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Carbamazepine

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VOL: 102, ISSUE: 02, PAGE NO: 31

Generic and proprietary names

- Carbamazepine: Tegretol; Carbagen SR; Tegretol Retard; Teril Retard.

Action

- Inhibits nerve impulses.

Classification

- Antiepileptic. 

Indications

- Partial/secondary generalised tonic-clonic seizures.

- Primary generalised seizures.

- Trigeminal neuralgia.

- Prophylaxis of bipolar disorder when unresponsive to lithium.

Cautions

- Hepatic/renal impairment.

- History of haematological reactions to other drugs.

- Skin reactions.

- Cardiac disease.

- Pregnancy and breastfeeding.

- Glaucoma.

- Avoid sudden withdrawal.

- Significant interactions with other drugs - check British National Formulary for details.

Contraindications

- Atrioventricular conduction abnormalities (unless paced).

- History of bone marrow depression. 

- Porphyria.

Common side-effects

- Nausea and vomiting. 

- Dizziness.

- Headache.

- Ataxia.

- Confusion and agitation - especially in older people.

- Problems with vision.

- Constipation.

- Diarrhoea.

- Anorexia.

- Rash.

- Blood disorders, including leucopenia, agranulocytosis, aplastic anaemia.

Rarer side-effects

- Cholestatic jaundice.

- Hepatitis.

- Stevens-Johnson syndrome.

- Toxic epidermal necrolysis.

- Alopecia.

- Thromboembolism.

- Arthralgia.

- Fever. 

- Proteinuria.

- Lymph node enlargement.

- Cardiac conduction disturbances.

- Dyskinesias.

- Paraesthesia.

- Depression.

- Impotence.

- Gynaecomastia

- Galactorrhoea.

- Aggression.

- Triggering of psychosis.

- Photosensitivity.

- Pulmonary hypersensitivity.

- Hyponatraemia.

- Oedema.

Administration

- Oral.

- Suppositories.

Nursing considerations

- Observe for confusion and agitation in older people.

- Observe for changes in mental state.

- Observe for allergic reactions such as rashes, purpura.

- Leucopenia which is severe, progressive or associated with clinical symptoms requires withdrawal.

Patient teaching

- Teach patient signs of blood, liver or skin disorders.

- Seek immediate medical attention if fever, sore throat, rash, mouth ulcers, bruising or bleeding develop.

- Take a missed dose as soon as possible. If the next is due within two hours, take a single dose immediately and miss the next. 

- Take with food to avoid gastrointestinal complications.

- Avoid driving or operating machinery in the first three days of treatment. 

- Alcohol can exacerbate sedative effects.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.

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