Carbamazepine valproate

Carbamazepine, valproate, and phenytoin enhance inactivation of voltage-gated sodium and calcium channels and limit the spread of electrical excitation by inhibiting sustained high-frequency firing of neurons. 

Lithium, carbamazepine, valproate, and antipsychotics have all been tried, with variable success, as therapy for conduct disorder in typically developing... 

Activated charcoai Tolbutamide, theophylline, phenytoin, digoxin, carbamazepine, valproate Decreased absorption... 

Specific myoclonic syndromes are usually treated with valproate an intravenous formulation can be used acutely if needed. It is nonsedating and can be dramatically effective. Other patients respond to clonazepam, nitrazepam, or other benzodiazepines, although high doses may be necessary, with accompanying drowsiness. Zonisamide and levetiracetam may be useful. Another specific myoclonic syndrome, juvenile myoclonic epilepsy, can be aggravated by phenytoin or carbamazepine valproate is the drug of choice followed by lamotrigine and topiramate. 

For simple and complex partial seizures and secondary generalized tonic-clonic seizures, the first line drugs are - carbamazepine, valproate and phenytoin. Second line drugs include - acetazolamide, clobazam, clonazepam, ethosuximide, felbamate, gabapentin, lamotrigine, levetiracetam, oxacarbamazepine, primidone, tiagabine, topiramate and vigabactin. 

Lithium + carbamazepine, valproate —> enhanced therapeutic effects of lithium. 

While there are no absolute contraindications to lithium, patients with advanced kidney disease or unstable fluid/ electrolyte balance may be more safely treated with an alternative mood stabilizer, such as carbamazepine, valproate, lamotrigine, or olanzapine. 

Anticonvulsants in treatment-resistant cases (carbamazepine, valproate). 

The effects on bone metabohsm of carbamazepine, valproate, or phenobarbital as monotherapy have been analysed in a case-control study in 118 ambulatory children with epilepsy and corresponding controls (120). Patients taking carbamazepine or phenobarbital had significantly raised alkaline phosphatase and bone and liver isoenzyme activities compared with controls. Although the authors concluded that children who take anticonvulsants may have their bone metabolism affected, this conclusion was based on abnormal values of a surrogate marker for bone disease. 

In patients taking carbamazepine, valproate slightly increases the serum concentration of the active metabolite carbamazepine-10,ll-epoxide, by inhibiting epoxide hydrolase and perhaps also by inhibiting the glucuronida-tion of carbamazepine-10,ll-trans-diol (128). 

Serum levels of paroxetine can decrease when it is co-administered with anticonvulsants (some of which are enzyme inducers). The data are limited, but it seems that phenytoin may cause the greatest decrease, followed by carbamazepine. Valproate serum levels are unchanged by paroxetine co-administration. 

If on lithium / carbamazepine / valproate, discontinue and start a course of... 

In cases of partial response to an SSRI, the addition of lithium has shown a beneficial response in several studies. If an SSRI fails, medication could be switched to an MAOl after an appropriate washout period. Carbamazepine, valproate, or an SCA could also be considered. Clozapine may be warranted after other treatments have failed. 

Andersen BB, Mikkelsen M, Versterager A, Dam MI, Kristensen HB, Pedersen B, Lund J, Mengel H. No influence of the antidepressant paroxetine on carbamazepine, valproate and phenytoin. Epilepsy Res (1991) 10, 201-4. 

Information is limited but the interaction appears to be established. Patients taking earbamazepine who also take valnoctamide could rapidly develop carbamazepine toxicity because the metabolism of its major metabolite, carbamazepine-10,11-epoxide, is inhibited. This interaction is very similar to the interaction that occurs between carbamazepine and val-promide (an isomer of valnoctamide), see Carbamazepine + Valproate , below. Concurrent valnoctamide should be avoided unless the carbamazepine dosage can be reduced appropriately. 

Uncertain. It seems possible that phenobarbital, phenytoin and car-bamazepine can induce the metabolism of zonisamide thereby reducing its serum levels. The plasma protein binding of zonisamide is unaffected by other antiepileptics (phenobarbital, phenytoin, carbamazepine, valproate). ... 

The risk of erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis in 72 patients with bipolar disorder taking carbamazepine, valproate, or other medications has been analysed using a large... 

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