Carbamazepine (Dosage)

Carbamazepine is an anticonvulsant and mood stabilizing drug used in epilepsy and bipolar disorder. The presence of genetic polymorphisms in genes involved in its metabolism can have an important impact on the response to the drug.

Carbamazepine is an antiepileptic of choice in partial and generalized epilepsies, accepted for use in children due to its low central depressant capacity. Also it is used in trigeminal neuralgia and neuropathic pain. Not recommended in absence crisis or myoclonic seizures. It is used as a first-line treatment for partial seizures, tonic-clonic, trigeminal glossopharyngeal neuralgia and as a stabilizer of mood to treat bipolar disorder.

Carbamazepine acts by reducing the release of glutamate, stabilizes the neuronal membranes and depresses the turnover of dopamine and noradrenaline.

If you wish to know all the substances that we analyze in our DNA test, please consult the pharmacological compatibility or pharmacogenetic section.

SIDE EFFECTS

There are no specific data in children.

The most serious adverse reactions are those that can appear in blood, skin, liver and cardiovascular system. Especially at the beginning of treatment, if the dose is too high certain types of common or common adverse reactions occur, eg adverse effects on the CNS (dizziness, headache, ataxia, somnolence, fatigue, diplopia); gastrointestinal disorders (nausea, vomiting) and allergic skin reactions.

The dose-dependent adverse effects usually remit after a few days, spontaneously or after a transient dose reduction. The appearance of adverse reactions on the CNS may be indicative of a relative overdose or of significant fluctuations in plasma levels. In these cases it is advisable to monitor plasma levels.

Disorders of blood and lymphatic system: leukopenia, eosinophilia, thrombocytopenia.

Endocrine disorders: edema, fluid retention, weight gain, hyponatremia and reduction of blood osmolarity due to an effect similar to that of antidiuretic hormone (ADH), leading in rare cases to watery intoxication accompanied by lethargy, vomiting, headaches, confusional, neurological disorders.

Nervous system disorders: dizziness, ataxia, somnolence, fatigue, headache, diplopia, accommodation disorders (eg, blurred vision).

Gastrointestinal disorders: nausea, vomiting, dry mouth.

Hepatobiliary disorders: increase in gamma-GT (due to hepatic enzyme induction), usually without clinical relevance, increase in blood alkaline phosphatase.

Skin and subcutaneous tissue disorders: allergic dermatitis, urticaria, which can be serious.

CONTRAINDICATIONS

Hypersensitivity to carbamazepine and structurally related drugs (eg, tricyclic antidepressants).

Alterations of atrioventricular conduction. At least 15 days should be left between the cessation of monoamine oxidase inhibitor intake and the initiation of carbamazepine administration.

It should not be administered to people who have had a history of bone marrow depression, liver porphyrias (acute intermittent porphyria, variegata, cutaneous tarda) and treatment with MAOIs within 2 weeks.

BRAND NAMES

  • Tegretol ®
  • Carbatrol ®

Genes analyzed

SCN1A

Bibliography

Daci A, Beretta G, Vllasaliu D, et al . Polymorphic Variants of SCN1A and EPHX1 Influence Plasma Carbamazepine Concentration, Metabolism and Pharmacoresistance in a Population of Kosovar Albanian Epileptic Patients. PLoS One. 2015 Nov 10;10(11):e0142408.

Tate SK, Depondt C, Sisodiya SM, et al. Genetic predictors of the maximum doses patients receive during clinical use of the anti-epileptic drugs carbamazepine and phenytoin. Proc Natl Acad Sci U S A. 2005 Apr 12;102(15):5507-12.

Zhao GX, Zhang Z, Cai WK, et al . Associations between CYP3A4, CYP3A5 and SCNIA polymorphisms and carbamazepine metabolism in epilepsy: A meta-analysis. Epilepsy Res. 2021 Jul;173:106615.

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