Carbamazepine Case Study

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Carbamazepine is the first anticonvulsant to show an effect in the treatment of mania in bipolar disorder (Stahl 2000). It was first discovered when patients with “epileptic personalities” showed an increase in their “psychic tempo”(Gualtrieri 2002), which included improvement in attention, concentration and preservation. It was discovered to be useful in the treatment of bipolar disorder in the 1970’s (Chen and Lin 2012). Carbamazepine is a tricyclic compound with a steric structure (Gualtrieri 2002) (figure 1).
Carbamazepine’s mode of action in bipolar disorder is not known, however it does have many modes of action that contribute to its effect in reducing mania.
Carbamazepine has the ability to block voltage-dependent sodium ion channels,
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Somatostatin is a major inhibitory modulator in the hypothalamo-pituitary axis and the hypercortisolism that frequently occurs in patients after taking carbamazepine (Leonard 1997).
Ordinarily after intake of a medication the body must metabolise it. Carbamazepine is extensively metabolised in the body (Downie et al. 2003), it produces 10,11-epoxide which has the greatest significance for both its pharmacological activity and neurotoxicity (Pies 1998). At least one fragment of carbamazepine’s metabolism is believed to go through cytochrome P450 3A4 (CYP3A4). CYP3A4 is an enzyme that metabolizes a wide range of endogenous compounds and xenobiotics, like environmental compounds and drug molecules (Williams et al.
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Given the fact that carbamazepine generally is a strong inducer of hepatic metabolism, it reduces the levels of other hepatically metabolized drugs. Therefore it reduces the levels of valproate but may increase valproate hepatotoxic metabolite levels (Pies 1998). Carbamazepine also reduce the metabolism of haloperidol, and other antipsychotics, it also reduces the levels of tricyclics, benzodiazepines, warfarin, prednisone, theophylline, and oral contraceptives (Pies 1998) the metabolism of carbamazepine is inhibited by cimetidine and valproates (Downie et al. 2003), verapamil, diltiazem, and erythromycin (Pies 1998). Many interactions may occur between carbamazepine and lithium or other antipsychotics leading to neurotoxicity (Pies

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