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Diseases & Conditions
It is frequently administered in conjunction with other anti-epileptic medications, such as phenytoin and valproic acid.
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Indicated for the treatment of partial seizures with complex symptomatology (eg, psychomotor, temporal lobe), generalized tonic-clonic seizures (grand mal), and mixed seizure patterns, which include the seizure types listed here or other partial or generalized seizuresMaintenance dose range: 800-1200 mg/day PO in divided dosesTherapeutic range: 4-12 mg/L (16.9-50.8 micromoles/L)Maximum dose of 1600 mg/day recommended (rarely, some patients have required 1.6-2.4 g/day)Indicated for pain associated with trigeminal neuralgia; beneficial results have also been reported in glossopharyngeal neuralgia; carbamazepine is not a simple analgesic and should not be used for the relief of trivial aches or painsMaintenance dose range: 400-800 mg/day PO in divided doses; attempts to reduce or discontinue the drug should be made at least every 3 months throughout the treatment period100-200 mg PO qDay; may increase slowly to 1200 mg/dayOrphan designation for treatment of epilepsy patients who cannot take anything by mouthIndicated for the treatment of partial seizures with complex symptomatology (eg, psychomotor, temporal lobe), generalized tonic-clonic seizures (grand mal), and mixed seizure patterns, which include the seizure types listed here or other partial or generalized seizuresImportant to initiate slowly by advancing dose every 5-7 days to minimize GI upset and allow autoinduction of liver enzymes to occur (autoinduction is complete at 3-5 weeks)Children <12 years who receive >400 mg/day may be converted to Carbatrol ER at the same dose, q12hr POSyndrome of inappropriate antidiuretic hormone secretion (SIADH)Hemopoietic system: Aplastic anemia, agranulocytosis, pancytopenia, bone marrow depression, thrombocytopenia, leukopenia, leukocytosis, eosinophilia, anemia, acute intermittent porphyria, variegate porphyria, porphyria cutanea tardaSkin: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) (see Black Box Warnings), pruritic and erythematous rashes, urticaria, photosensitivity reactions, alterations in skin pigmentation, exfoliative dermatitis, erythema multiforme and nodosum, purpura, aggravation of disseminated lupus erythematosus, alopecia, diaphoresis, generalized exanthematous pustulosis, and onychomadesisCardiovascular system: Congestive heart failure, edema, aggravation of hypertension, hypotension, syncope and collapse, aggravation of coronary artery disease, arrhythmias and AV block, thrombophlebitis, thromboembolism, and adenopathy or lymphadenopathyLiver: Abnormalities in liver function tests, cholestatic and hepatocellular jaundice, hepatitis; very rare cases of hepatic failureRespiratory System: Pulmonary hypersensitivity characterized by fever, dyspnea, pneumonitis, or pneumoniaGenitourinary System: Urinary frequency, acute urinary retention, oliguria with elevated blood pressure, azotemia, renal failure, and impotence (rare reports of impaired male fertility and/or abnormal spermatogenesis)Laboratory: Albuminuria, glycosuria, elevated BUN, decreased plasma calcium, and microscopic deposits in the urine, decreased values of thyroid function testsNervous system: Dizziness, drowsiness, disturbances of coordination, confusion, headache, fatigue, blurred vision, visual hallucinations, transient diplopia, oculomotor disturbances, nystagmus, speech disturbances, abnormal involuntary movements, peripheral neuritis and paresthesias, depression with agitation, talkativeness, tinnitus, hyperacusis, isolated cases of neuroleptic malignant syndromeDigestive system: Nausea, vomiting, gastric distress and abdominal pain, diarrhea, constipation, anorexia, and dryness of the mouth and pharynx, including glossitis, and stomatitis, liver damageEyes: Scattered punctate cortical lens opacities, increased intraocular pressure as well as conjunctivitisMusculoskeletal system: Aching joints and muscles, and leg crampsMetabolism: Fever and chills; SIADH; cases of frank water intoxication, with decreased serum sodium (hyponatremia) and confusion; decreased levels of plasma calcium leading to osteoporosisOther: Multiorgan hypersensitivity reactions occurring days to weeks or months after initiating treatment have been reported in rare cases, signs or symptoms may include fever, skin rashes, vasculitis, lymphadenopathy, disorders mimicking lymphoma, arthralgia, leukopenia, eosinophilia, hepatosplenomegaly and abnormal liver function testsSerious and sometimes fatal dermatologic reactions, including toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS), have been reported during treatment with carbamazepine; studies in patients of Chinese ancestry found a strong association between the risk of developing SJS/TEN and the presence of HLA-B*1502, an inherited allelic variant of the HLA-B gene; HLA-B*1502 is found almost exclusively in patients of Asian ancestry, with populations across broad areas of Asia producing such descendants; patients testing positive for the allele should not be treated with carbamazepine unless the benefit clearly outweighs the risk; patients with ancestry in genetically at-risk populations should be screened for the presence of HLA-B*1502 prior to initiation of treatment with carbamazepineAplastic anemia and agranulocytosis reported; patients with a previous history of adverse hematologic reaction to any drug may be at increased riskComplete pretreatment hematological testing should be obtained as a baseline; if a patient in the course of treatment exhibits low or decreased white blood cell or platelet counts, the patient should be monitored closely; consider discontinuation of therapy if significant bone marrow depression developsAdministration of MAO inhibitors within last 14 daysCoadministration with nefazodone; carbamazepine decreases plasma levels of nefazodone and its active metaboliteCoadministration with NNRTIs (eg, delavirdine, efavirenz, etravirine, nevirapine, rilpivirine); carbamazepine induces CYP3A4 and may substantially reduce NNRTI serum concentrationPregnancy (especially first trimester: risk of fetal carbamazepine syndrome)Monitor for notable changes in behavior that might indicate suicidal thoughts or depression and notify healthcare provider immediately if behavioral changes observedDiscontinue if significant bone marrow depression occursIncreased risk of agranulocytosis and aplastic anemiaMay cause ECG abnormalities; use caution in patients with conduction abnormalities; AV heart block, including second and third degree block, reported following carbamazepine treatment; effect occurred generally, but not solely, in patients with underlying EKG abnormalities or risk factors for conduction disturbancesMay exacerbate absence seizures; in the event of allergic or hypersensitivity reaction, more rapid substitution of alternative therapy may be necessaryBipolar mania: Efficacy inconsistent; APA recommends use after failure of or if there is resistance to lithium and valproateMay cause psychosis/confusion/agitation; elderly patients are at greater riskHigher risk of potentially fatal skin reactions (SJS/TEN) in patients of Asian ancestry (genetic testing recommended); increased risk of developing hypersensitivity reactions with presence of HLAA*3101 or HLA-B*1502, inherited allelic variants of the HLA-A and HLA-B gene (see Pharmacogenomics in the Pharmacology section);Hyponatremia may occur and appears to be a result of SIADH; may be dose-related and elderly individuals are at greater riskAssociated with hypotension, bradycardia, AV block, and signs and symptoms of HFFatal dermatologic reactions, including toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS), reportedNot a simple analgesic; do not use to relieve minor aches and painsSuspension formulation contains sorbitol; not for administration to patients with rare hereditary problems of fructose intoleranceAV heart block, including second and third degree block, reported following carbamazepine treatment; effect occurred generally, but not solely, in patients with underlying EKG abnormalities or risk factors for conduction disturbancesRare cases of anaphylaxis and angioedema involving larynx, glottis, lips, and eyelids reported with first or subsequent doses; angioedema associated with laryngeal edema can be fatal; if a patient develops reactions after treatment discontinue therapy and start alternative treatment; patients should not be rechallenged with drugMild anticholinergic activity; use caution in patients with snesitivity to anticholinergic effectsThere is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antiepileptic drugs (AEDs), during pregnancy; encourage women who receive therapy during pregnancy to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry; this can be done by calling the toll-free number 1-888-233-2334 or visiting http://www.aedpregnancyregistry.org, and must be done by the patient herselfTherapy can cause fetal harm when administered to a pregnant woman; an association between use of drug during pregnancy and congenital malformations, including spina bifida and malformations involving other body systems (e.g., craniofacial defects and cardiovascular malformations) shown; developmental delays reportedWomen of childbearing potential should be informed of potential risk to fetusConsideration should be given to discontinuing therapy in women who are pregnant or attempting to become pregnant if benefits of discontinuation outweigh risks of recurrent seizures; women with epilepsy should not discontinue therapy abruptly due to risk of status epilepticus and less severe seizures which may be life-threateningThere have been a few cases of neonatal seizures and/or respiratory depression associated with maternal carbamazepine in combination with other antiepileptic drugs; a few cases of neonatal vomiting, diarrhea, and/or decreased feeding have also been reported in association with maternal carbamazepine use; these symptoms may represent a neonatal withdrawal syndromeTests to detect birth defects using currently accepted procedures should be considered a part of routine prenatal care in childbearing women receiving carbamazepine; evidence suggests that folic acid supplementation prior to conception and during first trimester of pregnancy decreases risk for congenital neural tube defects in general population; not known whether risk of neural tube defects in offspring of women receiving therapy is reduced by folic acid supplementation, but dietary folic acid supplementation both prior to conception and during pregnancy should be recommended for patients in therapyDrug and its epoxide metabolite are excreted in human milk; there are no data to assess effects of drug or its metabolites on milk production, or on breastfed infant, of mothers taking drug; developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for drug and any potential adverse effects on the breastfed infant from drug or from underlying maternal conditionA: Generally acceptable.
The direct answer to your question is Yes, it is a safe replacement.
Medscape - Anticonvulsive, neuropathic pain, bipolar disorder-specific dosing for Tegretol, Equetro (carbamazepine), frequency-based adverse effects, comprehensive interactions, contraindications, pregnancy & lactation schedules, and cost information.