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TDM of Carbamazepine, accelerate the hepatic
metabolism of other drugs. -…
TDM of Carbamazepine
adverse drug reactions
Cardiovascular
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Serious- Atrioventricular block, cardiac dysrhythmia, congestive heart failure, eosinophilic , myocarditis, hypersensitivity, syncope
Dermatologic
Common - Pruritus (8%), rash (7%)
Serious- Stevens-Johnson syndrome, toxic epidermal
necrolysis
Gastrointestinal
Common- Constipation (10%), nausea (29%), vomiting (18%),
xerostomia (8%)
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Neurologic
Common- Asthenia (8%),
ataxia (15%),
dizziness (44%),somnolence
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Ophthalmic
Common -Blurred vision (6%), nystagmus
Endocrine metabolic
Hypocalcemia, hyponatremia (4% to 21.7%),
water intoxication syndrome
Hematologic
Agranulocytosis, aplastic anaemia, bone marrow depression, eosinophilia, leukopenia, pancytopenia, thrombocytopenia
Hepatic
Hepatitis, hepatotoxicity, liver failure, vanishing
bile duct syndrome
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Overdosage/Toxicology:
Peak serum concentration less than 30 mg/L are generally associated with mild
to moderate toxicity.
Peak serum concentration more than 40 mg/L may be
associated with coma, seizures and hypotension.
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Drug Monitoring
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Complete blood count, including platelets and differential; before initiating therapy and periodically thereafter.
Hepatic function tests, especially in patients with a history of liver disease; prior to initiation of therapy and periodically thereafter
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Pharmacokinetic
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Autoinduction
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When dosing is initiated, serum concentrations ↑according to the baseline clearance and half-life.
After a few doses of carbamazepine, enough auto-induction has occurred that clearance ↑, half-life ↓ and drug accumulation ↓.
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Hepatic Impairment
liver cirrhosis
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Carbamazepine serum concentrations and the presence of adverse drug
effects should be monitored frequently
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Dosage
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Adult
Epilepsy
Initial= 400mg/day in 2 divided dose (tablets or extended release tablet
OR
4 divided doses (oral suspension)
MD= ^up to 200mg/day at weekly intervals, BD, ER
OR
TDS/QID until optimal response achieved (800-1200mg/day)
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Bipolar disorder
Initial= 400mg/day, 2 divided doses, tablet/ER
OR
4 divided dose, oral suspension
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Trigeminal neuralgia
Initial= 200mg/day, 2 divided doses, tablets/ER
OR
4 divided doses, oral suspension, PC
As needd increase 200mg/day
MD= 400-800mg daily in 2 divided dose, tablet/ER
OR
4 divided dose, oral suspension
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Drug administration
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Controlled Release tablet: Swallow whole, do not chew/crush.
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Renal Impairment
Infants, Pediatric and Adolescents
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