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Carbamazepine
Kaplan and Saddock, Synopsis of Psychiatry 10th ed., Section 36.13
13
Medical
Graduate
09/19/2013

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Cards

Term
How successful is carbamazepine in the treatement of acute mania?
Definition
50-70% response seen in 2-3 weeks
Term
In which 3 groups of patients is carbamazepine especially effective as bipolar prophylaxis?
Definition

Bipolar II

Schizoaffective disorder

Dysphoric mania

Term
What are the 4 indications of carbamazepine in psychiatry?
Definition

1. Mania

2. Prophylaxis

3. Refractory depression

4. Control of aggression in patients with schizophrenia or schizoaffective disorder

Term
Does carbamazepine cause weight gain?
Definition
No
Term
What is the frequency of blood dyscrasias in carbamazepine therapy?
Definition

Aplastic anemia or agranulocytosis - 1:125,000

Leukopenia - 1-2%

Term
Are patients treated with carbamazepine who develop leukopenia at a higher risk for blood dyscrasias?
Definition
No
Term
What lab interferences does carbamazepine cause?
Definition

Hepatitis - cholestatic or hepatocellular

If aminotransferases are >x3 of UPN - discontinue

Term
What percentage of patients treated with carbamazepine develop a skin rash?
Definition
10-15% - benign maculopapular rash
Term
What are the 4 severe dermatological reactions to carbamazepine therapy?
Definition

Stevens-Johnson syndrome

Exfoliative dermatitis

Erythema multiforme

Toxic epidermal necrolysis

Term
What are the renal effects of carbamazepine?
Definition
Hyponatremia (SIAD-like effect), especially in the elderly
Term
Which 5 conditions are relative CI to carbamazepine therapy?
Definition

Glaucoma

Prostatic hypertrophy

Diabetes

History of alcohol abuse

Pregnancy

Term
What are the 3 major drug interactions with carbamazepine?
Definition

1. MAOIs - 2 week washout period

2. Contraceptives - reduced levels, breakthrough bleeding, uncertain pregnancy prevention

3. Valproate - lower dose of carbamazepine, increase dose of valproate

Term
Are adverse effect more or less common in oxcarbazepine (compared to carbamazepine)?
Definition

↓ risk of blood dyscrasias (no need for monitoring)

↓ risk of benign rash, serious rashes are rare. 25-30% of patients who develop a rash to carbamazepine, develop the same rash in oxcarbazepine

↑ risk of hyponatremia (3-5%)

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