Carbamazepine and oxcarbazepine

Meet the patient

A 24-year-old woman of Han Chinese ancestry is admitted with bipolar I mania. Lithium is unsuitable, and the overnight registrar has written up carbamazepine, first dose due with the morning round.^[1][2]

Her medication list includes the combined oral contraceptive pill. Nobody has asked about ancestry, nobody has ordered a genotype, and nobody has mentioned contraception.^[6][7][12]

Two gates were skipped before that prescription, and examiners will find both: the HLA gate and the pregnancy gate. This topic is the answer to why they exist.^[7][12][14]

Carbamazepine and oxcarbazepine are medium-weight fellowship psychopharmacology because examiners stack mania trial literacy, autoinduction, contraceptive failure, pharmacogenetic rash screening, hyponatraemia and honest evidence limits for oxcarbazepine into a single station.^[1][3][12]

References14ShowHide

1. [1]Weisler RH, Kalali AH, Ketter TA, et al. A multicenter, randomized, double-blind, placebo-controlled trial of extended-release carbamazepine capsules as monotherapy for bipolar disorder patients with manic or mixed episodes J Clin Psychiatry, 2004.PMID 15119909
2. [2]Weisler RH, Keck PE Jr, Swann AC, et al. Extended-release carbamazepine capsules as monotherapy for acute mania in bipolar disorder: a multicenter, randomized, double-blind, placebo-controlled trial J Clin Psychiatry, 2005.PMID 15766298
3. [3]Weisler RH, Hirschfeld R, Cutler AJ, et al. Extended-release carbamazepine capsules as monotherapy in bipolar disorder: pooled results from two randomised, double-blind, placebo-controlled trials CNS Drugs, 2006.PMID 16529527
4. [4]Ballenger JC, Post RM Carbamazepine in manic-depressive illness: a new treatment Am J Psychiatry, 1980.PMID 7386656
5. [5]Okuma T, Inanaga K, Otsuki S, et al. Comparison of the antimanic efficacy of carbamazepine and chlorpromazine: a double-blind controlled study Psychopharmacology (Berl), 1979.PMID 119267
6. [6]Chung WH, Hung SI, Hong HS, et al. Medical genetics: a marker for Stevens-Johnson syndrome Nature, 2004.PMID 15057820
7. [7]Chen P, Lin JJ, Lu CS, et al. Carbamazepine-induced toxic effects and HLA-B*1502 screening in Taiwan N Engl J Med, 2011.PMID 21428768
8. [8]McCormack M, Alfirevic A, Bourgeois S, et al. HLA-A*3101 and carbamazepine-induced hypersensitivity reactions in Europeans N Engl J Med, 2011.PMID 21428769
9. [9]Wagner KD, Kowatch RA, Emslie GJ, et al. A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents Am J Psychiatry, 2006.PMID 16816222
10. [10]Dong X, Leppik IE, White J, Rarick J Hyponatremia from oxcarbazepine and carbamazepine Neurology, 2005.PMID 16380624
11. [11]Cipriani A, Barbui C, Salanti G, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis Lancet, 2011.PMID 21851976
12. [12]Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder Bipolar Disord, 2018.PMID 29536616
13. [13]Tomson T, Battino D, Bonizzoni E, et al. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry Lancet Neurol, 2011.PMID 21652013
14. [14]Tomson T, Battino D, Bonizzoni E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry Lancet Neurol, 2018.PMID 29680205