Carbamazepine

Excreted Unchanged %
2-3
Half-Life (Normalesrd) Hours
25-65 single; 12-17 chronic/Unchanged
Plasma Protein Binding %
75
Volume Of Distribution L/Kg
0.8-1.6
Dose For Normal Renal Function
200 mg bid
Second Dose
Second Dose: to 1200 mg q24h
Adjustment For Renal Failure Method
D
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
75 % [D]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose for GFR <10, give after dialysis, [B]
Supplement For Dialysis [Recommendation Level]: Pd
PD: Dose for GFR <10, [D]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: 100%, [B]
References
Bertilsson L, Tomson T. Clinical pharmacokinetics and pharmacological effects of carbamazepine and carbamazepine-10,11-epoxide. An update. Clin Pharmacokinet. 1986; 11: 177-98. [PMID: 3524954] / Bock E, Keller F, Heitz J, Heinemeyer G. Treatment of carbamazepine poisoning by combined hemodialysis/hemoperfusion. Int J Clin Pharmacol Ther Toxicol. 1989; 27: 490-2. [PMID: 2684869] / Kielstein JT, Schwarz A, Arnavaz A, Sehlberg O, Emrich HM, Fliser D. High-flux hemodialysis&#151; an effective alternative to hemoperfusion in the treatment of carbamazepine intoxication. Clin Nephrol. 2002; 57: 484-6. [PMID: 12078955] / Lee CS, Wang LH, Marbury TC, Bruni J, Perchalski RJ. Hemodialysis clearance and total body elimination of carbamazepine during chronic hemodialysis. Clin Toxicol. 1980; 17: 429-38. [PMID: 7449356] / Milonovich LM, Headrick CL, Seikaly M, Morriss FC. Charcoal hemoperfusion via a continuous venovenous hemofiltration circuit to treat carbamazepine overdose. Crit Care Nurse. 2001; 21: 25-8. [PMID: 11767761] / Rouan MC, Lecaillon JB, Godbillon J, Menard F, Darragon T, Meyer P, et al. The effect of renal impairment on the pharmacokinetics of oxcarbazepine and its metabolites. Eur J Clin Pharmacol. 1994; 47: 161-7. [PMID: 7859804] / Tapolyai M, Campbell M, Dailey K, Udvari-Nagy S. Hemodialysis is as effective as hemoperfusion for drug removal in carbamazepine poisoning. Nephron. 2002; 90: 213-5. [PMID: 11818708]
Toxicity Notes
Rare aplastic anemia, agranulocytosis. Thrombocytopenia. Increases antidiuretic hormone secretion. Usual adult therapeutic levels are between 4 and 12 &#181;g/mL. CYP 3A4 inhibitors inhibit carbamazepine metabolism and can thus increase plasma carbamazepine levels. CYP 3A4 inducers can increase the rate of carbamazepine metabolism.