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Bipolar Disorders and Carbamazepine: Pharmacokinetics,Pharmacodynamics, Therapeutic Effects and Indications of Carbamazepine: Review of Articles

Getinet Ayano

Carbamazepine is a mood stabilizer which is approved for use in bipolar disorder with manic and mixed episodes. It is also approved for use for the treatment of trigeminal neuralgia, temporal lobe epilepsy (complex partial seizures) and generalized tonic-clonic seizure. It is metabolized in the liver, primarily by CYP450 3A4 and is an inducer of CYP450 3A4 enzyme. The specific mechanism of action of carbamazepine in stabilizing mood is unknown. It exerts effects by decreasing dopamine turn over, enhancement of brain γ-aminobutyric acid (GABA) levels via multiple actions of synthesis and degradation, and modulation of other neurotransmitters, voltage sensitive Na+ channels, extra hypothalamic neuropeptides, secondary messenger systems, and neuro protection. The most common side effects are nausea, vomiting, constipation, diarrhea, loss of appetite, sedation, dizziness and ataxia. Serious side effects may include skin rashes, decreased bone marrow function and confusion. It should not be used in those with a history of bone marrow problems. Routine blood level monitoring is necessary. There is an increased risk of fetal abnormalities if carbamaepine taken in pregnancy. Carbamaepine concentrations are known to be increased with concurrent use of antidepressants (such as fluexetine, fluovoxamine, nefazodone), omeperazole, efavirnaz, ratinovir, valproate, cemitidine and erythrpmycin. Its level decrease when administrated with Rifampin and Cisplatin.