What Are the Signs of a Carbamazepine Overdose?

Carbamazepine tablets, 1. Complex partial seizures (also known as psychomotor seizures or temporal lobe epilepsy), generalized tonic-paroxysmal seizures, two mixed seizures, or other partial or systemic seizures; typical Or atypical absence seizures, myoclonic or absence tonic seizures are not effective. 2. Trigeminal neuralgia and glossopharyngeal neuralgia, also used as long-term preventive medication after trigeminal neuralgia relief. It can also be used for spinal ridges and multiple sclerosis, diabetic peripheral neuralgia, pain in the affected limb and posttraumatic neuralgia, and postherpetic neuralgia. 3. Prevent or treat mania-depression; mania-depression that is ineffective or intolerable for lithium or antipsychotics or antidepressants can be used alone or in combination with lithium salts and other antidepressants. 4. Central partial diabetes insipidus can be used alone or in combination with sulfonylurea or clobetin. 5. For certain mental illnesses including schizophrenic affective disorders, refractory schizophrenia and runaway syndrome related to limbic dysfunction. 6. Restless legs syndrome (Ekbom syndrome), lateral hemifacial spasms. 7. Alcoholism withdrawal syndrome.

Carbamazepine tablets, 1. Complex partial seizures (also known as psychomotor seizures or temporal lobe epilepsy), generalized tonic-paroxysmal seizures, two mixed seizures, or other partial or systemic seizures; typical Or atypical absence seizures, myoclonic or absence tonic seizures are not effective. 2. Trigeminal neuralgia and glossopharyngeal neuralgia, also used as long-term preventive medication after trigeminal neuralgia relief. It can also be used for spinal ridges and multiple sclerosis, diabetic peripheral neuralgia, pain in the affected limb and posttraumatic neuralgia, and postherpetic neuralgia. 3. Prevent or treat mania-depression; mania-depression that is ineffective or intolerable for lithium or antipsychotics or antidepressants can be used alone or in combination with lithium salts and other antidepressants. 4. Central partial diabetes insipidus can be used alone or in combination with sulfonylurea or clobetin. 5. For certain mental illnesses including schizophrenic affective disorders, refractory schizophrenia and runaway syndrome related to limbic dysfunction. 6. Restless legs syndrome (Ekbom syndrome), lateral hemifacial spasms. 7. Alcoholism withdrawal syndrome.

Drug Name

Carbamazepine

Drug type

Work Injury Medical Insurance Class A Double Span

Hanyu Pinyin

Ka Ma Xi Ping Pian

Use classification

Sodium channel regulators

Carbamazepine Ingredients

The main ingredient of this product is carbamazepine.
Chemical name: 5H-Dibenzo [b, f] azepine-5-carboxamide Chemical structural formula:

Molecular formula: C ₁₅ H ₁₂ N ₂ O
Molecular weight: 236.27

Carbamazepine traits

This product is a white tablet.

Carbamazepine indications

1. Complex partial seizures (also known as psychomotor seizures or temporal lobe epilepsy), generalized tonic-paroxysmal seizures, two types of mixed seizures, or other partial or systemic seizures; typical or atypical absence seizures Myoclonus or absence of tonicity is ineffective.
2. Trigeminal neuralgia and glossopharyngeal neuralgia, also used as long-term preventive medication after trigeminal neuralgia relief. It can also be used for spinal ridges and multiple sclerosis, diabetic peripheral neuralgia, pain in the affected limb and posttraumatic neuralgia, and postherpetic neuralgia.
3. Prevent or treat mania-depression; mania-depression that is ineffective or intolerable for lithium or antipsychotics or antidepressants can be used alone or in combination with lithium salts and other antidepressants.
4. Central partial diabetes insipidus can be used alone or in combination with sulfonylurea or clobetin.
5. For certain mental illnesses including schizophrenic affective disorders, refractory schizophrenia and runaway syndrome related to limbic dysfunction.
6. Restless legs syndrome (Ekbom syndrome), lateral hemifacial spasms.
7. Alcoholism withdrawal syndrome.

Carbamazepine specifications

0.1g

Carbamazepine tablets dosage

Commonly used amount for adults 1. Anti-convulsive, start 0.1g once, 2 to 3 times a day; increase the daily 0.1g after the second day until the effect appears; maintain the amount according to the adjustment to the minimum effective amount, take in divided doses; pay attention to individualization , The maximum amount does not exceed 1.2g per day.
2. Analgesia, start 0.1g once, twice a day; increase by 0.1 0.2g every other day after the second day until the pain is relieved, maintain the amount of 0.4 0.8g daily, take in divided doses; the highest amount is not taken daily More than 1.2g.
3. Diabetes insipidus, 0.3-0.6g a day when used alone, if used in combination with other anti-diuretics, 0.2-0.4g a day, divided into 3 doses.
4. Anti-manic or anti-psychotic, start 0.2-0.4g daily, gradually increase to a maximum of 1.6g per week, and take 3 to 4 times. Daily limit, 12 to 15 years old, no more than 1g; 15 years old and not more than 1.2g; a few use 1.6g. Usually the adult limit is 1.2g, 12 to 15 years old does not exceed 1g per day, a few people need to use 1.6g. For analgesic use no more than 1.2g per day.
Anti-convulsions commonly used in children, before the age of 6 start daily at 5mg / kg body weight, increase the dosage every 5-7 days, up to 10 mg / kg daily, if necessary, to 20 mg / kg, adjust the maintenance amount to maintain blood The drug concentration is 8 12 g / kg, generally 10 20 mg / kg according to body weight, about 0.25 0.3g, but not more than 0.4g. Children 6 12 years old take 0.05 g 0.1g on the first day, take 2 times. Increase the weekly effect by 0.1g; the maintenance amount is adjusted to the minimum effective amount, generally 0.4 to 0.8g per day, no more than 1g, and taken in 3 to 4 times.

Carbamazepine adverse reactions

1. The more common adverse reactions are those of the central nervous system, manifested as blurred vision, diplopia, and nystagmus.
2. Water retention and hyponatremia (or water poisoning) caused by stimulation of antidiuretic hormone secretion, the incidence is about 10-15%.
3. Rare adverse reactions are allergic reactions, Stevens-Johnson syndrome or toxic epidermal necrolysis, rash, urticaria, itching; behavioral disorders in children, severe diarrhea, lupus erythematosus-like syndrome (urticaria, pruritus, Rash, fever, sore throat, bone or joint pain, fatigue).
4. Rare side effects include adenopathy, arrhythmia or atrioventricular block (especially for older people), bone marrow suppression, central nervous system poisoning (difficult speech, nervousness, tinnitus, tremor, hallucinations), allergic Hepatitis, hypocalcemia, directly affect bone metabolism leading to osteoporosis, kidney poisoning, peripheral neuritis, acute urinary violet disease, embolic vasculitis, allergic pneumonia, acute intermittent porphyria, can cause thyroid function Diminish. Because of the attention of a patient with myoclonic epilepsy with aseptic meningitis, meningitis recurred after receiving this product. Occasionally granulocytopenia, reversible thrombocytopenia, aplastic anemia, and toxic hepatitis.

Carbamazepine

Patients with a history of atrioventricular block, severe abnormalities in serum iron, bone marrow suppression, severe liver dysfunction, etc. are contraindicated.

Precautions for carbamazepine

1. Cross-allergic reaction with tricyclic antidepressants.
2. Pay attention to inspection during medication: whole blood cell examination (including platelets, reticulocytes and serum iron, should be re-examined frequently for 2 to 3 years), urine routine, liver function, ophthalmological examination; carbamazepine blood concentration determination
3. Do not use this product for general pain.
4. People with diabetes may cause an increase in urine sugar, so you should pay attention.
5. Patients with epilepsy cannot withdraw suddenly.
6. For patients who have been using other antiepileptic drugs, the dosage of this product should be gradually increased. After 4 weeks of treatment, the dose may need to be increased to avoid a decrease in blood concentration caused by self-induction.
7. The drug should be discontinued in the following cases: symptoms of liver poisoning or bone marrow suppression, adverse reactions of the cardiovascular system or rash.
8. When used for analgesia in specific pain syndrome, if the pain is completely relieved, it should be reduced to monthly withdrawal.
9. Taken after meals can reduce gastrointestinal reactions, should be taken as soon as possible if missed, do not take double the amount at one time, but can be replenished several times a day.
10. The following conditions should be used with caution: alcoholism, heart damage, coronary heart disease, diabetes, glaucoma, people with a history of blood reactions to other drugs (easy to induce bone marrow suppression), liver disease, abnormal antidiuretic hormone secretion or other endocrine disorders, urinary retention , Kidney disease.

Carbamazepine tablets for pregnant and lactating women

This product can pass through the placenta, and it is not clear whether it is teratogenic. It should be used with caution in early pregnancy; this product can be secreted into milk, which is about 60% of the blood drug concentration. It is not suitable for lactating women.

Carbamazepine tablets for children

This product can be used for children of all ages, please refer to [usage and dosage].

Carbamazepine tablets for the elderly

Elderly patients are more sensitive to this product, which can often cause cognitive dysfunction, agitation, anxiety, anxiety, insanity, atrioventricular block or bradycardia, and can also cause aplastic anemia.

Carbamazepine drug interactions

1. Combined with acetaminophen, especially a single overdose or long-term overdose, the risk of liver poisoning increases, which may make the latter less effective.
2. In combination with coumarin anticoagulants, due to the positive induction of liver enzymes of this product, the blood concentration of anticoagulants is reduced, the half-life is shortened, and the anticoagulant effect is weakened. The prothrombin time should be measured to adjust the dose .
3. Combined with carbonic anhydrase inhibitors, the risk of osteoporosis increases.
4. Due to the liver enzyme induction effect of this product, it is related to chlorosulfuramide, clobetin (antromene), desmopressin, lypressin, posterior pituitary, and Combining pressure and other drugs can strengthen the anti-diuretic effect, and the combined drugs need to be reduced.
5. When combined with estrogen-containing contraceptives, cyclosporine, digitalis (except possibly digoxin), estrogen, levothyroxine or quinidine, due to the positive induction of liver metabolic enzymes by carbamazepine, The effects of these drugs will be reduced, and the dosage should be adjusted to use oral contraceptives containing only progestin (progesterone). Large vaginal bleeding may occur in combination with oral contraceptives.
6. Combined with doxycycline (doxycycline), the blood concentration of the latter may decrease, and the dosage needs to be adjusted if necessary.
7. Erythromycin and troleandomycin and detropropoxyphene can inhibit the metabolism of carbamazepine, causing the plasma concentration of the latter to increase and a toxic reaction.
8. Haloperidol, losapine, maprotiline, thioxanthine or tricyclic antidepressants can enhance the metabolism of carbamazepine, causing the latter's blood concentration to increase and toxic reactions to occur.
9. Lithium salt can reduce the anti-diuretic effect of carbamazepine.
10. In combination with monoamine oxidase (MAO) inhibition, it can cause high fever or (and) hypertension crisis, severe convulsions and even death. The two drugs should be applied at least 14 days apart. When carbamazepine is used as an anticonvulsant, MAO inhibitors can change the type of seizures.
11. Carbamazepine can reduce the absorption and accelerate the elimination of nomifensine.
12. Phenobarbital and phenytoin accelerate the metabolism of carbamazepine and reduce t _{1/2 of} carbamazepine to 9-10 hours.

Carbamazepine overdose

Muscle twitches, tremors, angular arch reflexes, abnormal reflexes, rapid heartbeat, shock, etc. may occur. Treatment: gastric lavage, administration of activated carbon or laxatives, diuretics, etc., dialysis can be performed when severe poisoning and renal failure. In children with severe poisoning, blood can be exchanged, and the breathing, circulation and urinary function need to be observed for several days. Take corresponding measures according to the clinical situation.

Carbamazepine tablets pharmacology and toxicology

This product is anticonvulsant and antiepileptic drug. The pharmacological effects of carbamazepine include anticonvulsant, epilepsy, anti-neuronic pain, anti-manic-depressive disorder, improvement of symptoms of certain mental diseases, and anti-central diabetes insipidus. The mechanisms that produce these effects may be:
1. Use-dependently blocks Na + channels of various excitable cell membranes, so it can significantly inhibit the occurrence and diffusion of abnormal high-frequency discharges.
2. Inhibit T-type calcium channels.
3. Enhance the activity of central noradrenergic nerves.
4. Promote the secretion of antidiuretic hormone (ADH) or increase the effector's sensitivity to ADH.

Carbamazepine tablets pharmacokinetics

Oral absorption is slow and irregular. After oral administration of 400 mg, the plasma concentration reached a peak in 4 to 5 hours, and the peak plasma value (C _max ) was 8 to 12 g / ml, but the individual differences were very large. Peak time can reach 24 hours at high doses. The time to reach steady state blood drug concentration is 8 to 55 hours. Bioavailability is between 58 and 85%. Quickly distributed to systemic tissues, the plasma protein binding rate was about 76%. It is mainly metabolized in the liver, which can induce liver drug enzyme activity and accelerate self-metabolism. The pharmacological activity of the metabolite 10, 11-epoxidized carbamazepine is similar to that of the original drug, and its concentration in plasma and brain can reach 50% of the original drug. With a single dose of T _1/2 of 25 to 65 hours, the half-life of children is significantly shortened. Long-term use induces auto-metabolism, and T _1/2 decreases to 10-20 hours. It is mainly excreted in the form of inactive metabolites via urine and feces at 72% and 28%, respectively. This product can pass through the placenta and secrete into milk.

Carbamazepine tablets storage

Shaded and sealed.

Carbamazepine packaging

Polyethylene plastic bottles, 100 tablets per bottle.

Carbamazepine

36 months

Carbamazepine film implementation standards

First Supplement of the Chinese Pharmacopoeia 2010

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