2.少见视力模糊、恶心、嗜睡、鼻炎、感冒样综合征、消化不良、皮疹和协调障碍等。
Tegretol(Carbamazepine)
Carbamazepine (CBZ), sold under the trade name Tegretol, among others, is a anticonvulsant medication used primarily in the treatment of epilepsy and neuropathic pain.[1] It is not effective for absence or myoclonic seizures.[1] It is used in schizophrenia along with other medications and as a second-line agent in bipolar disorder.[1] Carbamazepine appears to work as well as phenytoin and valproate.[3][needs update][4]
Common side effects include nausea and drowsiness.[1] Serious side effects may include skin rashes, decreased bone marrow function, suicidal thoughts, or confusion.[1] It should not be used in those with a history of bone marrow problems.[1] Use during pregnancy may cause harm to the baby; however, stopping the medication in pregnant women with seizures is not recommended.[1] Its use during breastfeeding is not recommended.[1] Care should be taken in those with either kidney or liver problems.[1]
Carbamazepine was discovered in 1953 by Swiss chemist Walter Schindler.[5] It was first marketed in 1962.[6] It is available as a generic medication.[7] It is on the World Health Organization's List of Essential Medicines, which lists the most effective and safe medicines needed in a health system.[8] The wholesale cost in the developing world is between 0.01 and US$0.07 per dose as of 2014.[9] In 2016, it was the 197th most prescribed medication in the United States, with more than 2 million prescriptions.[10]
Medical uses
Carbamazepine is typically used for the treatment of seizure disorders and neuropathic pain.[1] It is used off-label as a second-line treatment for bipolar disorder and in combination with an antipsychotic in some cases of schizophrenia when treatment with a conventional antipsychotic alone has failed.[1][11] It is not effective for absence seizures or myoclonic seizures.[1]
In the United States, the FDA-approved medical uses are epilepsy (including partial seizures, generalized tonic-clonic seizures and mixed seizures), trigeminal neuralgia, and manic and mixed episodes of bipolar I disorder.[12]
The drug is also claimed to be effective for ADHD.[13]
As of 2014, a controlled release formulation was available for which there is tentative evidence showing fewer side effects and unclear evidence with regard to whether there is a difference in efficacy.[14]
Adverse effects
In the US, the label for carbamazepine contains warnings concerning:
§ effects on the body's production of red blood cells, white blood cells, and platelets: rarely, there are major effects of aplastic anemia and agranulocytosis reported and more commonly, there are minor changes such as decreased white blood cell or platelet counts, but these do not progress to more serious problems.[2]
§ increased risks of suicide[2]
§ increased risks of hyponatremia and SIADH[2][15]
§ risk of seizures, if the person stops taking the drug abruptly[2]
§ risks to the fetus in women who are pregnant, specifically congenital malformations like spina bifida, and developmental disorders.[2][16]
Common adverse effects may include drowsiness, dizziness, headaches and migraines, motor coordination impairment, nausea, vomiting, and/or constipation. Alcohol use while taking carbamazepine may lead to enhanced depression of the central nervous system.[2]Less common side effects may include increased risk of seizures in people with mixed seizure disorders,[17] abnormal heart rhythms, blurry or double vision.[2] Also, rare case reports of an auditory side effect have been made, whereby patients perceive sounds about a semitone lower than previously; this unusual side effect is usually not noticed by most people, and disappears after the person stops taking carbamazepine.[18]
Interactions
Carbamazepine has a potential for drug interactions; caution should be used in combining other medicines with it, including other antiepileptics and mood stabilizers.[12] Lower levels of carbamazepine are seen when administrated with phenobarbital, phenytoin, or primidone, which can result in breakthrough seizure activity. Carbamazepine, as a CYP450 inducer, may increase clearance of many drugs, decreasing their concentration in the blood to subtherapeutic levels and reducing their desired effects.[19] Drugs that are more rapidly metabolized with carbamazepine include warfarin, lamotrigine, phenytoin, theophylline, and valproic acid.[12] Drugs that decrease the metabolism of carbamazepine or otherwise increase its levels include erythromycin,[20] cimetidine, propoxyphene, and calcium channel blockers.[12] Carbamazepine also increases the metabolism of the hormones in birth control pills and can reduce their effectiveness, potentially leading to unexpected pregnancies.[12]As a drug that induces cytochrome P450 enzymes, it accelerates elimination of many benzodiazepines and decreases their action.[21]
Valproic acid and valnoctamide both inhibit microsomal epoxide hydrolase (MEH), the enzyme responsible for the breakdown of carbamazepine-10,11 epoxide into inactive metabolites.[22] By inhibiting MEH, valproic acid and valnoctamide cause a build-up of the active metabolite, prolonging the effects of carbamazepine and delaying its excretion.
Grapefruit juice raises the bioavailability of carbamazepine by inhibiting CYP3A4 enzymes in the gut wall and in the liver.[2] Carbamazepine increases the processing of methadoneresulting in lower blood levels.[23]
Pharmacogenetics
Serious skin reactions such as Stevens–Johnson syndrome or toxic epidermal necrolysisdue to carbamazepine therapy are more common in people with a particular human leukocyte antigen allele, HLA-B*1502.[2] Odds ratios for the development of Stevens-Johnson syndrome or toxic epidermal necrolysis in people who carry the allele can be in the double, triple or even quadruple digits, depending on the population studied.[24][25] HLA-B*1502 occurs almost exclusively in people with ancestry across broad areas of Asia, but has a very low or absent frequency in European, Japanese, Korean and African populations.[2][26] However, the HLA-A*31:01 allele has been shown to be a strong predictor of both mild and severe adverse reactions, such as the DRESS syndrome form of severe cutaneous reactions, to carbamazepine among Japanese, Chinese, Korean, and Europeans.[25][27]
Mechanism of action
Carbamazepine is a sodium channel blocker.[28] It binds preferentially to voltage-gated sodium channels in their inactive conformation, which prevents repetitive and sustained firing of an action potential. Carbamazepine has effects on serotonin systems but the relevance to its antiseizure effects is uncertain. There is evidence that it is a serotonin releasing agent and possibly even a serotonin reuptake inhibitor.[29][30][31]
