Therapeutic Classification: anticonvulsants, mood stabilizers
Absorption: Absorption is slow but complete. Suspension produces earlier, higher peak, and lower trough levels.
Distribution: Widely distributed to tissues. Crosses the blood-brain barrier.
Protein Binding: 7590%.
Metabolism/Excretion: Extensively metabolized in the liver by the CYP3A4 isoenzyme to active epoxide metabolite; epoxide metabolite has anticonvulsant and antineuralgic activity.
Half-Life: Children: 814 hr; Adults: 1217 hr.
(anticonvulsant activity)
ROUTE | ONSET | PEAK | DURATION |
---|
PO | up to 1 mo‡ | 45 hr‡ | 612 hr |
PO-ER | up to 1 mo‡ | 2312 hr‡ | 12 hr |
Contraindicated in:
- Hypersensitivity to carbamazepine or tricyclic antidepressants;
- Bone marrow suppression;
- Concomitant use or use within 14 days of MAO inhibitors;
- Concurrent use of nefazodone or NNRTIs that are CYP3A4 substrates;
- Lactation: Lactation.
Use Cautiously in:
- All patients (may ↑ risk of suicidal thoughts/behaviors);
- Cardiac or hepatic disease;
- Renal failure (dosing adjustment required for CCr <10 mL/min);
- ↑intraocular pressure;
- OB: Use during pregnancy only if potential maternal benefits outweigh potential fetal risks; additional vitamin K during last wk of pregnancy has been recommended;
- Geri: Appears on Beers list. May worsen or cause syndrome of inappropriate antidiuretic hormone (SIADH) secretion in older adults. Use with caution in older adults and closely monitor sodium concentrations when starting therapy or ↑ dose.
Exercise Extreme Caution in:
- Patients positive for HLA-B*1502 or HLA-A*3101 alleles (unless benefits clearly outweigh the risks) (↑ risk of serious skin reactions).

- When converting from immediate-release (IR) to extended-release (ER) formulation, administer same total daily dose (in 2 divided doses).
Seizures
- PO (Adults and Children >12 yr): 200 mg twice daily (IR tablets and ER tablets/capsules) or 100 mg 4 times daily (suspension); ↑ by up to 200 mg/day in divided doses (every 12 hr for ER tablets; every 68 hr for IR tablets and suspension) every 7 days until therapeutic levels are achieved (usual range = 6001200 mg/day); not to exceed 1000 mg/day in children 1215 yr old or 1200 mg/day in children 1518 yr old or 1600 mg/day in adults.
- PO (Children 612 yr): 100 mg twice daily (IR tablets or ER tablets/capsules) or 50 mg 4 times daily (suspension). ↑ by up to 100 mg/day in divided doses (every 12 hr for ER tablets; every 68 hr for IR tablets and suspension) every 7 days until therapeutic levels are achieved (usual range = 400800 mg/day); not to exceed 1000 mg/day.
- PO (Children <6 yr): 1020 mg/kg/day in 23 divided doses (IR tablets) or in 4 divided doses (suspension); may ↑ at weekly intervals until optimal response and therapeutic levels are achieved; not to exceed 35 mg/kg/day.
Trigeminal Neuralgia
- PO (Adults ): 100 mg twice daily (IR or ER tablets), 200 mg once daily (ER capsules), or 50 mg 4 times daily (suspension); ↑ by up to 200 mg/day in divided doses (every 12 hr for IR tablets or ER tablets/capsules; every 6 hr for suspension) as needed until pain is relieved (usual range = 400800 mg/day); not to exceed 1200 mg/day.
Acute Manic or Mixed Episodes Associated with Bipolar I Disorder
- PO (Adults ): Equetro: 200 mg twice daily; ↑ by 200 mg/day until optimal response is achieved; not to exceed 1600 mg/day.