Description overdue on 25.07.2012

Antiepileptics.   The active ingredient is a dibenzazepine derivative. The drug has antimanic, normotimicheskoe, antidiuretic (in patients with diabetes insipidus ), Analgesic (neuralgia) exposure. The principle impact of the medicament based on the blockade of voltage-gated sodium channels, which causes inhibition of the occurrence of bits of neurons stabilize neuronal membrane that effectively leads to a reduction of synaptic impulses. The drug inhibits the re-formation of sodium-dependent action potentials in depolarized neurons structure. Carbamazepine leads to a reduction of released glutamate (neuromediatory amino acid), can reduce the risk of epileptic seizure . Children, adolescents with epilepsy   against the backdrop of medication positive dynamics in relation to the severity of depression and anxiety, as well as the reduced aggressiveness, irritability. The impact on psychomotor performance, cognitive function   It is dose-dependent variability in each individual case. When trigeminal neuralgia (essential, secondary) marked decrease in the frequency of pain attacks. If postherpetic neuralgia, post-traumatic paresthesia, tabes   Carbamazepine helps to alleviate neuropathic pain. When alcohol withdrawal drug can reduce the severity of the main symptoms (tremor of the extremities, irritability, gait disturbance), raises the seizure threshold. Patients with diabetes   The drug reduces the feeling of heat, diuresis, leads to a rapid compensation of the water balance. Antimanic (antipsychotic), the effect is recorded after 7-10 days of therapy, develops as a result of oppression metabolism of noradrenaline, dopamine. The use of prolonged forms of carbamazepine can achieve a stable concentration of the basic substance in the blood, without registration, "failures" and "peak". Long-acting form of the drug take 1-2 times a day. Carbamazepine is available in the form of syrup, tablets.

Indications:

Carbamazepine prescribed for epilepsy: mixed forms of seizures, generalized forms of attacks Accompanied by tonic-clonic seizures, partial seizures . The drug used in idiopathic neuralgia glossopharyngeal nerve , Trigeminal neuralgia in patients with multiple sclerosis, idiopathic trigeminal neuralgia. The drug is recommended for use in acute manic states (combination therapy with antipsychotic drugs, lithium therapy). Carbamazepine prescribed for diabetic neuropathy with pain symptoms, and alcohol withdrawal syndrome (hyperexcitability, convulsions, anxiety, sleep disorders), with faznoprotekayuschih affective disorders, with central diabetes insipidus, polydipsia at neurohormonal origin, polyuria. The drug is prescribed for psychotic disorders (psychosis, schizoaffective and affective rasstroystvanarushenie functions of the limbic system, panic disorder) with obsessive-compulsive disorder in Kluver-Bucy syndrome , With senile dementia, tinnitus, dysphoria , Anxiety, somatization, chorea, depression, multiple sclerosis, tabes dorsalis, phantom limb pain, diabetic polyneuropathy , Acute idiopathic neuritis, gemifitsialnom spasm Ekboma syndrome, post-traumatic neuralgia, neuropathy, for migraine prophylaxis, post-herpetic neuralgia.

Contraindications:

Carbamazepine does not apply to atrioventricular block, the acute form of "intermittent" porphyria, disorders of bone marrow blood (leukopenia, anemia), with the main substance of intolerance, hypersensitivity tricyclic antidepressants . When asset alcoholism, decompensated form of chronic heart failure, adrenal insufficiency, hypothyroidism .   hypopituitarism , ADH hypersecretion syndrome, with hyponatremia dilutions, the oppression of bone marrow hematopoiesis, with increased intraocular pressure, prostatic hyperplasia, in the pathology of renal drug is prescribed with caution when evaluating possible risks.

Side effect:

Severity of adverse effect is dose-dependent. Nervous system:   paresis of accommodation, headaches, fatigue, ataxia, dizziness, rarely observed abnormal involuntary movements (tics, dystonia, tremor), paresthesia, peripheral neuritis , Horeoatetoidnye disorders, speech disorders, oculomotor disturbances, orofastsialnye dyskinesia, nystagmus, paresis of the symptoms, myasthenia gravis.   Mental health:   Activation psychosis disorientation , Agitation, aggressive behavior, anxiety, loss of appetite, depression, visual hallucinations, auditory hallucinations . Allergic reactions:   itchy skin, erythroderma, hives , Photosensitivity, Lyell's syndrome, Stevens-Johnson syndrome. Bodies of blood: aplastic anemia , Leukocytosis, thrombocytopenia, reticulocytosis, hemolytic anemia, lymphadenopathy. The digestive tract: pancreatitis , Stomatitis, glossitis, epigastric pain, stool disorders, liver failure, jaundice, granulomatous hepatitis, increased liver enzymes. Cardiovascular system:   aggravation of coronary artery disease, worsening of heart failure flow, atrioventricular block with syncope, bradycardia, unstable blood pressure, a violation of intracardiac conduction, arrhythmia,   thromboembolism , Thrombophlebitis. Metabolism and the endocrine system: hyperprolactinemia , Reduction of L-thyroxine, hyponatremia, weight gain, edema, fluid retention, high cholesterol, osteomalacia. Urogenital:   frequent urination, problems with the renal system, interstitial nephritis, reduced potency, hematuria, oliguria,   albuminuria . Musculoskeletal system:   cramps, myalgia, arthralgia. Senses: changing the perception of pitch, Gipoakuzija, hyperacusis, tinnitus, hearing impairment, conjunctivitis, cataract, breach of taste perception. It is also possible increase in perspiration, acne , Purpura, alopecia, a violation of skin pigmentation, hirsutism.

Overdose:

Manifest violation of the respiratory, cardiovascular and nervous systems. The sense organs, the nervous system: ataxophemia , Fainting, disorientation, nystagmus, hyporeflexia, myoclonus, psychomotor disorders, seizures, mydriasis, hypothermia, violation of visual perception, hallucinations, drowsiness, irritability. Cardiovascular system: cardiac arrest, violation of intraventricular conduction, tachycardia, instability Blood Pressure . It is also noted pulmonary edema, respiratory depression, nausea, vomiting, decreased motility of the colon, delayed evacuation of food from the stomach, hyponatremia , Fluid retention, anuria , Oliugriya, metabolic acidosis Hyperglycemia. The specific antidote is not developed. Treatment for posindromnoe.

Mode of application:

Carbamazepine is taken orally, drinking plenty of water .  Tablets long acting not chew, swallow whole, twice a day .  In epilepsy drug appointed as possible as monotherapy .  Treatment is recommended to start with small doses with gradual increase in dosage, which allows to achieve optimum results .  The starting dose for adults is 100-200 mg 1-2 times a day, gradually increasing the amount of medication .  Trigeminal neuralgia: the first day of treatment - 200-400 mg, with a gradual increase to 400-800 mg per day, and then gradually abolish drug Carbamazepine .  The initial dosage for pain syndrome of neurogenic origin is 100 mg twice a day, with increasing doses every 12 hours until pain relief .  Maintenance dose is 200-1200 mg per day, calculated on the number of receptions .  Average dose of alcohol withdrawal syndrome is 200 mg three times a day in severe condition to increase the dose of 400 mg three times a day .  In the first days of therapy is recommended in addition to appoint chlordiazepoxide, clomethiazole   and other sedative-hypnotics. When an adult diabetes insipidus 200 mg administered 2-3 times per day. In diabetic neuropathy pain administered 200 mg 2-4 times a day. Prevention of affective psychoses and schizoaffective: 600 mg 3-4 times daily. The daily dose of bipolar affective disorders, manic states leaves 400-1600 mg.

Special instructions:

Monotherapy with epilepsy begins with small dosages with a gradual increase amount of the drug to achieve the desired effect. In combination therapy it is advisable to determine the concentration of carbamazepine in plasma for the selection of the optimal dosage. With a sharp lifting of the drug are often recorded epileptic seizures . If necessary, cancel the patient's carbamazepine are trying to transfer to other antiepileptic medicines. During treatment requires monitoring of work on indicators of hepatic system, the state of the blood. Carbamazepine marked weak anticholinergic effects It requires continuous control of intraocular pressure indicator. The drug can reduce the effectiveness of oral contraceptives, which require the use of additional methods to protect against pregnancy.

Drug Interactions:

The metabolism of the drug carbamazepine carried out by cytochrome CYP3A4 . When concomitant administration of inhibitors of cytochrome marked increase in its concentration, and therefore enhanced the severity of side effects. Inductors cytochrome accelerate metabolic processes, reduce the level of drug concentration in the blood, reducing the severity of its therapeutic effect. The concentration of drug in the blood: nicotinamide, verapamil , Cimetidine, fluvoxamine, fluoxetine , Viloksazin, dextropropoxyphene, felodipine, diltiazem, acetazolamide, desipramine, danazol, trefenadin, macrolides (troleandomycin, clarithromycin, josamycin, erythromycin), azoles (fluconazole, itraconazole, ketoconazole), ritonavir, propoxyphene, isoniazid, loratadine. Phenobarbital, cisplatin, rifampicin, theophylline, fensuksimid, metsuksimid, primidone, phenytoin, valproic acid, valpromid, clonazepam, doxorubicin, cisplatin, increase the concentration of the drug in the blood.