📋 Indications & Clinical Dosage
*Prophylaxis of manic depressive psychosis unresponsive to lithium:*
Adult: Initially 400 mg daily in divided doses increasing gradually until symptoms controlled; max 1.6 gm daily in divided doses. Usual range, 400- 600 mg daily.
*Epilepsy; generalized tonic-clonic and partial seizures:*
Adult: Initially 100-200 mg once or twice daily, increasing slowly to optimum dosage, usually 800 mg-1.2 gm daily in divided doses. Max 1.6 gm daily.
*Trigeminal neuralgia:*
Adult: Initially 100 mg once or twice daily increasing gradually to control, usually 600-800 mg daily in divided doses; max 1.6 gm daily.
*Focal and Generalized tonic-clonic seizures, trigeminal neuralgia, prophylaxis of bipolar disorder:*
Children: 1 month-12 yrs: Initially 5 mg/kg at night or 2.5 mg/kg twice daily increased as necessary by 2.5-5 mg/kg every 3-7 days; usual maintenance dose 5 mg/kg 2-3 times daily; doses up to 20 mg/kg/day have been used; 12-18 yr: initially 100-200 mg 1-2 times daily, increased slowly to usual maintenance dose 200-400 mg 2-3 times daily; in some cases doses up to 1.8 gm/day may be needed.
⛔ Contraindications
A-V conduction abnormalities unless paced, acute porphyrias, history of bone-marrow depression
⚠️ Precautions & Warnings
Hepatic or renal disorders, cardiac disease, history of haematological reactions to other drugs, may exacerbate absence and myoclonic seizures, skin reactions, susceptibility to angle-closure glaucoma, elderly. Perform liver function tests and check blood count regularly. Carbamazepine should be withdrawn immediately in cases of aggravated liver dysfunction or acute liver disease and leucopenia (if necessary choose an alternative)
🔄 Drug Interactions
Oral anticoagulants, MAOls, combined oral con-traceptives. Erythromycin, isoniazid, cimetidine,
dextropropoxyphene, diltiazem, verapamil, viloxazine, Steroids, phenytoin, lithium
⚠️ Adverse Reactions / Side Effects
Aplastic anaemia, ataxia,blood disorders, dermatitis, dizziness, drowsiness, dry mouth, eosinophilia, fatigue, GI disturbance, haemolytic anaemia, headache, hyponatraemia, leucopenia, nausea, oedema, skin reactions, blurring of vision, thrombocytopenia, urticaria, vomiting, involuntary movements (including nystagmus), visual disturbances
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Caution advised, doses should be adjusted on the basis of plasma-drug concentration monitoring
Lactation / Breastfeeding:
Contraindicated
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.