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Carbamazepine

Dosage ;

Usual Dose = 100-1600 mg daily.

Children: 10-20mg/kg daily depending on severity of illness and indication.

A tricyclic iminostilbene derivative

Specific Dosages;

Dosing: Adult

Dosage must be adjusted according to patient's response and serum concentrations. Administer tablets (chewable or conventional) in 2-3 divided doses daily and suspension in 4 divided doses daily. Oral:

Epilepsy: Initial: 400 mg/day in 2 divided doses (tablets or extended release tablets) or 4 divided doses (oral suspension); increase by up to 200 mg/day at weekly intervals using a twice daily regimen of extended release tablets or capsules, or a 3-4 times/day regimen of other formulations until optimal response and therapeutic levels are achieved; usual dose: 800-1200 mg/day

Maximum recommended dose: 1600 mg/day; however, some patients have required up to 1.6-2.4 g/day

Trigeminal or glossopharyngeal neuralgia: Initial: 200 mg/day in 2 divided doses (tablets, extended release tablets, or extended release capsules) or 4 divided doses (oral suspension) with food, gradually increasing in increments of 200 mg/day as needed.

Maintenance: Usual: 400-800 mg daily in 2 divided doses (tablets, extended release tablets, or extended release capsules) or 4 divided doses (oral suspension); maximum dose: 1200 mg/day

Bipolar disorder: Initial: 400 mg/day in 2 divided doses (tablets, extended release tablets, or extended release capsules) or 4 divided doses (oral suspension), may adjust by 200 mg/day increments; maximum dose: 1600 mg/day.

Dosing: Pediatric

Dosage must be adjusted according to patient's response and serum concentrations. Administer tablets (chewable or conventional) in 2-3 divided doses daily and suspension in 4 divided doses daily.

Epilepsy: Oral:

Children <6 years: Initial: 10-20 mg/kg/day divided twice or 3 times daily as tablets or 4 times/day as suspension; increase dose every week until optimal response and therapeutic levels are achieved

Maintenance dose: Divide into 3-4 doses daily (tablets or suspension); maximum recommended dose: 35 mg/kg/day

Children 6-12 years: Initial: 200 mg/day in 2 divided doses (tablets or extended release tablets) or 4 divided doses (oral suspension); increase by up to 100 mg/day at weekly intervals using a twice daily regimen of extended release tablets or 3-4 times daily regimen of other formulations until optimal response and therapeutic levels are achieved

Maintenance: Usual: 400-800 mg/day; maximum recommended dose: 1000 mg/day

Note: Children <12 years who receive ≥400 mg/day of carbamazepine may be converted to extended release capsules (Carbatrol®) using the same total daily dosage divided twice daily

Children >12 years: Refer to adult dosing.

Maximum recommended doses:

Children 12-15 years: 1000 mg/day

Children >15 years: 1200 mg/day

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

Dosage adjustments are not required or recommended in the manufacturer’s labeling; however, the following guidelines have been used by some clinicians (Aronoff, 2007):

Children and Adults:

GFR <10 mL/minute: Administer 75% of dose.

Hemodialysis, peritoneal dialysis: Administer 75% of dose.

Continuous renal replacement therapy (CRRT):

Children: Administer 75% of dose.

Adults: No dosage adjustment recommended.

Dosing: Hepatic Impairment

Use with caution in hepatic impairment; metabolized primarily in the liver