Carbamazepine is the first line treatment for simple and complex partial seizures. Of note, it is a second line medication for tonic-clonic generalized seizures. It also has use in treating neuropathic pain and as a mood stabilizer.
In addition to its role as an anticonvulsant, carbamazepine is the first line treatment for trigeminal neuralgia, and is used for other neuropathic pain syndromes.
Carbamazepine acts by stabilizing the inactivated state of voltage-gated sodium channels, leaving cells less excitable and decreasing conductance. This drug has a similar mechanism of action to phenytoin.
A rare adverse side effect of carbamazepine includes severe rashes and fatal skin reactions as seen with Stevens-Johnson syndrome. This is a hypersensitivity complex involving the skin and mucous membranes.
Carbamazepine induces cytochrome P450, thus increasing its own metabolism and reducing its half life. It also may accelerate the clearance of other drugs and decrease their action.
Carbamazepine is teratogenic and is associated with birth defects, including spina bifida, craniofacial abnormalities, and cardiovascular and urinary tract anomalies.
An adverse side effect is hepatotoxicity, possible due to disturbances in glutathione metabolism, which may occur as a result of accumulated toxic metabolites. Drug-induced liver injury may be severe or fatal, but can be rapidly reversed by stopping therapy.
A rare side effect of carbamazepine includes blood dyscrasias, such as agranulocytosis and aplastic anemia.
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