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Transcript
Antiepileptic Medication: Tegretol, Tegretol XR, Carbatrol (carbamazepine) General Information Carbamazepine has been in use since the 1950s. It is used for the treatment of partial seizures and nerve pain. How does it work? Carbamazepine blocks sodium channels in neurons preventing it from entering the cells. This prevents repetitive electrical firing of neurons. Available forms This drug is available as a generic. Generic medications are not usually recommended for patients with uncontrolled seizures. It cannot be given intravenously. It is available in an extended release formulation: Carbatrol and Tegretol XR. Carbamazepine (Tegretol) is available in 100 mg chewable tablets, 200 mg tablets and elixir. Tegretol XR is available in 100 mg, 200 mg, and 400 mg tablets. Carbatrol is available in 100 mg, 200 mg and 300 mg capsules. Drug basics The medication will be at the highest level 4 to 8 hours after you take your dose. You might be more aware of dose related side effects at this time if you have them. Initially it takes 24 to 36 hours for half of the drug to leave your body. After approximately 6 weeks this is greatly reduced to 12 to 15 hours. The half-life of Carbatrol and Tegretol XR is longer. 75% of the drug binds to proteins. This portion of the drug is not active. It is metabolized in the liver and excreted in the urine. Tegretol XR note: When you have a bowel movement, you may notice the drug shell in the stool. This does not mean that you didn’t get the medication. Side Effects Carbatrol and Tegretol XR have fewer side effects than generic carbamazepine. There are 3 different types of side effects: • Drug specific: ▬ Low sodium and water retention ▬ Low levels of platelets, red blood cells and white blood cells ▬ Painful rash that is over most of your body (like a sunburn) ▬ Lupus or liver failure • Dose-related: ▬ Blurry or double vision ▬ Dizziness ▬ Feeling unsteady • Initiation: You may notice some of the dose related side effects during the first couple of weeks of treatment. Your body should get used to the medication if you give it a chance. You need to report any signs of drug specific reactions to the doctor immediately: Painful rash, intense fatigue and flu-like illness that does not go away, intense thirst and muscle cramping. You may be asked to stop the medication. • • • • • • • • • Many Drug Interactions Other AEDs: phenytoin, felbamate, tiagabine, topiramate, and valproate. Antibiotics Antacids Calcium channel blockers Propoxyphene (Darvon/Darvocet) Low dose oral contraceptives Chemotherapy Coumadin Grapefruit Lab Monitoring We can check the amount of carbamazepine in your blood. It is not necessary to do this on a regular basis. Final Note If you are having difficulty with your medication, please notify your doctor. Your dose may be able to be adjusted. Created by Diana Murray RN, CNS, MS, CNRN & Mark Yerby MD, MPH Portland, Oregon 1/2010