Epilepsy (except absence seizures, myoclonic or sluggish seizures) partial seizures with complex and simple symptoms, primary and secondary generalized forms of attacks with testosterone blend 250mg topikoklonicheskimi seizures, mixed forms of seizures (monotherapy or in combination with other anticonvulsants): idiopathic trigeminal neuralgia trigeminal nerve in multiple sclerosis, idiopathic glossopharyngeal neuralgia, alcohol withdrawal syndrome, the treatment of affective disorders, polydipsia and polyuria with diabetes insipidus, pain in diabetic polyneuropathy.
Prevention faznoprotekayuschih affective disorder (manic depression, schizoaffective disorder, and so-called).
Hypersensitivity to karbamazeiinu and similar chemically drugs (tricyclic antidepressants) or any other component of the drug, acute intermittent porphyria (including history), concomitant use of monoamine oxidase inhibitors (MAOIs below) and within 2 weeks after their withdrawal, infringement of bone marrow testosterone blend 250mg hematopoiesis, atrio-ventricular block, pregnancy and lactation, children under 5 years.
Be wary – hyponatremia breeding, advanced age, alcohol intake, inhibition of bone marrow hematopoiesis in patients receiving medication (in history); prostatic hyperplasia, increased intraocular pressure, severe heart failure, liver failure, chronic renal failure.
Dosage and administration:
Inside, regardless of the meal with a small amount of liquid.
In epilepsy: possible, carbamazepine should be administered in a monotherapy. Treatment is initiated with small daily doses, which thereafter slowly increased until the optimum effect. Accession to the already ongoing carbamazepine antiepileptic therapy should be gradual. For adults, the initial dose of 100-200 mg 1-2 times a day. Then the dose is slowly increased to 400-600 mg 2 times a day. The maximum daily dose of 1600-2000 mg. The dosage for children from 5 years of 10-20 mg / kg body weight for 2 admission. The maximum daily dose for children 5-10 years – 600 mg / day. for children from 10 to 15 years – 1,000 mg / day.
For trigeminal neuralgia and neurogenic pain syndrome: 100-200 mg 2 times a day, then: gradually increase the dose of not more than 200 mg a day until the end of pain (on average up to 600 – 800 mg). then reduced to the minimum effective dose. The effect is usually within 1 – 3 days after starting treatment. Prescribe medication for a long time; with premature drug discontinuation pain may testosterone blend 250mg return. In the treatment of elderly patients the initial dose of 100 mg 2 times a day.
Alcohol withdrawal syndrome: the average dose – 200 mg 2 times a day. In severe cases, the dose during the first days can be increased to 600 mg 2 times a day. At the start of treatment for severe withdrawal phenomena given in conjunction with detoxification therapy and sedative-hypnotic drugs.
Diabetes insipidus: the average dose for adults – 200 mg 2 times a day. Diabetic neuropathy, pain accompanied by: 200-300 mg 2 times a day.
For the prevention of affective disorders: the first week of daily dose 200 – 400 mg. Subsequently the dose increased to 200 mg per week, bringing it to about 1 g / day. Daily dose equally divided into 2 admission.
Going to treatment with carbamazepine should be gradual, with decreasing doses of the previous formulation. Discontinuation of therapy should be gradual. Duration of treatment is determined by your doctor.
On the part of the central nervous system: dizziness, testosterone blend 250mg ataxia, drowsiness, weakness, headache, paresis of accommodation, tremors, tics, eye, orofacial dyskinesia, oculomotor disturbances, dysarthria, horeoatetoidnye disorders, peripheral neuritis, paresthesia, muscle weakness, and paresis.
From the psychic sphere: hallucinations, depression, loss of appetite, anxiety. aggressive behavior, agitation, disorientation, activation of psychosis.
Allergic reactions: rash, exfoliative dermatitis, erythroderma, lupus-like syndrome, Stevens-Johnson syndrome. toxic epidermal necrolysis, photosensitivity, erythema multiforme and nodosum. There may be a delayed multiorgan hypersensitivity reaction with fever mud, skin rashes, vasculitis, limfadenonatiey, symptoms resembling lymphoma, arthralgia, leukopenia, eosinophilia, hepatosplenomegaly and altered liver function tests (these manifestations occur in various combinations). There may also be involved and other organs (eg, lungs, kidneys, pancreas, myocardium, colon). Very rarely – aseptic meningitis with myoclonus, anaphylactic reaction, angionevroticheekpy edema, hypersensitivity reactions on the part of the lung, characterized by fever, dyspnoea, pneumonitis or pneumonia.
From the side of hematopoiesis: leukopenia, thrombocytopenia, eosinophilia, leukocytosis, lymphadenopathy; agranulocytosis, aplastic anemia, pure red cell aplasia, megaloblastic anemia, acute intermittent porphyria, reticulocytosis, hemolytic anemia.
From the digestive system (hereinafter GI) tract: nausea, vomiting, dry mouth, diarrhea or constipation, abdominal pain, glossitis, stomatitis, pancreatitis. Liver: increased activity of gamma-glutamyl transpeptidase (usually no clinical significance). increased activity of alkaline phosphatase and “liver” transaminases, testosterone blend 250mg hepatitis (granulomatous, cholestatic, parenchymal (hepatocellular) or mixed type), liver failure.
Cardio-vascular system (hereafter CAS): violation of intracardiac conduction: a reduction or increase in blood pressure; bradycardia, arrhythmias. atrio-ventricular block with syncope, collapse, worsening or development of congestive heart failure, aggravation of coronary heart disease (including the appearance or increased frequency of angina attacks), thrombophlebitis, thromboembolic syndrome.
On the part of the endocrine system and metabolism: edema, weight gain, hyponatremia, increased prolactin levels (may be accompanied by galactorrhea and gynecomastia): reduction of L-thyroxine (free T4, T3) and increasing the level of thyroid stimulating hormone (TSH) (normally not accompanied by symptomatic), disorders of calcium-phosphorus metabolism in bone tissues (decline in the concentration of Ca2 + and 25-OH cholecalciferol in plasma); osteomalacia; hypercholesterolemia and hypertriglyceridemia.
With the genitourinary system: interstitial nephritis, renal failure, renal dysfunction (albuminuria, hematuria, oliguria, increase in urea / azotemia), urinary frequency, urinary retention, sexual dysfunction / impotence.
From the musculoskeletal system: arthralgia, myalgia or cramps.
From the senses: taste disturbance, cataract, conjunctivitis; hyper- or Gipoakuzija, changes in the perception of pitch.
Other: disorders of skin pigmentation, purpura, acne, sweating, alopecia.
Symptoms of respiratory depression: hyperreflexia replaced at hyporeflexia, hypothermia, inhibition of gastrointestinal motility, increased severity of side effects.
Treatment: there is no specific antidote. Gastric lavage, the appointment of activated carbon (late evacuation of gastric contents may result in delayed absorption for 2-3 hours and re-emergence of symptoms of intoxication), symptomatic therapy. Ineffective forced diuresis, hemodialysis and peritoneal dialysis (dialysis shows a combination of severe poisoning and renal failure). Children may need to exchange blood transfusion. It recommended holding hemosorption on coal sorbents.
Interaction with other drugs:
carbamazepine enhances liver microsomal enzyme activity and can reduce the effectiveness of drugs metabolized in the liver. Simultaneous administration of carbamazepine with CYP 3A4 inhibitors may lead to an increase in its concentration in plasma. The combined use of CYP 3A4 inducers may accelerate the metabolism of carbamazepine and reduce its concentration in blood plasma, on the other hand, their removal may reduce the rate of biotransformation of carbamazepine and lead to an increase in its concentration.
Increasing the concentration of carbamazepine in plasma: verapamil, diltiazem, felodipine, dextropropoxyphene, viloksazin, fluoxetine, fluvoxamine, cimetidine, acetazolamide, danazol, desipramine, nicotinamide (in adults, only in high doses); macrolides (erythromycin, josamycin, clarithromycin, troleandomycin); azoles (itraconazole, ketoconazole, fluconazole), terfenadine, loratadine, isoniazid, propoxyphene, grapefruit juice, viral protease inhibitors used in HIV therapy. Felbamate reduces the concentration of carbamazepine in the plasma and increases the concentration of carbamazepine-10,11 epoxide, possibly with the simultaneous reduction in serum concentration of felbamate. The concentration of carbamazepine reduce phenobarbital, phenytoin, primidone, metsuksimid, fensuksimid, theophylline, rifampicin, tsisplastin, doxirubicin possibly: clonazepam, valpromid, valproic acid, oxcarbazepine, and herbal preparations containing St. John’s wort (Hypericum perforatum). There are reports of possible displacement of valproic acid and primidone carbamazepine in connection with plasma proteins and increase in the concentration of the pharmacologically active metabolite (carbamazepine 10,11-epoxide). Isotretinoin modifies the bioavailability and / or clearance of carbamazepine and carbamazepine-10,11-epoxide (carbamazepine be monitored plasma concentration). Carbamazepine may lower the plasma concentration (reduce or even reverse the effects), and require dose adjustment following drugs: klobazama, clonazepam, ethosuximide, primidone, valproic acid, alprazolam, corticosteroids (prednisone, dexamethasone) cyclosporine, doxycycline, haloperidol, methadone, oral preparations containing estrogen and / or progesterone (requires selection of alternative contraceptive methods), theophylline, oral anticoagulants (warfarin, fenprokumona, dicumarol), lamotrigine, topiramate, tricyclic antidepressants (imigramina, amitritpilina, nortriptyline, clomipramine), clozapine, felbamate, tiagabine, oxcarbazepine, protease inhibitors used in the treatment of HIV infection (indinavir, ritonavir, saquinovir), calcium channel blockers (group digidropiridonov, eg, felodipine), itraconazole, levothyroxine, midazolam, olazapina, praziquantel, risperidone, tramadol, ziprasidone. It has been reported that in patients receiving carbamazepine phenytoin plasma levels may either rise or fall, and mefenitoina level – to rise (in rare cases). Carbamazepine or combined with paracetamol increases the risk of toxic effects on the liver and reduces the therapeutic efficacy (acceleration of metabolism of paracetamol). Co-administration of carbamazepine with phenothiazines, pimozide, thioxanthenes, molindone, haloperidol, maprotiline, clozapine and tricyclic antidepressants leads to increased inhibitory effect on the central nervous system and weaken the anticonvulsant effect karbamazenina. Co-administration with diuretics (gndrohlorotiazid, furosemide) may lead to hyponatremia, accompanied by clinical symptoms. It reduces the effects of non-depolarizing muscle relaxants (pancuronium). Reduces portability of ethanol. It accelerates the metabolism of indirect anticoagulants, hormonal contraceptive drugs, folic acid, praziquantel, may enhance the elimination of thyroid hormones. It accelerates metabolism funds for general anesthesia (enflurane, halothane, halothane) higher. the risk of hepatotoxic effects: enhances the formation of nephrotoxic metabolites methoxyflurane. It enhances the hepatotoxic effects of isoniazid.
Before treatment is necessary to conduct testosterone blend 250mg a complete blood count (including platelet count, reticulocyte count), urinalysis, to determine the level of iron, the concentration of electrolytes and urea in serum.Subsequently, these indicators should be monitored during the first month of treatment each week, and then – on a monthly basis. When administered to patients with elevated intraocular pressure it needs periodic monitoring. Non-progressive asymptomatic leukopenia does not require a cancellation, however, treatment should be discontinued when a progressive leukopenia or leucopenia, accompanied by clinical symptoms of the infectious disease. In the period of treatment should refrain from activities potentially hazardous activities that require high concentration and psychomotor speed reactions. It is recommended to give up alcohol.
The long-acting tablets coated 200mg. 400 mg. 3 aluminum strips of 10 tablets together with instructions for use are packed in a cardboard box.
List B. In a dry, dark, place inaccessible to children at temperature not above 25 ° C
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