Introduction Carbamazepine, initially designed as an anticonvulsant, has shown efficacy in

mood stabilization, particularly for individuals with bipolar disorder resistant to lithium.

Dosage and Plasma Concentrations

The usual recommended dosage falls within the range of 400 to 1600 mg per day,
administered in divided doses. It is advisable to monitor plasma concentrations, although
the correlation between these concentrations and the therapeutic response is not fully
understood.

pharmacokinetics

Carbamazepine gets into your system slowly but completely, and it spreads throughout
your body after being broken down. The good effects come from a substance it turns into,
called carbamazepine epoxide. A 20-hour half-life during long-term treatment is observed.
One important thing to know is that carbamazepine makes your liver produce special
enzymes, and this can affect how much of other drugs are in your blood.

Mechanism of action:

Carbamazepine exerts its therapeutic effects primarily through the blockade of neuronal
sodium channels, preventing abnormal electrical activity in the brain associated with
conditions like epilepsy and bipolar disorder. This sodium channel inhibition leads to the
stabilization of neuronal membranes, crucial for maintaining resting potential and
preventing uncontrolled neuronal firing. Additionally, carbamazepine facilitates serotonin
(5-HT) neurotransmission, contributing to its mood-stabilizing properties. it means that
the drug enhances or promotes the activity of serotonin, a neurotransmitter in the brain.
Extensively metabolized in the liver, carbamazepine's active metabolite, carbamazepine
epoxide, further contributes to its overall pharmacological impact. The collective reduction
in neuronal excitability through these mechanisms makes carbamazepine an effective
treatment for both seizures and mood disorders.

Indication

: Carbamazepine is prescribed for epilepsy, particularly in managing partial seizures, and

as a mood stabilizer for bipolar disorder, especially when other treatments are ineffective.
It is effective in cases of rapid mood swings and mixed affective states and can be added as
an adjunct to existing treatments. Additionally, it is used in the acute treatment of mania.

Contraindication:
 Carbamazepine should not be used in individuals with pre-existing cardiac conduction
abnormalities, a history of severe hypersensitivity reactions, or bone marrow suppression.
Caution is advised when considering its use with MAOIs. Careful assessment of patient
conditions and medical history is crucial to determine the appropriateness of
carbamazepine use.

Drug Interactions Carbamazepine interacts with various drugs, influencing their

metabolism. Caution is advised when combining carbamazepine with other medications,
and neurotoxicity risks increase when used concomitantly with lithium.

Clinical Use of Carbamazepine

When treating acute mania, it is preferable to initiate the treatment slowly, gradually
increasing the dosage. Regular monitoring of blood counts, liver function, and electrolytes
is recommended, with a focus on clinical vigilance as the primary safeguard. This cautious
approach ensures close observation and adjustment to optimize the effectiveness and
safety of the treatment for individuals experiencing acute mania.

Side effects
e
Common Side Effects of Carbamazepine:

• Rash:
o The most frequently observed side effect. This
refers to skin eruptions or changes.
• Gastrointestinal Effects:
o Nausea, vomiting, and diarrhea are common.
These are disturbances in the digestive system.
• Central Nervous System Effects:
o Sedation, dizziness, ataxia (loss of coordination),
and confusion may occur. Ataxia refers to a lack
of muscle coordination during voluntary
movements.
• Cardiac Effects:
o AV conduction delays, requiring monitoring.
This involves disruptions in the electrical signals
between the atria and ventricles of the heart.
• Serious and Rare Conditions:
 o Aplastic anemia (failure of blood cell production
in the bone marrow) and agranulocytosis
(severe drop in white blood cell count), though
extremely rare (less than 0.002%), are severe
and warrant immediate attention.
• Water Retention and Hyponatremia:
o Carbamazepine may cause water retention,
potentially leading to low sodium levels
(hyponatremia) due to a vasopressin-like effect.
Vasopressin is a hormone affecting water
balance in the body.
o Drug-Drug Interactions:
o
• Carbamazepine can influence the metabolism of various drugs,
leading to changes in their concentration levels in the
bloodstream. This interaction may either enhance or diminish
the effects of co-administered drugs, emphasizing the need for
careful consideration and monitoring to avoid adverse
reactions or reduced therapeutic efficacy.
•
o

Pre-Medication Assessments

Before initiating the medication, and after one month of using medication , thorough
assessments are essential:

• Liver Function Tests (LFT)

• Complete Blood Count (CBC)
• Electrocardiogram (EKG)

• carbamazepine, has a tendency to speed up its own breakdown in the body over
time. This self-metabolism can affect the drug's levels in the bloodstream, requiring
careful monitoring and potential adjustments in dosage to ensure its continued
effectiveness.
• Carbamazepine can influence the metabolism of various drugs, leading to changes in
their concentration levels in the bloodstream. This interaction may either enhance
or diminish the effects of co-administered drugs, emphasizing the need for careful
consideration and monitoring to avoid adverse reactions or reduced therapeutic
efficacy.