Carbamazepine

INTRODUCTION

Indications

Treatment of tonic-clonic, mixed, and complex-partial seizures. Management of pain in trigeminal neuralgia or diabetic neuropathy. Equetro only: Acute mania and mixed mania. Unlabeled Use: Other forms of neurogenic pain.

Action

Decreases synaptic transmission in the CNS by affecting sodium channels in neurons. Therapeutic Effects: Prevention of seizures. Relief of pain in trigeminal neuralgia. Decreased mania.

Adverse Reactions/Side Effects

CNS: ataxia, drowsiness, fatigue, psychosis, sedation, suicidal behavior or ideation, vertigo. EENT: blurred vision, nystagmus, corneal opacities. Resp: pneumonitis. CV: CHF, edema, hypertension, hypotension, syncope. GI: hepatitis, pancreatitis, weight gain. GU: hesitancy, urinary retention. Derm: photosensitivity, RASHES, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, urticaria. Endo: syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, THROMBOCYTOPENIA, eosinophilia, leukopenia. Misc: chills, fever, lymphadenopathy, elevated liver enzymes, multiorgan hypersensitivity reactions, hepatic failure (rare).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor skin reactions such as rash, itching/burning skin, hives, exfoliation, and dermatitis. Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrosis).

• Be alert for signs of agranulocytosis (fever, sore throat, mucosal lesions, signs of infection), aplastic anemia (unusual fatigue, weakness, dizziness, pallor), thrombocytopenia (bruising, nose bleeds, bleeding gums), or fatigue and poor health that might be due to other anemias and blood dyscrasias. Report these signs to the physician immediately. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.

• If used to treat trigeminal neuralgia or other types of neurogenic pain, assess pain using visual analogue scales or other appropriate pain scales to document whether this drug is successful in helping manage the patient's pain.

• If treating acute or mixed mania, monitor the patient's mood and behavior and report changes in manic symptoms (excitement, agitation) to help determine drug effectiveness.

• Assess vertigo, ataxia, or syncope that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for suicidal thoughts and ideology; notify physician immediately if patient exhibits signs of depression or other changes in mood and behavior.

• Monitor daytime drowsiness, confusion, agitation, or psychosis-like reactions. Repeated or excessive symptoms may require change in dose or medication.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess signs of congestive heart failure such as ...