Tegretol

carbamazepin \  المادة الفعالة

 

مضاد للتشنجات

tegretol 200 mg ( 20 tab ) >>> 11 L.E

tegretol CR 200 mg ( 20 tab ) >>> 16 L.E

tegretol CR 400 mg ( 10 tab ) >>> 12 L.E

tegretol 100 mg / 5 ml ( syrup ) >>> 8 L.E

Class of drug: Anticonvulsant, analgesic.

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Mechanism of action:

Anticonvulsant action: blocks polysynpatic transmission by inhibiting influx of sodium ions across thecell membrane.



Analgesic action: blocks polysynpatic transmission within the CNS. Also has anticholinergic, antidiuretic, antiarrythmic, muscle relaxant properties.

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Indications/dosage/route: Oral only.



• Epilepsy: tonic–clonic, partial seizures with complex symptoms (psychomotor or temporal lobe seizures)

Ð Adults, children >12 years: Initial: 200 mg b.i.d.; increase dose weekly by 200 mg/d maximum. Maintenance: 800–1200 mg/d.

Maximum: 1600 mg/d.

Ð Children 6–12 years: Initial: 100 mg b.i.d.; increase dose

weekly by 100 mg/d. Maintenance: 400–800 mg/d. Maximum:

1000 mg/d.

• Trigeminal neuralgia (unlabeled use)

Ð Adults: Initial: 100 mg b.i.d. Maintenance: 200 mg–1.2 g/d.

Maximum: 1.2 g/d.

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Adjustment of dosage

• Kidney disease: creatinine clearance <10 mL/min: 75% of standard dose.

• Liver disease: None.

• Elderly: Reduce dose and monitor carefully.

• Pediatric: Safety and efficacy have not been established in children<6 years.

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Food: Should be taken with food to prevent GI upset.

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Pregnancy: Category C. Should be continued during pregnancy if favorable benefits versus risk.

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Lactation: Present in breast milk. Considered compatible by American Academy of Pediatrics. Should be continued during lactation if favorable benefits versus risk.

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Contraindications: Bone marrow depression, use of MAO inhibitor within 14 days, cross-sensitivity with tricyclic antidepressants, hypersensitivity to carbamazepine.

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Warnings/precautions

• Use with caution in patient with the following conditions: mixed type seizures, liver and cardiac disease.

• Carbamazepine should be discontinued if WBC is <3000 and neutrophils <=1500.

• Abrupt withdrawal may precipitate seizures.

• Aplastic anemia and agranulocytosis are significant risks in using carbamazepine.

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Advice to patient

• To minimize possible photosensitivity reaction, apply adequate sunscreen and use proper covering when exposed to strong sunlight.

• If you are receiving an oral contraceptive, use an alternative method of birth control.

• Avoid alcohol and other CNS depressants such as opiate analgesics and sedatives (eg, diazepam) when taking this drug.

• Avoid driving and other activities requiring mental alertness or that are potentially dangerous until response to drug is known.

• Notify dentist or treating physician prior to surgery if taking this medication.

• Do not stop taking this drug without consulting treating physician.

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Adverse reactions

• Common: drowsiness, dizziness, ataxia, confusion, nausea, vomiting, rash, blurred vision, nystagmus.

• Serious: worsening of seizures, bone marrow depression (including aplastic anemia), hepatitis, Stevens–Johnson syndrome, toxic

epidermal necrolysis, CHF, heart block, arrhythmia.

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Clinically important drug interactions

• Drugs that increase effects/toxicity of carbamazepine: isoniazid, cimetidine, diltiazem, verapamil, erythromycin, propoxyphene,

danazol.

• Drugs that decrease effects/toxicity of carbamazepine: phenobarbital, phenytoin, primidone, theophylline.

• Carbamazepine increases effects/toxicity of following: primidone, clomipramine, lithium, phenytoin.

• Carbamazepine decreases effects/toxicity of following: phenytoin,

warfarin, doxycycline, theophylline, alprazolam, rifampin,

cisplatin, oral contraceptives, cyclosporine, clonazepam, valproic acid.