Carbamazepine guidelines

Outside of the evidence-based guidelines, other pharmacologic treatments are commonly used or avoided. For initial treatment of absence seizures, ethosuximide and valproate are commonly used, not only in the United Kingdom, but also in the United States. Zonisamide may be also used for initial treatment of absence and myoclonic seizures. In absence and myoclonic seizures, carbamazepine, oxcarbazepine, gabapentin, tiagabine, and pregabalin should be avoided, as they have been associated with an exacerbation of these types of seizures. 

U.K. guidelines Carbamazepine Lamotrigine Oxcarbazepine Topiramate Valproic acid ... 

Adjunctive therapy For dosing guidelines below, enzyme-inducing antiepileptic drugs (ElAEDs) include phenytoin, carbamazepine, phenobarbital, and primidone. Patients 2 to 12 years of age ... 

Conversion from adjunctive therapy with AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate to monotherapy with lamothgine No specific dosing guidelines can be provided for conversion to monotherapy with lamothgine with AEDs other than carbamazepine, phenobarbital, phenytoin, primidone, or valproate. 

Antipsychotics. Clear guidelines for measuring therapeutic serum concentrations of antipsychotics have not yet been established. There may, however, be specific situations in which they may be of value (e.g., monitoring of haloperidol [HPDL] levels might be useful in patients on concurrent carbamazepine therapy because the latter agent can substantially reduce serum HPDL concentrations). These issues are discussed in greater detail in the Pharmacokinetics/Plasma Level section in Chapter 5. 

A wide variety of medications have been found to sometimes be helpful in self-injurious behavior. Those that have been found to sometimes be helpful in self-injurious behavior in the context of a personality disorder, including MAO inhibitors, SSRIs, carbamazepine, lithium, antipsychotics, and benzodiazepines. The choice of medication should be based on the associated features present. Thus, when depressive features are present, try an SSRI when there are symptoms of atypical depression and rejection sensitivity, an MAOI and when psychotic features are present, an antipsychotic. This is an area where there are no clear guidelines for medication use and no guarantee of effectiveness. However, using trial and error, one can often find a drug that has significant benefit. 

There are no recommendations or treatment guidelines at this time. Valproate or carbamazepine are compatible with breast-feeding, but potential risks should be considered. 

Drug overdose Of 16 796 toxic exposures to antiepileptic drugs (phenytoin, valproic acid, and carbamazepine) in the USA in 2006, 12 resulted in death, as reported by the US Toxic Surveillance System [67 ]. Some specific problems determined by overdose of some old and new antiepileptic drugs have been briefly reviewed. For example, topiramate can cause a significant metabolic acidosis, lamotrigine Stevens-Johnson syndrome, oxcarbazepine hyponatremia, and levetiracetam psychosis. Possible adoption of guidelines for critical care management of overdose are discussed. 

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