{"id":1700,"date":"2023-06-25T17:32:51","date_gmt":"2023-06-25T17:32:51","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/carbamazepine\/"},"modified":"2023-06-25T19:39:53","modified_gmt":"2023-06-25T19:39:53","slug":"carbamazepine","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/carbamazepine\/","title":{"rendered":"Carbamazepine"},"content":{"rendered":"

<\/p>\n

Carbamazepine<\/h1>\n

CLINICAL USE<\/h3>\n
  • All forms of epilepsy except absence seizures<\/li>\n
  • Trigeminal neuralgia<\/li>\n
  • Prophylaxis in manic depressive illness
    \n

    DOSE IN NORMAL RENAL FUNCTION<\/h3>\n<\/li>\n
  • Epilepsy: initially 100\u2013200 mg 1\u20132 times daily, increased to maintenance of 0.4\u20131.2 g daily in divided doses; maximum 1.6\u20132 g daily<\/li>\n
  • Rectal: maximum 1 g daily in 4 divided doses for up to 7 days use<\/li>\n
  • Trigeminal neuralgia: initially 100 mg 1\u20132 times daily; usual dose 200 mg 3\u20134 times daily; maximum 1.6 g\/day; reduce dose gradually as pain goes into remission<\/li>\n
  • Prophylaxis in manic-depressive illness: 400\u2013600 mg daily in divided doses, maximum 1.6 g\/day
    \n

    PHARMACOKINETICS<\/h3>\n<\/li>\n
  • Molecular weight                           :236.3<\/li>\n
  • %Protein binding                           :70\u201380<\/li>\n
  • %Excreted unchanged in urine     : 2<\/li>\n
  • Volume of distribution (L\/kg)       :0.8\u20131.9<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      :5\u201326\/Unchanged
    \n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n<\/li>\n
  • 20 to 50     : Dose as in normal renal function<\/li>\n
  • 10 to 20     : Dose as in normal renal function<\/li>\n
  • <10           : Dose as in normal renal function
    \n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                :Not dialysed. Dose as in normal renal function<\/li>\n
  • HD                     :Not dialysed. Dose as in normal renal function<\/li>\n
  • HDF\/high flux   :Unknown dialysability. Dose as in normal renal function<\/li>\n
  • CAV\/VVHD      :Not dialysed. Dose as in normal renal function
    \n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugs<\/li>\n

  • Analgesics: effect enhanced by dextropropoxyphene; decreased effect of tramadol and methadone<\/li>\n
  • Antibacterials: reduced effect of doxycycline; concentration increased by clarithromycin, erythromycin and isoniazid; increased risk of isoniazid hepatotoxicity; concentration reduced by rifabutin; concentration of telithromycin reduced \u2013 avoid concomitant use<\/li>\n
  • Anticoagulants: metabolism of coumarins accelerated (reduced anticoagulant effect)<\/li>\n
  • Antidepressants: antagonism of anticonvulsant effect; concentration increased by fluoxetine and fluvoxamine; concentration of mianserin, mirtazepine, paroxetine and tricyclics reduced; avoid concomitant use with MAOIs; concentration reduced by St John\u2019s wort \u2013 avoid concomitant use<\/li>\n
  • Antifungals: concentration possibly increased by fluconazole, ketoconazole and miconazole; concentration of itraconazole, caspofungin, posaconazole and voriconazole possibly reduced, avoid with voriconazole, consider increasing caspofungin dose<\/li>\n
  • Antimalarials: chloroquine, hydroxychloroquine and mefloquine antagonise anticonvulsant effect<\/li>\n
  • Antipsychotics: antagonism of anticonvulsant effect; reduced concentration of aripiprazole (increase aripiprazole dose), haloperidol, clozapine, olanzapine, quetiapine, risperidone and sertindole; avoid concomitant use with other drugs that can cause agranulocytosis<\/li>\n
  • Antivirals: reduced concentration of amprenavir, darunavir, indinavir, lopinavir, nelfinavir and saquinavir; concentration possibly increased by ritonavir; concentration of both drugs reduced in combination with efavirenz<\/li>\n
  • Calcium-channel blockers: effects enhanced by diltiazem and verapamil; reduced effect of felodipine, isradipine and probably dihydropyridines, nicardipine and nifedipine<\/li>\n
  • Ciclosporin: metabolism accelerated (reduced ciclosporin concentration)<\/li>\n
  • Corticosteroids: reduced effect of corticosteroids<\/li>\n
  • Diuretics: increased risk of hyponatraemia; concentration increased by acetazolamide; reduced eplerenone concentration \u2013 avoid concomitant use<\/li>\n
  • Hormone antagonists: metabolism inhibited by danazol; accelerated metabolism of gestrinone and possibly toremifene<\/li>\n
  • Oestrogens and progestogens: reduced contraceptive effect<\/li>\n
  • Ulcer-healing drugs: concentration increased by cimetidine
    \n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n

    \u2013<\/p>\n

    Route<\/h4>\n

    Oral, rectal<\/p>\n

    Rate of Administration<\/h4>\n

    \u2013<\/p>\n

    Comments<\/h4>\n

    When switching a patient from tablets to liquid the same total dose may be used, but given in smaller more frequent doses125 mg suppository is equivalent to 100 mg of tablets<\/p>\n

    OTHER INFORMATION<\/h4>\n<\/li>\n
  • Important to initiate carbamazepine therapy at a low dose and build this up over 1\u20132 weeks, as it autoinduces its metabolism<\/li>\n
  • May cause inappropriate antidiuretic hormone secretion<\/li>\n
  • Therapeutic plasma concentration range: 4\u201312 micrograms\/mL (<\/li>\n
  • 20 to 50<\/li>\n

    micromol\/L at steady state).<\/p>\n","protected":false},"excerpt":{"rendered":"

    Carbamazepine CLINICAL USE All forms of epilepsy except absence seizures<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-1700","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1700","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=1700"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1700\/revisions"}],"predecessor-version":[{"id":2826,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1700\/revisions\/2826"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=1700"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=1700"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=1700"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}