carbamazepine

Carbamazepine and oxcarbazepine are first-line drugs for focal epilepsy in adults and children. NICE NG217 2022 recommends carbamazepine or lamotrigine as first choice for focal seizures. ILAE and Russian clinical guidelines align with this. The drug reduces seizure frequency by more than 50% in 60–70% of patients with focal epilepsy.

In patients of Asian descent (Han Chinese, Thai, Indonesian), HLA-B*15:02 genotyping is recommended before initiation due to high risk of severe cutaneous reactions.

Carbamazepine remains the first-line drug for trigeminal neuralgia per AAN 2017 and European guidelines. NNT for 50% pain reduction is approximately 1.7. Starting dose 100–200 mg twice daily, titrated to clinical response (usually 600–1200 mg/day). Oxcarbazepine is considered an alternative with better tolerability.

When pharmacotherapy fails and pain is disabling, consider microvascular decompression or gamma knife radiosurgery.

Carbamazepine is considered an alternative to benzodiazepines for mild-to-moderate alcohol withdrawal in outpatients without seizure risk. Meta-analyses show comparable efficacy in this subgroup. For severe withdrawal and delirium risk, benzodiazepines remain first-line.

In bipolar disorder, carbamazepine is used as a third-line mood stabilizer after lithium and valproate. NICE CG185 and RANZCP 2022 recommend considering carbamazepine when first-line drugs are intolerable or ineffective. Effective for acute mania and maintenance therapy. Use is complicated by strong CYP induction and drug interaction risk.

In Russia, the bipolar disorder indication is registered only for selected brand names (e.g., Zeptol); use is off-label per clinical guidelines.