Carbamazepine action. General characteristics. Compound. Possible negative manifestations

The drug was created in the 50s of the twentieth century. Since then, scientists have created many drugs that compete with it in properties, but Carbamazepine, side effects that should not be ignored, continues to occupy leading place among anticonvulsants. The Japanese were the first to notice something else important property drug - relief from manic syndrome, bipolar disorder and acute forms of schizophrenia. In the period from 70-90. There have been quite a few studies that have proven this. Following Japan, the rest of the world adopted this, and today Carbamazepine is effectively used for any epilepsy syndromes, as well as acute mental disorders Oh.

When to receive?

Carbamazepine not only helps with cramps, but is also an excellent pain reliever and is recommended in the following cases:

To prevent psycho-emotional diseases;
Alcohol withdrawal;
Epilepsy in any manifestations;
Painful diabetic neuropathy;
Neuralgia trigeminal nerve;
Manic syndrome.

Experts in the field of psychiatry also insist on the effectiveness of the drug for aggressiveness, psychosis, schizophrenia and transformations of brain tissue. Laboratory experiments to determine the effectiveness of these specific diseases have not been carried out; here we can rely solely on clinical researches doctors.

In epileptics, this medicine reduces the risk of seizures by increasing the threshold convulsive readiness. Psychiatrists use carbamazepine as a rehabilitation medicinal product in socially maladapted patients.

For teenagers, the drug is useful because it reduces the level of aggressiveness, depression and nervousness. The effect of the medicine is individual. It is forbidden to indulge in self-medication and prescribe it for yourself or a child yourself.

Principles of application and analogues

The drug has a unique effect on our body. Based on this, self-medication with this medicine is contraindicated; it can only be taken with the prescription of a specialist.

Compliance following rules strictly required upon admission:

So as not to cause negative effects the drug, you need to take it carefully following the instructions and regimens prescribed by your doctor;
Before starting treatment with Carbamazepine, perform a liver examination. If during the course you feel a deterioration in your liver condition, you need to stop taking the medication immediately;
The state of your intraocular pressure is important. Carbamazepine activates greater production of ocular secretion. If before taking the drug you had problems with intraocular pressure, there is a risk of vision loss.

Carbamazepine has a number of analogues in properties and therapeutic actions. The most common are considered Carbapine, Tegretol, Mazepine and Carbamazepine Nycomed. Doctors and patients claim that the effects of the drugs are similar to the original Carbamazepine.

Carbamazepine not an antidepressant and does not cure all mental disorders, and its use requires constant supervision by a specialist and regular testing.

How to use? Permissible doses

Carbamazepine is available in tablets, which already indicates that they are taken orally. They should be drunk before or after meals. It is also possible to take the medicine while eating, then you need to take the tablets with a significant amount of liquid.

People with epilepsy are not advised to take other medications while being treated with carbamazepine.

The dose of the drug is increased gradually from the first day of administration to the dose required for treatment. If carbamazepine is administered with other drugs, this recommendation remains valid. The dosage of other medications does not change.

Exact doses:

Overdose and side effects

Symptoms of overdose include:

Loss of coordination;
Drowsiness;
Memory loss;
Sudden loss of orientation;
Weakness;
Hallucinations;
Coma.

An overdose is extremely life-threatening.

Overdose symptoms:

Arrhythmia eyeballs, foggy veil, unnatural dilation of pupils;
Sensation of muscle twitching, impaired speech intelligibility;
Sudden surges in pressure, tachycardia, cardiac arrest.

If symptoms of overdose are noticed, you must immediate hospitalization. If this is not possible, it is necessary to rinse and take activated carbon.

Do not increase the dose on your own. If you experience symptoms of side effects, contact your doctor immediately.

Side effects are demonstrated in the form of severe drowsiness, severe headache, taste bud disturbances, aggression, vomiting, dizziness, chronic fatigue, depression, nausea, dry mouth. If there is an individual intolerance to the components of the drug, an allergy appears.

Contraindications for use and interactions with other medications

Despite such a large and frightening list of side effects, in the lion's share of cases it is tolerated without problems. With minor changes in well-being, the problem can be solved by reducing the dose and adjusting the treatment regimen.

Who is contraindicated to take Carbamazepine:

People with atrioventricular block;
In the presence of hepatic porphyria;
During and breastfeeding;
Taking MAO inhibitors.

Be sure to notify your doctor about all medications you are taking at this time. Some drugs increase the risk of overdose. An example of such drugs: Fluoxetine, Erythromecin, Nicotinamide, etc.

Upon admission oral contraceptives with hormones there is a possibility of uterine bleeding.

Alcohol intake is contraindicated; it increases the patient's state of depression.

The general trend of taking Carbamazepine is quite productive. Doctors have been successfully using it in treatment for more than half a century. Side effects, although wide in the range of damage, occur rarely enough to safely take it when prescribed by a specialist.

Video about self-correction of psychosomatic conditions

In this video you will learn how and why to take Carbamazepine:

Carbamazepine tablets are a synthetic anticonvulsant drug. What does this medicine help with? The medication has antidiuretic, neurotropic, antiepileptic and psychotropic effects. The instructions for use suggest taking the drug “Carbamazepine” for the treatment of mental disorders and epilepsy.

Release form and composition

The active element is “Carbamazepine”. Additional ingredients are: starch, povidone, talc, silicon dioxide, polysorbate and magnesium stearate.

Pharmacological properties

The active component "Carbamazepine", the instructions for use confirm this, has an antidiuretic, neurotropic, antiepileptic and psychotropic effect. The medication eliminates irritability, aggressiveness, depression, anxiety and the frequency of seizures in patients with epilepsy.

For neuralgia this drug prevents the occurrence of paroxysmal pain. Regarding the syndrome alcohol withdrawal, then the medication for this pathology reduces tremor, increased nervous excitability, and also increases the threshold of convulsive readiness.

As an antipsychotic and mood stabilizer, Carbamazepine tablets, which help with mental problems, are very often used in the treatment of affective disorders. For diabetes insipidus, the medicine significantly reduces diuresis and thirst.

In the pediatric field to achieve therapeutic action given pharmacological agent used in very high doses, which cannot be said about adult patients. This is due to physiological features.

Carbamazepine tablets: what does the medicine help with?

Indications for use include:

epilepsy (excluding absence seizures, myoclonic or flaccid seizures) - partial seizures with complex and simple symptoms, primary and secondary generalized forms of seizures with tonic-clonic seizures, mixed forms seizures (monotherapy or in combination with other anticonvulsants);
alcohol withdrawal syndrome;
trigeminal neuralgia in multiple sclerosis;
treatment of affective disorders;
prevention of phase leaks affective disorders(manic-depressive psychosis, schizoaffective disorders, etc.);
idiopathic trigeminal neuralgia;
idiopathic glossopharyngeal neuralgia;
polydipsia and polyuria in diabetes insipidus;
pain syndrome in diabetic polyneuropathy.

Instructions for use

"Carbamazepine" is intended for oral use, regardless of food intake. The tablets are washed down a small amount water. Dosage depends on pathological condition which requires correction.

Pain syndrome in diabetic neuropathy

Patients are prescribed 200 mg 2-4 times a day. Acute manic states and maintenance therapy of bipolar affective disorders The daily dosage is 400-1600 mg, which is equal to 200-600 mg 2-3 times a day.

Permissible in case of urgent need rapid rise dosage. Small doses of the drug are prescribed as maintenance therapy.

Epilepsy

For the treatment of epilepsy, Carbamazepine is used as monotherapy. Treatment should begin with a small dosage, which is gradually increased until the desired therapeutic effect is achieved.

For adults daily dosage is 100-200 mg 1-2 times a day. Gradually the dose is increased to 400 mg 2-3 times a day. The maximum permissible daily dosage is 2000 mg.

Children under 3 years old initial stage treatment is prescribed 20-60 mg. Then the dosage is increased by 20-60 every 2 days.
Over the age of 3 years, children are prescribed 100 mg per day. The dosage is increased gradually - 100 mg per week.
Children 4-5 years old are prescribed 200-400 mg in 2 doses. At the age of 6-10 years, the recommended dosage is 400-600 mg, taken in 2-3 doses.
For children 11-15 years old, 600-1000 mg is prescribed in several doses. Maintenance therapy in childhood is 10-20 mg per kilogram of weight, which is taken in 2-3 doses.

Alcohol withdrawal syndrome

The initial daily dosage is 200 mg three times a day. In particular severe cases It is permissible to increase the dose to 400 mg 3 times a day. At the initial stage of treatment, Carbamazepine is used in combination with detoxification therapy, sleeping pills and sedatives.

Neuralgia of the trigeminal or glossopharyngeal nerves

The initial dosage is 200-400 mg. If necessary, the dosage is increased by no more than 200 mg per day until the pain syndrome is completely relieved. Loan dosage is reduced to the minimum effective dose.

For elderly patients, the initial dosage is 100 mg twice daily.

Polyuria and polydipsia in diabetes insipidus

For adults, the average dosage is 200 mg 2-3 times a day. The dose for children is selected individually, taking into account weight and age.

Contraindications

Acute intermittent porphyria (including indications in medical history).
Hypersensitivity to the components of the drug, as well as to those similar to the active substance in chemically medications (tricyclic antidepressants).
Pregnancy and lactation period.
Simultaneous use with monoamine oxidase inhibitors and for 14 days after their discontinuation.
Atrioventricular block.
Bone marrow hematopoiesis disorder.

According to the instructions, "Carbamazepine" should be used with caution simultaneously with alcohol intake, in elderly patients, as well as in patients with severe heart failure, dilution hyponatremia, increased intraocular pressure, inhibition of bone marrow hematopoiesis while taking medications (history), prostatic hyperplasia, liver failure, chronic renal failure.

Side effect

The following side effects may occur during treatment:

worsening or development of congestive heart failure;
arrhythmias;
arthralgia;
violations taste sensations;
skin pigmentation disorders;
nausea, vomiting;
Stevens-Johnson syndrome;
erythema multiforme and nodosum;
muscle weakness and paresis;
interstitial nephritis;
thrombophlebitis;
depression;
swelling;
collapse;
exacerbation coronary disease heart (including the appearance or increased frequency of angina attacks);
anxiety;
tics;
lupus-like syndrome;
abdominal pain;
increased prolactin levels (may be accompanied by galactorrhea and gynecomastia);
hallucinations;
excitation;
peripheral neuritis;
impaired renal function (albuminuria, hematuria, oliguria, increased urea/azotemia);
disorientation;
general weakness;
loss of appetite;
angioedema;
ataxia;
glossitis;
sweating;
anaphylactic reaction;
pulmonary hypersensitivity reactions characterized by fever, shortness of breath, pneumonitis or pneumonia;
decrease or increase in blood pressure;
bradycardia;
cataract;
headache;
stomatitis;
photosensitivity;
intracardiac conduction disorders;
drowsiness;
diarrhea or constipation;
oculomotor disorders;
dry mouth;
erythroderma;
hives;
purpura;
thromboembolic syndrome;
activation of psychosis;
atrioventricular block with fainting;
hypercholesterolemia and hypertriglyceridemia;
aseptic meningitis with myoclonus;
aggressive behavior;
alopecia;
acne;
pancreatitis;
frequent urination;
renal failure;
changes in the perception of pitch;
sexual dysfunction/impotence;
nystagmus;
paresthesia;
dizziness;
urinary retention;
exfoliative dermatitis;
weight gain;
conjunctivitis;
leukopenia, thrombocytopenia, eosinophilia, leukocytosis, lymphadenopathy, agranulocytosis, aplastic anemia.

special instructions

Monotherapy for patients with epilepsy begins with small dosages with a gradual increase in the amount of the drug to achieve the desired effect. At combination therapy It is advisable to determine the concentration of "Carbamazepine" in plasma to select optimal dosage.

When the drug is abruptly discontinued, epileptic seizures are often recorded. If it is necessary to discontinue Carbamazepine, they try to transfer the patient to another antiepileptic drug. During therapy, monitoring of performance indicators is required hepatic system, blood condition.

Carbamazepine has a weak anticholinergic effect, which requires constant monitoring above the intraocular pressure indicator. The drug may reduce the effectiveness oral contraceptives, which requires the use additional methods to protect against pregnancy.

Analogues of the drug "Carbamazepine"

Complete analogues for the active element:

Storylat.
Carbalepsin retard.
Carbamazepine Nycomed (Akri, Ferein).
Finlepsin retard.
Karbasan retard.
Epial.
Zagretol.
Stazepin.
Tegretol CR.
Mazepin.
Actinerval.
Finlepsin.
Apo Carbamazepine.
Tegretol.
Carbapin.
Zeptol.

Price, holiday conditions

The average price of “Carbamazepine” tablets (Moscow) is 55 rubles for 50 pieces of 200 mg each. In Kyiv, the medicine costs 32 hryvnia, in Kazakhstan - 970 tenge. In Minsk, pharmacies offer the product at a price of 3.6 - 9 bel. rubles The drug is sold according to prescription.

According to statistics, about 80% of the world's population suffers from seizures. They appear as a result of stress, muscle strain, circulatory disorders or disease nervous system body. Cramps can be mild or severe. IN mild form There may be a slight tingling in the affected area, and in severe cases - a so-called epileptic attack. Find out about the anticonvulsant drug Carbamazepine - instructions for use, composition of the drug, doses for effective treatment.

What is Carbamazepine

Carbamazepine tablets are an antiepileptic and anticonvulsant. The medicine is used for seizures and focal psychomotor epilepsy. Action active substance carbamazepine are aimed at eliminating the patient's pain, which will reduce the risk of recurrent seizures. The product should be used only as prescribed by a doctor.

Compound

Carbamazepine is structurally similar to antidepressants such as imipramine. The active substance of the drug is carbamazepine at a dosage of 200 mg. Excipients consisting of:

starch (81 mg);
colloidal silicon dioxide (17 mg);
talc (3 mg);
magnesium stearate (3 mg);
PVP (14 mg);
polysorbate (3 mg);
acid.

Release form

Flat-cylindrical tablets are available in white or yellowish color in blister packs. There is an insert - instructions for Carbamazepine. The drug can be sold in the form of syrup. The medication is available only with a prescription. The release form of the medicine is different:

small cell packaging of 10-25 pcs.;
medium contour pack of 30 pcs.;
large polymer jar of 20-100 pieces.

Mechanism of action

The effect of this drug: in the process of metabolism, the patient’s body produces carbamazepine from the main substance, which provides antiepileptic properties even when taking the usual dose. The inhibitor suppresses seizures, delays their manifestation, without causing any harm. general condition person. The substance can be taken even by small children; it does not interfere with the development of children. The dosage, divided into several doses, is calculated as follows:

20 mg/kg body weight (with increasing dose by 20-50 mg daily) – up to 5 years;
100 mg (with the addition of 100 mg daily) – from 5 years and older.

In addition, Carbamazepine reduces the conductivity of calcium channels to the desired level, reducing the effect of proteins, and this leads to inhibition of the uptake of high concentrations of catecholamine hormones. As a result, carbamazepine suppresses epileptic seizures and eliminates affective disorders that accompany epilepsy. The period of accumulation of the maximum concentration of the substance is 4-24 hours, elimination is several days.

Indications for use

The medication is prescribed for the treatment of diseases such as:

leukopenia (decrease in white blood cells);
neuralgia (including chronic, trigeminal and glossopharyngeal nerve);
abstinence (in in this case they use the “blockade” method, that is, they do not allow addicts to take drugs);
epilepsy (attacks are accompanied by convulsions, foam at the mouth and other signs);
alcohol withdrawal syndrome (convulsions, anxiety, hyperexcitability, insomnia);
diabetes insipidus;
psychological disorders;
aggressive behavior of patients with brain lesions;
Kluver-Bucy syndrome, dysphoria, tinnitus, obsessive-compulsive disorder;
for pain syndromes of neurogenic origin (Guillain-Barre syndrome);
for the prevention of headaches and migraines.

Instructions for use of Carbamazepine

The patient is given a small daily dose of the medicine and gradually increases it each time to desired effect. If Carbamazepine is prescribed, the instructions for use for epilepsy are as follows:

Adults – 2 times a day, 150 mg. IN next appointment the dose is increased to 350 mg.
For children 4 years of age, the initial dose on the first day is 40 mg per day. Every other day, to enhance the effect, the child’s dose can be increased to 50 mg. Children five years of age and older should take 100 mg once daily. Every week, if necessary, the dose is increased by 100 mg.
From the age of six - 0.5 g 3 times a day, and after 11 years the dose changes and the child needs to take 1 g of the substance.

Other reception options:

For trigeminal neuralgia, give 400 mg per day, increasing the amount by no more than 150 mg per day until it disappears discomfort. Then the dose is reduced to the minimum.
With alcoholic withdrawal syndrome take 0.2 g 2 times a day. In severe cases, the dose is increased to 350 mg.
Adults with diabetes insipidus should be taken 2 times a day, 0.2 mg. Children are given a dose according to their weight and age. For acute affective disorders You need to take 1.5 g per day. The average dose is 550 mg 2-3 times a day.

The annotation of the drug indicates only average dosages. Full instructions The instructions for use can be found in the package insert of the medicine, and the treatment regimen can be found from the doctor. Other instructions:

The tablets are taken regardless of meals, washed down with water.
The drug should not be chewed, but swallowed whole.
In some cases, the doctor may increase the dose.

Side effects

Development side effects possible with an overdose of the drug or significant fluctuations in plasma concentrations of carbamazepine. Headache, tic, speech impairment, and symptoms of paresis are observed. The drug can affect the human psyche, causing hallucinations, depression, anxiety, agitation, disorientation, and decreased appetite. The drug can cause urticaria, sometimes erythroderma. Rarely, a reaction in the form of hypersensitivity with fever and rash is observed.

Leukopenia, thrombocytopenia, and less commonly leukocytosis are often observed. Abdominal discomfort, dry mouth, vomiting, stomatitis or pancreatitis may occur. Swelling and weight gain also occur. Very rarely there is a decrease in potency and urinary retention. Myalgia, convulsions, impaired taste perception, conjunctivitis, tinnitus, and hearing changes are rarely observed. At intensive care observe:

heart function;
temperature;
condition of the kidneys, bladder.

Contraindications

Carbamazepine should be taken carefully during pregnancy and under medical supervision. If you are hypersensitive to carbamazepine or other components of the drug, the drug should not be used. The medication is prohibited for disorders of bone marrow hematopoiesis, while taking inhibitors. People should take the drug with caution:

aged;
with active alcohol addiction;
with renal failure;
with increased intraocular pressure.

Interaction

Compatibility with other drugs is good, most do not affect the function of the product. Many drugs (Tramadol, Methadone, Doxycycline) can reduce therapeutic effect or become toxic, damage the liver (like Paracetamol, anti-tuberculosis Isoniazid). Plasma concentrations of carbamazepine can be increased by:

Verapamil;
Viloxazine;
Nicotinamide;
Danazol;
Acetanazole.

Increases concentration also grapefruit juice, Ritonavir. There is evidence that the concentration of metabolites Phenytoin, Clonazepam, Rifampicin and Primidone reduces. Tricyclic antidepressants and oral anticoagulants are compatible with the substance. Concomitant use of carbamazepine with diuretics leads to hyponatremia.

Analogues

Akrikhin, Zeptol, Carbalepsin, Tegretol, Mazepin, Stazepin and Finlepsin are considered analogues of this drug. Carbamazepine substitute Zeptol has a price of 175 rubles. Its advantages are considered to be high bioavailability and a choice of release forms. As with the prescription of the drug itself, any substitute drug should be used only after consultation with your doctor.

A psychotropic, antiepileptic drug is Carbamazepine. What does this medicine help with? The drug has a neurotropic, antidiuretic effect. Carbamazepine instructions for use prescribes use for alcoholism, epilepsy, neuralgia.

Release form and composition

Carbamazepine is available in tablet form. Carbamazepine tablets, which help with alcohol withdrawal, contain 200 mg of the active substance of the same name. Auxiliary elements are: talc, povidone K30, colloidal silicon dioxide (Aerosil), polysorbate 80, potato starch, magnesium stearate.

pharmachologic effect

The active component of the drug is Carbamazepine, which helps with epileptic seizures and other conditions, has antidiuretic, neurotropic, antiepileptic and psychotropic effects. According to the instructions, Carbamazepine eliminates irritability, aggressiveness, depression, anxiety and the frequency of seizures in patients with epilepsy. For neuralgia, this drug prevents the occurrence of paroxysmal pain. As for alcohol withdrawal syndrome, the medication for this pathology reduces tremor, increased nervous excitability, and also increases the threshold of convulsive readiness.

Carbamazepine tablets are very often used as an antipsychotic and mood stabilizer in the treatment of affective disorders. For diabetes insipidus, the medicine significantly reduces diuresis and thirst. In the pediatric field, to achieve a therapeutic effect, this pharmacological agent is used in very high doses, which cannot be said about adult patients. This is related, according to medical specialists, with physiological features.

Medicine Carbamazepine: what helps

Indications for use include the following pathological conditions:

Alcohol withdrawal syndrome.
Generalized tonic-clonic seizures.
Mild and severe attacks of epilepsy.
Acute manic states.
Mixed forms of epileptic seizures.
Idiopathic neuralgia of the glossopharyngeal nerve.
Pain syndrome in diabetic neuropathy.
Polydipsia and polyuria of neurohormonal etiology in diabetes insipidus.
Trigeminal neuralgia.

Reviews of Carbamazepine indicate that this drug is effective for bipolar affective disorders.

Contraindications

Carbamazepine instructions for use prohibit when:

atrioventricular block;
acute form"intermittent" porphyria;
disorders of bone marrow circulation (leukopenia, anemia);
intolerance to the main substance;
hypersensitivity to tricyclic antidepressants.

In case of active alcoholism, decompensated form of CHF, adrenal insufficiency, hypothyroidism, hypopituitarism, ADH hypersecretion syndrome, dilution hyponatremia, suppression of bone marrow hematopoiesis, increased intraocular pressure, prostatic hyperplasia, pathology of the renal system, the drug is prescribed with caution, assessing possible risks.

The drug Carbamazepine: instructions for use

The drug is taken orally with a small amount of liquid. The tablets can be taken regardless of meals. In the treatment of epilepsy, in cases where this is possible, the drug is prescribed as monotherapy. The drug is taken with a small daily dose, which is then gradually increased to the optimal dose. If antiepileptic therapy is already being carried out, carbamazepine should be added gradually (depending on the indications, the doses of drugs used simultaneously may be adjusted).

Initial adult dose is 100-200 mg 1-2 times a day. If necessary, it is slowly increased until the optimal therapeutic effect(usually up to 400 mg 2-3 times a day). Maximum daily dose- 1600-2000 mg. Children are prescribed the following dosage regimen:

Up to 5 years: initial daily dose - 20-60 mg, every other day the dose is gradually increased by 20-60 mg.
From 5 years: initial daily dose - 100 mg, every week the dose is gradually increased by 100 mg.
Maintenance dose for children - 10-20 mg/kg per day in 2-3 doses (to ensure accurate dosing in children under 5 years of age, liquid oral dosage forms of the drug should be used).

For other indications, Carbamazepine is prescribed:

Trigeminal neuralgia: on the first day - 200-400 mg per day; the dose is gradually increased until the pain stops, but not more than 200 mg per day (average daily dose - 400-800 mg), then reduced to the minimum effective dose.
Pain syndrome of neurogenic origin: on the first day - 100 mg 2 times a day; until the pain subsides, the dose is increased by no more than 200 mg per day (it is possible to increase by 100 mg every 12 hours). Maintenance daily dose - 200-1200 mg (in several doses).
Diabetic neuropathy accompanied by pain: the average dose is 200 mg 2-4 times a day. To prevent relapses of schizoaffective and affective psychoses - 600 mg per day in 3-4 doses; Diabetes insipidus: average adult dose - 200 mg 2-3 times a day. For children, Carbamazepine is prescribed in accordance with the body weight and age of the child.
Alcohol withdrawal syndrome: average dose - 200 mg 3 times a day; at severe course during the first few days, the single dose can be increased to 400 mg. At the beginning of therapy for severe withdrawal symptoms, it is recommended simultaneous use with drugs with sedative-hypnotic effects (clomethiazole, chlordiazepoxide).
Acute manic states and affective (bipolar) disorders: daily dose - 400-1600 mg (on average, the drug is taken 400-600 mg in 2-3 doses).
At acute course illness, the dose is increased quickly, and for maintenance treatment of affective disorders - gradually (to improve tolerability). Elderly patients and patients with hypersensitivity Carbamazepine is usually prescribed at an initial dose of 100 mg 2 times a day.

Side effects

The use of Carbamazepine, according to patient reviews, can cause the following undesirable reactions:

Nervous system: diplopia, dizziness, muscular dystonia, headache, asthenia, nystagmus, peripheral neuropathy, paresthesia, paresis, oculomotor disorders, tremor, fatigue, taste disturbance, drowsiness, auditory and visual hallucinations, aggressive behavior, disorientation, anxiety, mental disorders.
CVS: decreased or increased blood pressure, congestive heart failure, thrombophlebitis, arrhythmia, intracardiac conduction disorders.
Gastrointestinal tract: nausea, diarrhea, vomiting, impaired taste, dry mouth, abdominal pain, constipation.
Skin reactions: itching, urticaria, systemic lupus erythematosus, erythroderma, allergic dermatitis, sweating.
Other: aplastic anemia, weight gain, urinary retention, edema, renal failure, pneumonia, agranulocytosis, increased intraocular pressure, leukocytosis, shortness of breath, frequent urination and many other side effects.

Interaction

Metabolism of the drug is carried out using cytochrome CYP3A4. When administered simultaneously with inhibitors of this cytochrome, an increase in its concentration is observed, and, accordingly, the severity of side effects increases. Cytochrome inducers accelerate metabolic processes, reduce the level of drug concentration in the blood, reducing the severity of its therapeutic effect.

The concentration of the drug in the blood increases: Nicotinamide, Verapamil, Cimetidine, Fluvoxamine, Fluoxetine, Viloxazine, Dextropropoxyphene, Felodipine, Diltiazem, Acetazolamide, Desipramine, Danazol, Trefenadine, macrolides, azoles, Ritonavir, Propoxyphene, Isoniazid, Loratadine.

special instructions

Monotherapy for patients with epilepsy begins with small dosages with a gradual increase in the amount of the drug to achieve the desired effect. In combination therapy, it is advisable to determine the plasma concentration of carbamazepine to select the optimal dosage. When the drug is abruptly discontinued, epileptic seizures are often recorded. If it is necessary to discontinue carbamazepine, they try to transfer the patient to another antiepileptic drug.

During therapy, monitoring of the performance of the liver system and blood condition is required. Carbamazepine has a weak anticholinergic effect, which requires constant monitoring of intraocular pressure. The drug can reduce the effectiveness of oral contraceptives, which requires the use of additional methods to protect against pregnancy.

Analogues and price

Carbamazepine can be replaced with the following drugs:

Zeptol.
Carbalex.
Carbapin.
Mezakar.
Tegretol.
Timonil.
Finlepsin.

The price of Carbamazepine tablets in Minsk is 4-9 bel. rubles, Moscow - 76-90 rubles, Kyiv - 16-35 hryvnia, Almaty - 870 tenge.

The page contains instructions for use Carbamazepine. It is available in various dosage forms drug (tablets 200 mg), and also has a number of analogues. This abstract has been verified by experts. Leave your feedback on the use of Carbamazepine, which will help other site visitors. The drug is used for various diseases(epilepsy, neuralgia, psychosis, affective disorders). The product has a number of side effects and interactions with other substances. Doses of the drug differ for adults and children. There are restrictions on the use of the medicine during pregnancy and breastfeeding. Treatment with Carbamazepine should only be prescribed by a qualified physician. The duration of therapy may vary and depends on the specific disease. Composition and interaction of the drug with alcohol.

Instructions for use and dosage

Inside, regardless of food intake, along with a small amount of liquid.

Epilepsy. Where possible, carbamazepine should be prescribed as monotherapy. Treatment begins with a small daily dose, which is subsequently slowly increased until the optimal effect is achieved.

The addition of carbamazepine to existing antiepileptic therapy should be carried out gradually, with doses of medicines do not change or, if necessary, adjust.

For adults, the initial dose is 100-200 mg 1-2 times a day. Then the dose is slowly increased until the optimal therapeutic effect is achieved (usually 400 mg 2-3 times a day, maximum 1.6-2 g per day).

Children over 3 years old - an initial dose of 20-60 mg per day, gradually increasing by 20-60 mg every other day.

In children over 3 years old, the initial dose is 100 mg per day, the dose is increased gradually, every week by 100 mg. Maintenance doses: 10-20 mg/kg per day (in several doses): for 4-5 years - 200-400 mg (in 1-2 doses), 6-10 years - 400-600 mg (in 2-3 doses ), for 11-15 years - 600-1000 mg (in 2-3 doses).

For trigeminal neuralgia, 200-400 mg per day is prescribed on the first day, gradually increased by no more than 200 mg per day until the pain stops (on average 400-800 mg per day), and then reduced to the minimum effective dose.

At pain syndrome neurogenic origin, the initial dose is 100 mg 2 times a day on the first day, then the dose is increased by no more than 200 mg per day, if necessary, increasing it by 100 mg every 12 hours until the pain subsides. Maintenance dose - 200-1200 mg per day in several doses.

When treating elderly patients and patients with hypersensitivity, the initial dose is 100 mg 2 times a day.

Alcohol withdrawal syndrome: average dose - 200 mg 3 times a day; in severe cases, the dose can be increased to 400 mg 3 times a day during the first few days. At the beginning of treatment for severe withdrawal symptoms, it is recommended to prescribe in combination with sedative-hypnotic drugs (clomethiazole, chlordiazepoxide).

Diabetes insipidus: the average dose for adults is 200 mg 2-3 times a day. In children, the dose should be reduced according to the age and body weight of the child.

Diabetic neuropathy accompanied by pain: average dose - 200 mg 2-4 times a day. For the prevention of relapses of affective and schizoaffective psychoses - 600 mg per day in 3-4 doses.

For acute manic states and affective (bipolar) disorders, daily doses are 400-1600 mg. The average daily dose is 400-600 mg (in 2-3 doses). In acute manic state the dose is increased quickly, and during maintenance treatment of affective disorders - gradually (to improve tolerability).

Compound

Carbamazepine + excipients.

Release forms

Tablets 200 mg.

Carbamazepine- an antiepileptic drug (dibenzazepine derivative), which also has a normothimic, antimanic, antidiuretic (in patients with diabetes insipidus) and analgesic (in patients with neuralgia) effect.

The mechanism of action is associated with the blockade of voltage-gated Na channels, which leads to stabilization of the neuronal membrane, inhibition of the occurrence of serial neuronal discharges and a decrease in synaptic conduction of impulses. Prevents the re-formation of Na-dependent action potentials in depolarized neurons. Reduces the release of the excitatory neurotransmitter amino acid glutamate, increases decreased seizure threshold etc. reduces the risk of developing an epileptic attack. Increases conductivity for K, modulates voltage-gated Ca channels, which can also determine the anticonvulsant effect of the drug. Corrects epileptic personality changes and, ultimately, increases the sociability of patients, promotes their social rehabilitation. It can be prescribed as the main therapeutic drug and in combination with other anticonvulsants. Effective for focal (partial) epileptic seizures (simple and complex), accompanied or not accompanied by secondary generalization, for generalized tonic-clonic epileptic seizures, as well as in combination specified types(usually ineffective for minor seizures - petit mal, absence seizures and myoclonic seizures).

In patients with epilepsy (especially children and adolescents), it has been noted positive influence on symptoms of anxiety and depression, as well as a decrease in irritability and aggressiveness. Influence at cognitive function and psychomotor performance is dose dependent and highly variable.

The onset of the anticonvulsant effect varies from several hours to several days (sometimes up to 1 month due to autoinduction of metabolism). In case of essential and secondary neuralgia of the trigeminal nerve, in most cases it prevents the occurrence of painful attacks. Effective for relieving neurogenic pain due to tabes spinal cord, post-traumatic paresthesia and postherpetic neuralgia. Relief of pain in trigeminal neuralgia is observed after 8-72 hours. In alcohol withdrawal syndrome, it increases the threshold of convulsive readiness (which, when this state usually reduced) and reduces the severity of clinical manifestations of the syndrome ( increased excitability, tremor, gait disturbances).

In patients with diabetes insipidus it leads to rapid compensation water balance, reduces diuresis and thirst.

The antipsychotic (antimanic) effect develops after 7-10 days and may be due to inhibition of the metabolism of dopamine and norepinephrine.

Pharmacokinetics

Absorption is slow, but quite complete (food intake does not affect the speed and extent of absorption). IN cerebrospinal fluid(hereinafter referred to as CSF) and saliva, concentrations are created in proportion to the amount of active substance not bound to proteins (20-30%). Penetrates through the placental barrier. The concentration in breast milk is 25-60% of that in plasma. Metabolized in the liver, mainly along the epoxide pathway with the formation of the main metabolites: active - carbamazepine-10,11-epoxide and inactive conjugate with glucuronic acid. A low-active metabolite, 9-hydroxy-methyl-10-carbamoylacridan, is also formed. Can induce its own metabolism. The concentration of carbamazepine-10,11-epoxide is 30% of the concentration of carbamazepine.

Excreted in the form of inactive metabolites in urine (70%) and feces (30%). There is no evidence that the pharmacokinetics of carbamazepine changes in elderly patients. Data on the pharmacokinetics of carbamazepine in patients with impaired renal or hepatic function are not yet available.

Indications

epilepsy (excluding absence seizures, myoclonic or flaccid seizures) - partial seizures with complex and simple symptoms, primary and secondary generalized forms of seizures with tonic-clonic seizures, mixed forms of seizures (monotherapy or in combination with other anticonvulsants);
idiopathic trigeminal neuralgia;
trigeminal neuralgia in multiple sclerosis;
idiopathic glossopharyngeal neuralgia;
alcohol withdrawal syndrome;
treatment of affective disorders;
polydipsia and polyuria in diabetes insipidus;
pain syndrome in diabetic polyneuropathy;
prevention of phasic affective disorders (manic-depressive psychosis, schizoaffective disorders, etc.).

Contraindications

hypersensitivity to carbamazepine and chemically similar drugs (tricyclic antidepressants) or to any other component of the drug;
acute intermittent porphyria (including history);
simultaneous use of monoamine oxidase inhibitors (hereinafter referred to as MAO inhibitors) and for 2 weeks after their discontinuation;
violation of bone marrow hematopoiesis;
atrioventricular block;
pregnancy;
lactation period.

special instructions

Before starting treatment, it is necessary to general analysis blood (including counting platelets, reticulocytes), general urine analysis, determine the level of iron, concentrations of electrolytes and urea in the blood serum. Subsequently, these indicators should be monitored weekly during the first month of treatment and then monthly. When prescribed to patients with increased intraocular pressure, periodic monitoring is necessary. Non-progressive asymptomatic leukopenia does not require discontinuation, however, treatment should be discontinued if progressive leukopenia or leukopenia accompanied by clinical symptoms infectious disease.

Information about possible influence medicine for medical use on the ability to manage vehicles, mechanisms. During the treatment period, care must be taken when driving vehicles and engaging in other potentially dangerous species activities requiring increased concentration attention and speed of psychomotor reactions.

Side effect

dizziness;
ataxia;
drowsiness;
general weakness;
headache;
tics;
nystagmus;
oculomotor disorders;
peripheral neuritis;
paresthesia;
muscle weakness and paresis;
hallucinations;
depression;
loss of appetite;
anxiety;
aggressive behavior;
excitation;
disorientation;
activation of psychosis;
hives;
exfoliative dermatitis;
erythroderma;
lupus-like syndrome;
Stevens-Johnson syndrome;
photosensitivity;
erythema multiforme and nodosum;
aseptic meningitis with myoclonus;
anaphylactic reaction;
angioedema;
pulmonary hypersensitivity reactions characterized by fever, shortness of breath, pneumonitis or pneumonia;
leukopenia, thrombocytopenia, eosinophilia, leukocytosis, lymphadenopathy, agranulocytosis, aplastic anemia;
nausea, vomiting;
dry mouth;
diarrhea or constipation;
abdominal pain;
glossitis;
stomatitis;
pancreatitis;
intracardiac conduction disorders;
decrease or increase in blood pressure;
bradycardia;
arrhythmias;
atrioventricular block with fainting;
collapse;
worsening or development of congestive heart failure;
exacerbation of coronary heart disease (including the appearance or increase in frequency of angina attacks);
thrombophlebitis;
thromboembolic syndrome;
swelling;
weight gain;
increased prolactin levels (may be accompanied by galactorrhea and gynecomastia);
hypercholesterolemia and hypertriglyceridemia;
interstitial nephritis;
renal failure;
impaired renal function (albuminuria, hematuria, oliguria, increased urea/azotemia);
frequent urination;
urinary retention;
sexual dysfunction/impotence;
arthralgia;
taste disturbances;
cataract;
conjunctivitis;
changes in the perception of pitch;
skin pigmentation disorders;
purpura;
acne;
sweating;
alopecia.

Drug interactions

Carbamazepine increases the activity of microsomal liver enzymes and may reduce the effectiveness of drugs metabolized in the liver. Co-administration of carbamazepine with CYP3A4 inhibitors may lead to an increase in its concentration in the blood plasma. Combined use with CYP3A4 inducers can lead to an acceleration of the metabolism of carbamazepine and a decrease in its concentration in the blood plasma; on the contrary, their cancellation can reduce the rate of biotransformation of carbamazepine and lead to an increase in its concentration.

Increase the concentration of carbamazepine in plasma: verapamil, diltiazem, felodipine, dextropropoxyphene, viloxazine, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazol, desipramine, nicotinamide (in adults, only in high doses); macrolides (erythromycin, josamycin, clarithromycin, troleandomycin); azoles (itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, isoniazid, propoxyphene, grapefruit juice, viral protease inhibitors used in HIV therapy. Felbamate reduces the plasma concentration of carbamazepine and increases the concentration of carbamazepine-10,11-epoxide, and a simultaneous decrease in the serum concentration of felbamate is possible. The concentration of carbamazepine is reduced by phenobarbital, phenytoin, primidone, methsuximide, fensuximide, theophylline, rifampicin, cisplastin, doxirubicin, possibly: clonazepam, valpromide, valproic acid, oxcarbazepine and herbal preparations, containing St. John's wort (Hypericum perforatum). There are reports of the possibility of valproic acid and primidone displacing carbamazepine from binding to plasma proteins and increasing the concentration of the pharmacologically active metabolite (carbamazepine-10,11-epoxide). Isotretinoin alters the bioavailability and/or clearance of carbamazepine and carbamazepine-10,11-epoxide (monitoring of carbamazepine plasma concentrations is necessary). Carbamazepine may reduce plasma concentrations (reduce or even completely eliminate effects) and require dose adjustment the following drugs: clobazam, clonazepam, ethosuximide, primidone, valproic acid, alprazolam, glucocorticosteroids (prednisolone, dexamethasone), cyclosporine, doxycycline, haloperidol, methadone, oral medications containing estrogens and/or progesterone (selection required alternative methods contraception), theophylline, oral anticoagulants (warfarin, phenprocoumon, dicumarol), lamotrigine, topiramate, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline, clomipramine), clozapine, felbamate, tiagabine, oxcarbazepine, protease inhibitors used in the treatment of HIV infection (indinavir , ritonavir, saquinovir), calcium channel blockers (dihydropyridone group, for example, felodipine), itraconazole, levothyroxine, midazolam, olazapine, praziquantel, risperidone, tramadol, ciprasidone. There are reports that while taking carbamazepine, the level of phenytoin in the blood plasma may either increase or decrease, and the level of mephenytoin may increase (in rare cases). Carbamazepine for joint use with paracetamol increases the risk of its toxic effect on the liver and reduces therapeutic effectiveness (acceleration of paracetamol metabolism). The simultaneous administration of carbamazepine with phenothiazine, pimozide, thioxanthenes, molindone, haloperidol, maprotiline, clozapine and tricyclic antidepressants leads to an increased inhibitory effect on the central nervous system and a weakening of the anticonvulsant effect of carbamazepine. Concomitant administration with diuretics (hydrochlorothiazide, furosemide) can lead to hyponatremia, accompanied clinical manifestations. Reduces the effects of non-depolarizing muscle relaxants (pancuronium). Reduces ethanol (alcohol) tolerance. Speeds up metabolism indirect anticoagulants, hormonal contraceptives, folic acid; praziquantel, may enhance hormone elimination thyroid gland. Accelerates the metabolism of funds for general anesthesia(enflurane, halothane, fluorothane) with an increased risk of hepatotoxic effects; enhances the formation of nephrotoxic metabolites of methoxyflurane. Strengthens the hepatotoxic effect of isoniazid.

Analogues of the drug Carbamazepine

Structural analogues of the active substance:

Actinerval;
Apo Carbamazepine;
Zagretol;
Zeptol;
Carbalepsin retard;
Carbamazepine Nycomed;
Carbamazepine Acri;
Carbamazepine Ferein;
Carbapin;
Karbasan retard;
Mazepin;
Stazepin;
Storilat;
Tegretol;
Tegretol CR;
Finlepsin;
Finlepsin retard;
Epial.

Use in children

Use is possible in children over 3 years of age according to the dosage regimen.

Use during pregnancy and breastfeeding

When pregnancy occurs (when deciding whether to prescribe carbamazepine during pregnancy), it is necessary to carefully compare the expected benefits of therapy and its possible complications, especially in the first 3 months of pregnancy. It is known that children born to mothers with epilepsy are predisposed to disorders intrauterine development, including developmental defects.

Carbamazepine, like all other antiepileptic drugs, may increase the risk of these disorders. There are isolated cases reported congenital diseases and developmental defects, including spina bifida and hypospadias. Patients should be provided with information about the possibility of an increased risk of malformations and the opportunity to undergo antenatal diagnosis.

Antiepileptic drugs increase folic acid deficiency, which is often observed during pregnancy, which may contribute to an increase in the incidence of birth defects in children (before and during pregnancy, supplemental folic acid is recommended). In order to prevent increased bleeding in newborns, women in last weeks Pregnancy, as well as newborns, are recommended to be prescribed vitamin K1.

Carbamazepine penetrates into breast milk, you should compare the advantages and possible undesirable consequences breastfeeding during ongoing therapy. Mothers taking carbamazepine may breastfeed their infants, provided that the infant is monitored for possible developmental adverse reactions(for example, severe drowsiness, allergic skin reactions).