Carbamazepine trigeminal neuralgia

Uses. Carbamazepine is used for secondary generalised and partial seizures, and primary generalised seizures. Because another antiepilepsy drug (phenytoin) was sometimes beneficial in trigeminal neuralgia, carbamazepine was tried in this condition, for which it is now the drug of choice... 

Trigeminal neuralgia 100 mg bid titrate to 400 mg bid. Macrolide antibiotics elevate carbamazepine level. 

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 anti-epileptic, which may also be used in the treatment of trigeminal neuralgia. Monitoring of carbamazepine plasma concentrations is required if high doses are administered as carbamazepine tends to be an autoinducer, meaning that the half-life is shortened following repeated administration of the drug. 

Carbamazepine is also used to treat trigeminal neuralgia and neuropathic pain. 

Baclofen, labeled as a skeletal muscle relaxant binds to GABA receptors and depresses excitation. It is also useful in the treatment of paroxysms of trigeminal neuralgia. Baclofen is effective in patients with carbamazepine-resistant pain and has been used successfully to relieve attacks in patients previously unresponsive to carbamazepine or phenytoin. 

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). 

Closely related to imipramine and other antidepressants, carbamazepine is a tricyclic compound effective in treatment of bipolar depression. It was initially marketed for the treatment of trigeminal neuralgia but has proved useful for epilepsy as well. 

Considerable concern exists regarding the occurrence of idiosyncratic blood dyscrasias with carbamazepine, including fatal cases of aplastic anemia and agranulocytosis. Most of these have been in elderly patients with trigeminal neuralgia, and most have occurred within the first 4 months of treatment. The mild and persistent leukopenia seen in some patients is not necessarily an indication to stop treatment but requires careful monitoring. The most common idiosyncratic reaction is an erythematous skin rash other responses such as hepatic dysfunction are unusual. 

Carbamazepine is recommended as the drug of first choice in the treatment of trigeminal neuralgia... 

In 1962, Blom was the first to report the analgesic properties of carbamazepine in neuropathic pain conditions. In clinical studies in patients suffering from trigeminal neuralgia, oral doses of up to 2400 mg/day for 5 to 14 days produced moderate to excellent results (Campbell et al., 1966 Killian and Fromm, 1968 Nicol,... 

In fact, carbamazepine is recommended as the drug of first choice in the treatment of trigeminal neuralgia. Results from clinical trials have been positive in the treatment of painful diabetic neuropathy (Rull et al., 1969 Wilton, 1974 Gomez-Perez et al., 1996). After 4 weeks treatment with carbamazepine, central pain after stroke was improved only in five out of 14 patients (Leijon and Boivie, 1989). Carbamazepine was found to be effective for migraine prophylaxis (Rompel and Bauermeister,... 

Lamotrigine, which has been shown to be effective in several neuropathic pain conditions, offers an alternative approach to carbamazepine for the management of trigeminal neuralgia... 

In a clinical trial in trigeminal neuralgia patients, Lindstrom (1987) reported significant pain relief after treatment with 900-2100 mg/day oxcarbazepine which was comparable to the effects of carbamazepine (400-1200 mg/day). 

Lindstrom, P. The analgesic effect of carbamazepine in trigeminal neuralgia, Pain 1987, 4, S85. 

Therapeutic uses Carbamazepine is highly effective for all partial seizures (simple and complex) and is often the drug of first choice. In addition the drug is highly effective for tonic-clonic seizures and is used to treat trigeminal neuralgia. It has occasionally been used in manic-depressive patients to ameliorate the symptoms. 

Carbamazepine is used in the treatment of epilepsy and trigeminal neuralgia. Unlabeled uses include treatment of postherpetic pain syndrome, neurogenic diabetes insipidus, bipolar disorder, alcohol withdrawal, and cocaine dependence. 

Trade names Apo-Carbamazepine Atreol Carbatrol Epitol (Teva) Foxsalepsin Kodapan Lexin Mazepine Sirtal Tegretol (Novartis) Tegretol XR Teril Timonil Indications Epilepsy, pain or trigeminal neuralgia Category Anticonvulsant Antipsychotic Mood stabilizer Half-life 18-55 hours... 

Carbamazepine is useful in the prophylaxis and therapy of partial seizures and psychomotor seizures. It is also useful in the therapy of trigeminal neuralgia, and as adjunct therapy in the treatment of manic-depressive disorders. 

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