Effects of withdrawal

As with other antiepileptic drugs, carbamazepine should be gradually tapered over several weeks to avoid rebound seizures. Dosage and administration

Before initiating therapy with carbamazepine, a medical history and physical examination should be performed, with emphasis on neurological, haematological, and hepatic abnormalities. It is also important to note any medications the patient is taking. The patient should be educated about the signs and symptoms of blood dyscrasias, hepatic failure, and severe dermatological reactions, and told to report these to the physician immediately. Patients, especially women taking oral contraceptives, should be educated about potential drug interactions.

Carbamazepine is generally initiated at a starting dose of 100 to 400 mg, taken either as a single dose or two divided doses (see Table 1 for dosage forms). The dose is gradually increased by 100 or 200 mg every few days as the patient tolerates. The usual therapeutic serum concentration is 4 to 15 pg/ml, which is measured before the first morning dose. The half-life of carbamazepine will decrease with chronic administration due to autoinduction, necessitating continued dosage adjustment in the first 2 months of therapy. Therefore, frequent monitoring of the serum carbamazepine concentration may be helpful initially.

Laboratory screening

Given the risk of severe blood dyscrasias and hepatic failure, some authorities recommend obtaining a complete blood count and liver function tests at the initiation of treatment. These tests are often repeated every 2 weeks for the first few months of treatment, and then every 3 to 6 months thereafter. However, as these rare idiosyncratic reactions usually occur rapidly and are often not preceded by laboratory abnormalities, other authorities argue that testing is unnecessary.

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