Seizure disorders carbamazepine

Carbamazepine has become a major drug in the treatment of seizure disorders. It has high efficacy, is well tolerated by most patients, and exhibits fewer long-term side effects than other drugs. 

Support is scant for the efficacy of anticonvulsant agents in the treatment of OCD (Jenike 1990 Joffe and Swinson 1987). If there is a role for carbamazepine in OCD, it may be in patients with clinical or electroen-cephalographic evidence of a seizure disorder (Jenike and Brotman 1984 Khanna 1988). The anti-OC efficacy of combined SRI-carbamazepine treatment has not been adequately studied. Sodium valproate was found ineffective in two cases of OCD (McElroy and Pope 1988 McElroy et al. 1987). However, one author has suggested that sodium valproate may be a useful pretreatment for patients with OCD who might otherwise tolerate SRIs poorly (Deltito 1994). The anticonvulsant clonazepam is discussed earlier in this chapter. 

Carbamazepine should be initiated at a dosage of 200 mg twice a day, with increases in increments of 200 mg/day every 3-5 days. Cited plasma levels of 8-12 ng/mL are based on clinical use in patients with seizure disorders and do not correlate with clinical response in patients with psychiatric disorders. We recommend dose titration to achieve clinical response and minimize side effects... 

Based on theories that mania may kindle further episodes of mania, a logical parallel with seizure disorders was drawn, since seizures can kindle more seizures. Thus, trials of several anticonvulsants, beginning with carbamazepine, have been conducted, and several are showing indications of efficacy in treating the manic phase of bipolar disorder (Table 7—1). Only valproic acid, however, is actually approved for this indication. 

Use with caution in patients with mixed seizure disorders that include atypical absence seizures because carbamazepine has been associated with increased frequency of generalized convulsions in such patients... 

A 33-year-old man on stable therapy with carbamazepine (400 mg tds) for a seizure disorder became stupor-ose due to carbamazepine toxicity after taking fluconazole 150 mg/day for 3 days. Withdrawal of both drugs resulted in a fall in carbamazepine concentrations (maximum concentration 25 pg/ml) and return of the... 

Anticonvulsants (barbiturates, including phenobarbital and primidone carbamazepine felbamate phenytoin Possible decreased contraceptive effect Avoid simultaneous use use alternative contraceptive (DMPA) for patients with seizure disorder... 

The client with a seizure disorder who is taking carbamazepine (Tegretol) tells the clinic nurse, I am taking evening primrose oil for my premenstrual cramps and it is really working. Which statement would be the nurse s best response ... 

Carbamazepine, an iminostilbene compound, was introduced in the United States in 1974 for the treatment of trigeminal neuralgia. It has become a first-line drug for the treatment of generalized and partial complex seizure disorders, and has found expanded use for pain syndromes, psychiatric illnesses, and drug withdrawal reactions. 

Epilepsy is a clinical disorder characterized by spontaneous, recurrent seizures arising from excessive electrical activity in certain parts of the brain [51]. Currently available drugs, such as phenytoin, carbamazepine, valproic acid, lamotrigine, and topiramate (for molecular structures see Fig. 6), provide symptomatic seizure suppression in only 60-70% of those receiving treatment [52-54]. These drugs are also associated with unwanted side... 

Largactil is a proprietary preparation of chlorpromazine, an aliphatic antipsychotic with marked sedation and moderate antimuscarinic and extrapyramidal side-effects. Serenace is a proprietary preparation of haloperidol, a butyrophenone antipsychotic with marked extrapyramidal side-effects, moderate sedation but not very likely to cause hypotension. Tegretol is a proprietary preparation of carbamazepine, an anti-epileptic drug indicated in partial and secondary generalised tonic-clonic seizures, primary generalised tonic-clonic seizures, trigeminal neuralgia and in the prophylaxis of bipolar disorder unresponsive to lithium. 

Carbamazepine is an effective agent for the treatment of partial seizures and generalized tonic-clonic seizures its use is contraindicated in absence epilepsy. Carbamazepine is also useful in the treatment of trigeminal neuralgia and is an effective agent for the treatment of bipolar disorders (see Chapter 33). 

A child with attention-deficit hyperactivity disorder [ADHD] and conduct disorder is treated with 45 mg/d of methylphenidate and 2 mg/d of risperidone. A new diagnosis of complex partial seizures is made and the child is started on carbamazepine. About 10 days after the initiation of carbamazepine, the child develops withdrawal dyskinesias of mouth and tongue. After discontinuation of carbamazepine, the movements last for 1 week. 

Post RM, Weiss SRB, Ghuang D, et al Mechanisms of action of carbamazepine in seizure and affective disorders, in Anticonvulsants in Mood Disorders. Edited by Joffe RT, Calabrese JR. New York, Marcel Dekker, 1994b, pp 43-92... 

Weiss SRB, Post RM, Sohn E, et al Cross tolerance between carbamazepine and valproate on amygdala-kindled seizures. Epilepsy Res 16 37-44, 1993 Weiss SRB, Clark M, Rosen JB, et al Contingent tolerance to the anticonvulsant effects of carbamazepine relationship to loss of endogenous adaptive mechanisms. Brain Res Brain Res Rev 20 305-325, 1995 Weissman MM Panic disorder impact on the quality of life. J Clin Psychiatry 52 [suppl) 6-8, 1991... 

A 19-year-old man with focal epilepsy took carbamazepine 1000 mg/day and lamotrigine 300 mg/day. Because his seizures persisted topiramate was added up to 200 mg/day and the dose of carbamazepine was reduced to 300 mg/day. Behavioral problems started within a week and worsened over the following months. He finally developed obsessive-compulsive disorder. Citalopram was given in doses up to 60 mg/ day and topiramate was tapered within 2 weeks. The symptoms improved. 

Carbamazepine (Tegretol) (seizures, nerve pain, and bipolar disorder)... 

These findings have important implications for the treatment of bipolar affective disorder. Some agents used to treat partial-complex seizures such as carbamazepine and various valproate formulations have been found to be effective in bipolar affective disorder (Bowden 1995). One such agent, divalproex, is now the most commonly prescribed antimanic agent. These agents may be more effective in subtypes of mania that are not lithium responsive. As noted earlier, African Americans are more often prescribed antipsychotics. Poor tolerance of lithium maybe a factor. Improving access to alternatives to lithium may reduce the need for antipsychotics in some African Americans with mania. 

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