Carbamazepine

Question 1

Carbamazepine - indications

Answer 1

1) Seizure prophylaxis

2) Trigeminal neuralgia to control pain and frequency of attacks

Question 2

Carbamazepine - adverse effects (common)

Answer 2

• GI upset: nausea, vomiting
• Neuro effects: dizziness and ataxia
• Oedema and hyponatraemia (due to ADH-like effect)

Question 3

Carbamazepine - adverse effects (rare)

Answer 3

• Carbamazepine hypersensitivity (rare - 10% of pxts): mild maculopapular rash
• Antiepileptic hypersensitivity syndrome (rare - 1 in 5000): skin reaction, fever, lymphadenopathy

Question 4

Carbamazepine - caution

Answer 4

• pregnancy

- hepatic, renal or cardiac disease

Question 5

Carbamazepine - contraindication

Answer 5

Hx of Antiepileptic hypersensitivity syndrome

Question 6

Carbamazepine - interactions

Answer 6

• drugs metabolised by CYP enzymes (warfarin, oestrogens and progestogens)
• CYP inhibitors (macrolides)
• Other anti-epileptic drugs (lamotrigine)
• Drugs that lower seizure threshold (antipsychotic and tramadol)

Question 7

Carbamazepine - patient communication

Answer 7

Explain to patients that the aim of treatment is to reduce seizure frequency, not to ‘cure’ epilepsy.

Advise patients that they must not drive unless they have been seizure-free for 12 months, and for 6 months after changing or stopping treatment.