs: initial 5 mg/kg/dose PO BID (max 100 mg/dose); increase by up to 100 mg/day weekly (Maximum 1000 mg/24 hr)
> 12 yrs: initial 200 mg/dose PO BID. Increase by up to 200 mg/day weekly (usual maximum: 1000-1200 mg/day)

Anticonvulsant - sodium channel blocker preventing repetitive and sustained firing of an action potential.

tablet: 200 mg
chewable tablet: 100 mg,  200 mg
controlled release (CR) tablet: 200 mg, 400 mg
liquid: 20 mg/mL

*Divide daily dose BID for CR tablets. Divide daily dose TID for suspension, regular and chewable tablets.

Consider screening high-risk individuals (Asians) for HLA-B*1502 allele before starting therapy (increases risk of Steven Johnson Syndrome).

Ideally, the lowest dosage should be used and for epilepsy, doses with serum levels below the target range may be effective.

Dose increases are to achieve optimal response and therapeutic levels.

Dosage should be gradually increased over 1 month to minimize side effects and to allow development of tolerance to side effects.

As carbamazepine induces its own metabolism, do not measure serum level until final maintenance dose is achieved.

Many drug interactions via cytochrome P450 system; refer to Micromedex for a complete list of interacting drugs.

Refer to Therapeutic Drug Monitoring (white pages in print copy).

Therapeutic Range:  25-50 μmol/L (trough).

CR tablets may be split.

Dose-related side effects include: sedation, diplopia, ataxia, vomiting. Other side effects include hematological toxicity, hyponatremia, rash.

Full effects on neuropathic pain may not be seen for 2-3 weeks, but some change in the pain may be seen after 4-5 days.

Also effective as a mood stabilizer in bipolar disorder.

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2022-06-15 23:02:08