Carbamazepine (CBZ)

1) The main possible mechanism: voltage-gated sodium channel blocker.

2) Therapeutic indications: mainly suitable for focal epilepsy.

3) Warning: avoid use in children with atrioventricular block, severe abnormality of serum iron, bone marrow depression, and severe liver dysfunction. People with heart disease, especially when taking calcium channel blockers and β-receptor blockers at the same time, should also be avoided as much as possible, as the combined use is likely to cause cardiotoxicity. In addition, it should be used with caution in the type of seizure that is manifested as absence, atonic or myoclonic, and it may be aggravated after use. 

4) Dosage for children: Click to view the dosage for children of different ages and weights.

5) Major adverse reactions in children: Allergic rash (generally, it occurs within 2-6 weeks after treatment. Severe rashes such as Stevens-Johnson and Lyell syndrome may be life-threatening and require close observation during treatment), liver damage and aplastic anemia ( rarely seen). Long-term use may cause hyponatremia. In addition, some dose-related side effects may occur, such as dizziness, double vision, blurred vision, nausea, lethargy, neutropenia, etc.

6) Interaction with other anti-epileptic drugs: Carbamazepine easily affects other drugs and is also easily affected by other drugs. For example, valproate sodium can significantly increase the active metabolite of carbamazepine, carbamazepine-10,11-epoxide (also has antiepileptic effects and toxicity, and stronger), But it is not accompanied by changes in the blood concentration of carbamazepine (the blood concentration may be normal at this time), and the other two drugs may affect liver function, so we should be very careful when they are combined, and pay close attention to the adverse reactions. In addition, combined with lamotrigine will increase the toxicity induced by carbamazepine. Furthermore, carbamazepine can reduce the blood concentration of perampanel by about 2.75 times.

7) Interaction with non-anti-epileptic drugs: 1. Erythromycin can inhibit the metabolism of carbamazepine and increase its toxic reaction, so the combination should be avoided as much as possible. 2. Avoid long-term combined use with acetaminophen as much as possible, because both of them mainly metabolized through the liver, and there is a high possibility of liver damage in long-term use. 3. When combined with oral anticoagulants, because carbamazepine can accelerate the metabolism of these drugs, prothrombin time should be detected in order to adjust the dose of anticoagulants. 4. Because it is similar to tricyclic antidepressants in structure, try to avoid combination with monoamine oxidase inhibitors (monoamine oxidase inhibitors shall be stopped for at least 2 weeks before taking carbamazepine).

Carbamazepine Instructions:

FDA, EMC.