This drug belongs to the category of iminostilbenes and is used in the treatment of psychomotor and grand mal epilepsy. Nowadays it is considered as the drug of first choice for grand-mal epilepsy. It provides partial or complete relief to at least 65% of the patients. It is useful In the treatment of neuralgia (a condition in which there is severe neural pain in some area of the face) uncontrollable hiccoughs manic depressive illness and acute mania. It is preferred in young girls because it does not have cosmetic adverse effects of phenytoin.



Dosage: The average daily oral dose of carbamazepine is 0.4 to 1.2 g in 2 or 3 divided doses.

Adverse effects: Its adverse effects may be mild, causing nausea, loss of appetite, drowsiness, and sedation. The drug may also cause pigmentation or discolouration of skin in about 3% cases and rarely depression of the bone marrow. Dose related neurotoxicity, ataxia, double vision, unsteadiness and occasionally seizures, may also occur. Water retention with low blood sodium concentration may occur in elderly.

Precautions

The drug should not be taken on an empty stomach.

It should not be taken by those suffering from heart disease or high blood pressure.

Total and differential white blood cell count should be done periodically.

The drug should be stopped immediately if there are any signs of allergy such as a sore throat, fever, or skin rash.

Phenobarbital (Luminal)

This drug, which is a barbiturate, has been in use in the treatment of grand mal epilepsy since 1912, and is still employed since it is inexpensive and has low toxicity. This is employed either alone or in combination with diphenylhydantoin.

Dosage: The usual daily oral dosage of phenobarbital is 100 to 300 mg given in divided parts.

Adverse Effects: The adverse effects of this drug is mild in nature. The most common effect is drowsiness which can be minimized by giving the drug in divided doses at suitable intervals. Moreover, the patients soon develop tolerance to this adverse effect. These drugs may cause impairment in learning and memory and mild allergic reactions which are in the

form of skin rashes in 1 to 2% cases. Severe types of allergy are extremely rare. Like phenytoin, long term use of phenobarbital may cause vitamin D and folic acid deficiency.

Precautions

Do not stop these drugs abruptly as this may precipitate a severe epileptic attack.

If any abnormal response in the form of excitation is seen, which happens in children, the drugs should not be repeated and the doctor consulted immediately.

Consumption of alcohol and other depressant-drugs may cause marked sedation and should be avoided.