THERAPEUTICS

Brands

• Tegretol, Carbatrol, Tegretol XR, Equetro, Teril, Timonil, Carbagen, Arbil, Epimaz, Mazepine, Novo-Carbamaz

Generic?

• Yes

Class

• Antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

• Complex partial seizures with or without secondary generalization (adults and children, monotherapy and adjunctive)

• Generalized tonic-clonic seizures

• Mixed seizure patterns (except absence seizures, juvenile myoclonic epilepsy)

• Trigeminal neuralgia

• Bipolar I disorder (acute manic and mixed episodes)

• Glossopharyngeal neuralgia

• Lennox-Gastaut syndrome

• Neuropathic pain

• Alcohol withdrawal

• Restless leg syndrome

• Psychosis/schizophrenia (adjunctive)

How the Drug Works

• Blocks voltage-dependent sodium channels

• Modulates sodium and calcium (L type) channels and NMDA glutamate transmission

How Long Until It Works

• Seizures: 2 weeks or less

• Trigeminal neuralgia or neuropathic pain: hours to weeks

• Mania: weeks

If It Works

• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years without seizures, depending on the type of epilepsy

• Trigeminal neuralgia: should dramatically reduce or eliminate attacks, pain may recur. Periodically attempt to reduce to lowest effective dose or discontinue

If It Doesn't Work

• Increase to highest tolerated dose. Subject to autoinduction, meaning that dose requirements can change over time

• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind. Check level if compliance is in question

• Trigeminal neuralgia: try an alternative agent. For truly refractory patients referral to tertiary headache center, consider surgical or other procedures

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Epilepsy: drug interactions can complicate multi-drug therapy

• Pain: can combine with other AEDs (gabapentin or pregabalin) or TCAs