Tegretol

Tegretol is a medicine against epilepsy.

Indications of the tegretola

Tegretol is used in the therapy of many pathologies:
1. Epilepsy;
2. Alcohol abstinence;
3. Inflammation of the trigeminal (primary or with multiple sclerosis) and glossopharyngeal nerve (primary);
4. Manic conditions (prevention of complications and reduction of clinical manifestations);
5. Degenerative-dystrophic lesion of nerve fibers of diabetic etiology with pain symptom;
6. Non-diabetes mellitus;
7. Possible use:

• mental disorders;
• aggressive behavior in patients with depression;
• anxiety;
• pain of a neurogenic cause;
• prevention of migraine.

[1], [2], [3]

Release form

The medication is available in three forms - syrup, tablets and capsules. The syrup is packaged in 100 ml bottles, in a pack there is one piece and a measuring spoon. Capsules and tablets are packaged in blisters of ten units, in a pack can be from three to five plates.

Pharmacodynamics

The active substance of Tegretol is carbamazepine, but information about its mechanism is not enough. The main effect will be the blocking of sodium channels, as a result of which the prevention of sodium-dependent potentials in the weakened neurons occurs. In addition, Tegretol regulates the membranes of excited nerve fibers, suppresses the formation of secondary neuronal discharges and thereby reduces the synaptic conduction of stimulating pulses.
Regulation of neuronal membranes, reduction of glutamate causes an anticonvulsant effect of the drug. But the suppression of dopamine and norepinephrine causes an antimanic effect.
In the treatment of most neurological pathologies, Tegretol displays neutropenic activity. He also relieves painful attacks with inflammation of the trigeminal nerve of primary or secondary etiology. The medication increases the threshold of spastic readiness, reduced with alcohol withdrawal, and as a result, tremor decreases, nervousness improves gait.
With diabetes of the central genesis, the medication reduces the feeling of thirst in patients and reduces the volume of urination.

[4], [5], [6], [7],

Pharmacokinetics

Tegretol is absorbed completely, but at different rates in patients. The maximum bioavailability can reach up to one hundred percent. The concentration reaches a maximum value after twelve hours. A stable position - after one or two weeks. But it is worth noting, these indicators depend on many factors (for example, the status of the patient before treatment, duration and therapy scheme).
Seventy to eighty percent of carbamazepine reacts with serum proteins. The remaining twenty to thirty percent refers to the concentration of an unchanged substance in the cerebrospinal fluid and saliva. In the mother's milk, the concentration of the drug is about 25 - 60% and corresponds to the level in the serum. In addition, Tegretol passes through the placental barrier.
Metabolism occurs in the liver. The half-life is about 36 hours, but with a long reception it will decrease to 16 -24 hours. At a dosage of 400 mg, 72% will be excreted with urine, 28 - with feces.
Because of the high rate of excretion of drugs, children may need to use stronger doses than adults (based on the weight of the child).
There is no information as to whether dosage adjustment is necessary for the gerontological patient or for the pathological changes in the functions of the liver or kidneys.

[8], [9], [10]

Dosing and administration

The medication should be consumed exclusively inside with a small amount of water. To homogeneously distribute the active ingredient in the syrup, before using it, shake it (preliminarily close the bottle). The medicine can be used as a motor therapy.
Syrup is used for patients who have difficulty swallowing, or those in the treatment schedule need an accurate dosage. To start treatment it is necessary from small dosages, as in the syrup the density of carbamazepine rises more strongly (in relation to tablets). For this, the daily dose can be divided into three uses. If you do not, unwanted effects can occur.
It will be necessary to increase the dosage if there is a need for a transition from Tegretol to Tegretol CR, and it is also advisable to switch to motor therapy. This is due to the fact that in this form, with small or myoclonic seizures, the drug does not have the proper effect.
Treatment, under the control of the level of concentration of the drug, you need to start with minimal doses, gradually increasing them. If joint therapy is to be carried out, minimal doses should also be started.

Thus, the initial daily dose should not be more than 0.2 g of the drug, divided into two doses. Then it can gradually increase, with an average consumption of 0.8-1.2 grams for two to three doses. If necessary, the dose can grow to two grams.
In pediatrics (children under four years), the start of treatment begins at a maximum of 0.06 mg per day, with a gradual increase of 0.02-0.06 mg not more often than once every two days. In the older age, the treatment starts from 0.1 grams per day, with an increase of 0.1 grams per week.
For children under three years you can use only syrup.

The maximum daily dose for inflammation of the trigeminal nerve at the beginning of treatment is 0.4 grams. Further, it increases until the disappearance of pain (an average of 0.8 grams). Then it goes down to the one that can stop the pain. For elderly patients - the initial daily dose is not more than 0.2 grams.
To treat withdrawal, on average, a dose equal to 0.6 grams (dividing it into three doses). In severe cases, you can increase the dose to 0.4 grams per day. Most often in this case, Tegretol is used in conjunction with soothing, hypnotics. Then, when the acute period of the pathological process passes, the medication can be used as a motor therapy.
In cerebral diabetes insipidus diabetes (if it is associated with an increase in the amount of urine and a constant thirst), the dose begins with 0.4-, 06 grams per day. Children in this case, the dose is selected individually.
Dose, divided into two to four uses per day and making up 0.4-0.8 grams, is used to relieve pain on the background of diabetic neuropathy.
To treat manic conditions use a daily dose of up to 1.6 grams, quickly raising it. To maintain the condition of a sick person, the dose is raised gradually, for the normal transfer of therapy.

[14], [15], [16], [17]

Use of the tegretola during pregnancy

Before using Tegretola, you need to carefully evaluate the possible benefits for the mother with a risk for the development of the child. This is especially important in the first trimester of gestation. When taking Tegretol, you must additionally consume folic acid before and during the gestational period. Since medications against epilepsy cause a significant decrease in the level of this vitamin, as a result, the fetus may have an intrauterine pathology. There is also information that because of the use of antiepileptic medication, newborns may develop bleeding. Therefore, in the last weeks of pregnancy, the future mother for prevention should appoint vitamin K1.
In addition, children may experience seizures or respiratory depression if they take Tegretol in combination with other epilepsy drugs during the gestational period. The newborn can also experience vomiting, diarrhea, or decreased appetite if his mother used carbamazepine during pregnancy. Most likely this will be an expression of withdrawal syndrome.
As the medication enters the mother's milk, during the use of it, the feeding should be interrupted.

Contraindications

You can not use medicines for treatment in the presence of the following pathological processes:
1. Fructose intolerance;
2. Antrioventricular blockade.
With caution can be used in the following cases:
1. Heart pathology;
2. Hypothyroidism;
3. Increased intraocular pressure;
4. Gestational period;
5. The period of breastfeeding;
6. Elderly age

[11], [12]

Side effects of the tegretola

When appointing Tegretola, you need to warn the patient about the possible occurrence of the following undesirable reactions:

• a disorder of vision, manifested in the form of double vision in the eyes;
• a violation of taste sensations;
• paralysis, paresthesia;
• allergy, anaphylaxis;
• arrhythmia, low or high blood pressure;
• depression, aggression;
• disorientation in space;
• asthenia;
• erythroderma;
• pain in the epigastric region;
• stool disorders;
• hallucinations (auditory or visual);
• peripheral neuropathy;
• thrombophlebitis, thromboembolism;
• hyperhidrosis;
• increased drowsiness, asthenia;
• agranulocytosis;
• ataxia, muscle spasm;
• swelling;
• stomatitis, dryness of the oral mucosa, glossitis;
• tremor;
• reduction of spermatogenesis, impotence;
• impaired renal function, anuria, hematuria;
• liver failure;
• inflammation of the pancreas;
• vasculitis;
• arthralgia;
• glaucoma, nystagmus;
• lymphadenopathy, leukemia, anemia;
• dermatitis of various genesis;
• pneumonia;
• photosensitivity.

When the dosage is increased, the undesirable effects will be intensified.

[13]

Overdose

At the use of doses exceeding recommended for reception, the patient most likely will have the following pathological conditions:
Seizures, CNS suppression, disorientation in space, excitation, hyperreflexia, speech disturbance, coma;

• Hyperglycaemia;
• Hypothermia;
• Tachycardia, hypertension or hypotension, cardiac arrest;
• Pulmonary edema, respiratory depression,
• Vomiting, dyskinesia, gastric retention, decreased motility of the gastrointestinal tract, acidosis;
• Nystagmus, blurred vision, mydriasis;
• Anuria, oliguria;
• Increase in the level of creatine phosphokinase;
• Dysarthria, ataxia

Teparia is symptomatic. To assess the degree of overdose, medical personnel should measure the level of drug concentration in the plasma. The patient must be under medical supervision in the hospital, where he is sure to be washed out of the stomach and given sorbents. In the case of low blood pressure, Dopamine will be injected intravenously, and hyponatremia will be injected with fluid to reduce the risk of swelling in the brain tissue. Hemodialysis is not used because of low efficiency. But it is worth keeping in mind that the symptoms can manifest again. This is due to the slow absorption of Tegretol.

[18], [19], [20], [21],

Interactions with other drugs

With the joint treatment of Tegretol with certain drugs, various types of interaction are possible:

• Clobaz, Haloperidol, Warfarin, corticosteroids and other drugs that metabolize in the liver - Tegretol increases their metabolism and reduces the effect.
• Phenytoin - Tegretol reduces or, conversely, increases the concentration of phenytoin.
• Phenobarbital - the concentration of Tegretol in the serum decreases;
• Macrolides, calcium antagonists - increase the concentration of Tegretol.
• Metoclopramide - there is an increase in adverse reactions.
• Hydrochlorothiazide, furosemide - there may be an undesirable reaction in the form of hyponatremia.
• Oral contraceptives - with simultaneous reception may decrease their effectiveness, as well as bleeding in the middle of the menstrual cycle.
• Alcoholic beverages - side effects will increase.

[22], [23]

Storage conditions

Both syrup and tablets should be kept in a place that will not be accessible to children, observing the temperature regime (not above 30 ° C).

[24], [25], [26]

Special instructions

Reviews
Tegretol long enough in the pharmaceutical market, he managed to prove himself as an effective tool. Especially often it is prescribed for epilepsy. If the patient is discharged this medication for the treatment of withdrawal symptoms, it is advisable to use it in a hospital under the supervision of medical personnel.

Shelf life

The medication can not be used after the expiration of five years from the date of manufacture.