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Carbamazepine Dosage

Applies to the following strength(s): 100 mg ; 100 mg/5 mL ; 200 mg ; 400 mg ; 300 mg

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Epilepsy

Initial dose: 200 mg orally 2 times a day (immediate and extended release) or 100 mg orally 4 times a day (suspension)
Increase dose at weekly intervals by adding up to 200 mg/day using a 2 times a day regimen of extended release or a 3 times a day or 4 times a day regimen of the other formulations.
Maintenance dose: 800 to 1200 mg/day.
Dosage generally should not exceed 1200 mg/day.
However, doses up to 1600 mg/day have been used in rare instances.

Use: Epilepsy:
-Partial seizures with complex symptomatology (psychomotor, temporal lobe)
-Generalized tonic-clonic seizures (grand mal)
-Mixed seizure patterns which include the above, or other partial or generalized seizures

Usual Adult Dose for Trigeminal Neuralgia

-Initial dose: 100 mg orally 2 times a day (immediate or extended release) or 50 mg orally 4 times a day (suspension)
-May increase by up to 200 mg per day using increments of 100 mg every 12 hours (immediate or extended release), or 50 mg 4 times a day (suspension), only as needed to achieve freedom from pain. Do not exceed 1200 mg per day.
-Maintenance dose: 400 to 800 mg per day
Comments:
-Some patients may be maintained on as little as 200 mg per day while others may require as much as 1200 mg per day.
-At least once every 3 months throughout the treatment period, attempts should be made to reduce the dose to the minimum effective level or to discontinue the drug.

Use:
-True trigeminal Neuralgia
-Beneficial results have also been reported in glossopharyngeal neuralgia

Usual Pediatric Dose for Epilepsy

Less than 6 years of age:
-Initial dose: 10 to 20 mg/kg/day orally in 2 to 3 divided doses (tablets) or 4 divided doses (suspension)
-Increase dose at weekly intervals to achieve optimal clinical response administered 3 or 4 times a day.
-Maximum dose: 35 mg/kg/day
-If satisfactory response not achieved, measure plasma levels to determine if in therapeutic range.
-Comments: The manufacturer makes no recommendation regarding the safety of doses above 35 mg/kg/24 hours.

6 to 12 years of age:
-Initial dose: 100 mg orally 2 times a day (immediate or extended release tablets) or 50 mg orally 4 times a day (suspension)
-Increase dose at weekly intervals in 100 mg per day increments using a 2 times a day regimen of extended release or a 3 times a day or 4 times a day regimen of the other formulations.
Maintenance dose: 400 to 800 mg per day
Maximum dose: 1000 mg per day

Greater than 12 years of age:
-Initial dose: 200 mg orally 2 times a day (immediate and extended release) or 100 mg orally 4 times a day (suspension)
-Increase dose at weekly intervals in 200 mg per day increments using a 2 times a day regimen of extended release or a 3 times daily to 4 times daily regimen of the other formulations.
-Maintenance dose: 800 to 1200 mg per day
-Dosage generally should not exceed 1000 mg in children 12 to 15 years and 1200 mg/day in patients older than 15 years.
-Doses up to 1600 mg/day have been used in rare instances.

Use: Epilepsy:
-Partial seizures with complex symptomatology (psychomotor, temporal lobe)
-Generalized tonic-clonic seizures (grand mal)
-Mixed seizure patterns which include the above, or other partial or generalized seizures

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Dosage should be adjusted to the needs of the individual patient. A low initial daily dosage with a gradual increase is advised. As soon as adequate control is achieved, the dosage may be reduced very gradually to the minimum effective level.

Precautions

US BOXED WARNINGS:
-Serious dermatologic reactions and HLA-B 1502 allele:
Serious and sometimes fatal dermatologic reactions, including toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS), have occurred in patients treated with this drug, often accompanied by mucous membrane ulcers, fever, or painful rash. The risk is 10 times higher in patients with the human leukocyte antigen (HLA) allele, HLA-B 1502 which occurs mostly in Asian patients. These patients should be screened for HLA-B 1502 allele before starting treatment. Treatment should not be initiated in these patients unless benefit clearly outweighs risk.
-Aplastic anemia and agranulocytosis:
Risk of developing aplastic anemia and agranulocytosis is 5 to 8 times greater in patients treated with this drug than in the general population. A complete blood count should be obtained before beginning treatment and CBC should be routinely monitored.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is slightly dialyzed by hemodialysis. The dialysis clearance averages 54 mL/min. Using a Cobe Century II hollow tube dialyzer with a cuprophane membrane, 10% of a dose is removed during 4 hour of hemodialysis.

Hemoperfusion has been reported to be useful in the removal of carbamazepine during acute overdose.

Other Comments

Administration advice:
-Tablets (including the chewable and extended release forms) and the suspension should be taken with meals. The extended release capsules can be taken with or without food.
-The controlled-release tablets may be halved, but should be swallowed without chewing, crushing, or dividing a controlled-release half tablet. If necessary, the capsules can be opened and the contents sprinkled over food, such as a teaspoonful of applesauce or other similar food products. Capsules should not be crushed or chewed.
-The oral suspension is particularly useful for patients who have difficulty swallowing or who need careful dosage adjustments. The oral suspension should be shaken prior to administration.
-Abrupt dose reduction or withdrawal may precipitate convulsions or status epilepticus. If this drug has to be withdrawn abruptly in a patient with epilepsy, the changeover to the new antiepileptic agent should be made under cover of a suitable agent (such as intravenous diazepam or intravenous phenytoin).
-Damaged tablets or extended-release tablets without a release portal should not be consumed.
-When converting patients from conventional tablets and liquid to modified-release tablets, the total daily dose may need to be increased. When converting patients from the oral route to rectal suppositories, the dosage should be increased by 25%. Final dosages should always be based upon individual response and plasma levels.

Monitoring:
-Baseline and periodic complete urinalysis and BUN determinations are recommended for patients treated with this drug because of observed renal dysfunction.
-Liver function tests should be performed prior to initiating therapy with this drug and routinely thereafter, especially in patients with a history of liver disease and in elderly patients. Therapy should be withdrawn immediately in cases of aggravated liver dysfunction or acute liver disease.
-Complete blood counts (including platelets and possible reticulocytes) and serum iron should be obtained prior to initiating therapy with this drug and routinely thereafter. If the white blood cell or platelet count is definitely low or decreased during treatment, the patient and the complete blood count should be closely monitored.

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