Plasma arginine vasopressin concentrations in epileptics under monotherapy

Plasma arginine vasopressin concentrations were determined by radio-immunoassay in 112 adult epileptics who were taking carbamazepine, phenytoin, primidone, or sodium valproate in long-term monotherapy, and in 19 controls. No significant difference was found between the groups, but some epileptics taking carbamazepine and primidone showed low values. Serum concentrations of carbamazepine did not correlate with the concentrations of plasma arginine vasopressin. In conclusion, there was no evidence of a stimulating effect of chronic carbamazepine medication or a special inhibiting effect of phenytoin on the release of vasopressin arginine from the posterior pituitary

Therapeutic Drug Monitoring and Methods of Quantitation for Carbamazepine

Carbamazepine is an early anticonvulsant still used today in the treatment of several forms of epilepsy. An active metabolite in the human body contributes to its pharmacological effect. Carbamazepine metabolism has high inter-individual variability, such that it is relatively difficult to establish a direct link between dose and concentration, or between concentration and pharmacological effect. Carbamazepine is thus a good candidate for therapeutic drug monitoring (TDM). Good UV specific absorbance and high plasmatic concentrations allow for the use of UV detection, which is often more accessible than other methods of detection. This paper presents several methods used for the detection of carbamazepine in plasma, methods that are capable of detecting drug and metabolites at adequate levels/ acceptance criteria. These methods have possible application not only in pharmacokinetic, bioequivalence, and permeability studies, but also in the therapeutic drug monitoring of carbamazepine

The association between Parkinson's disease and anti-epilepsy drug carbamazepine: a case-control study using the UK General Practice Research Database.

AIMS: To investigate whether the use of carbamazepine is associated with reduced risk of Parkinson's disease. METHODS: We conducted a population-based, matched case-control study of patients randomly selected from the UK General Research Practice Database. We identified 8549 patients with Parkinson's disease using diagnosis criteria with a positive predictive value of 90%. These patients were compared with 42, 160 control subjects matched for age, sex and general practice. RESULTS: Overall, 3.0% of cases (257 of 8549) had at least one recorded prescription for carbamazepine compared with 2.5% (1050 of 42, 160) of controls. The crude odds ratio for the association between Parkinson's disease and carbamazepine was 1.22 (95% confidence interval 1.06-1.40), but this reduced to 0.93 (95% confidence interval 0.81-1.08, P = 0.34) after adjusting for annual consultation rate. Further adjustment for body mass index, smoking status, alcohol consumption or use of calcium channel blockers did not affect results. There was no evidence that risk decreased with higher doses or longer duration of carbamazepine use. CONCLUSIONS: There was little to no evidence that use of carbamazepine is associated with reduced risk of Parkinson's disease. Although the study was underpowered, it does indicate that any effect of carbamazepine is likely to be small

Carbamazepine on a carbamazepine monolayer forms unique 1D supramolecular assemblies

High-resolution STM imaging of the structures formed by carbamazepine molecules adsorbed onto a pseudo-ordered carbamazepine monolayer on Au(111) shows the formation of previously unreported 1-dimensional supramolecular assemblies

Removal of Carbamazepine from Drinking Water

Due to the increasing prevalence of prescription medication over the past few decades, pharmaceuticals have accumulated in various water sources. This has become a public health concern because many pharmaceuticals have limited research on the effects of chronic low-level exposure. According to the World’s Health Organization (WHO), traces of pharmaceuticals products have been reported in different water sources such as surface waters, wastewater, groundwater, and drinking water.[1] One pharmaceutical of interest that has been detected in water sources is carbamazepine. Carbamazepine is a common pharmaceutical prescribed for the treatment of seizure disorders, neuropathic pain, and various psychological disorders. It’s mechanism of action is “sodium channel blocking,” which is the impairment of conduction of sodium ions in sodium channels. This, in effect, reduces nervous-system conductivity in key areas related to the treated disorders mentioned above.[2] Carbamazepine is also not easily biodegradable and current conventional treatment methods in some drinking water and wastewater facilities do not adequately remove carbamazepine and other pharmaceuticals from treated water. While carbamazepine is not federally regulated by the Environmental Protection Agency (EPA) under the Safe Water Drinking Act (SWDA) at this time, it does have the potential for producing adverse health effects in humans. Therefore, being proactive in finding ways to remove carbamazepine and compounds like it should be encouraged. The Carbamaza-Clean team designed a bench scale unit as well as an in-home treatment system using granular activated carbon (GAC) to effectively remove carbamazepine from water. GAC was chosen for this design because it is inexpensive and does not create byproducts that are harmful to human health. Several experiments were conducted to determine the efficiency of the removal of carbamazepine using two different GACs: coconut shell GAC (CSGAC) and bituminous coal GAC (BGAC). A packed bed column was constructed to determine if both carbons could reduce the concentration of carbamazepine from 1 ppm to 1 ppb or lower. The CSGAC packed bed was able to lower the concentration below 1 ppb at a packed bed length of 4.4 ft, while the BGAC only required half that (2.2 ft). Both carbons can remove carbamazepine to the desired concentration; however, the costs vary. An economic analysis was performed to determine the costs of the carbons. The CSGAC system would cost $990 for the first year and$589.68 for each following year. The BGAC system would cost $639 for the first two years, and then$200 every two years following the initial capital investment

Differential efficacy of lithium and carbamazepine in the prophylaxis of bipolar disorder: Results of the MAP study

In a randomized clinical trial with an observation period of 2.5 years, the differential efficacy of lithium versus carbamazepine was compared in 171 bipolar patients (DSM-IV). In order to investigate the efficacy of the two drugs in clearly defined subsamples, a series of subgroup analyses was carried out. First, patients with a bipolar I disorder (n = 114) were analyzed separately. In these patients, lithium was superior to carbamazepine. In contrast, carbamazepine was at least equally as efficacious as lithium in the subsample of patients with bipolar II disorder or bipolar disorder not otherwise specified (n = 57). In a second analysis on differential efficacy, the whole sample was subdivided into a classical subgroup (bipolar I patients without mood-incongruent delusions and without comorbidity; n = 67) and a nonclassical subgroup including all other patients (n = 104). Classical bipolar patients had a significantly lower hospitalization rate under lithium than under carbamazepine prophylaxis (26 vs. 62%, p = 0.012). For the nonclassical group, a tendency in favor of carbamazepine was found. In a third step, we analyzed the impact of episode sequence on differential efficacy. In a global view, the episode sequence prior to the index episode was not correlated to differential efficacy. Our results might, however, indicate that patients with an episode sequence of mania-depression-free interval responded better to lithium. Besides differential efficacy, suicidal behavior and patients' satisfaction with treatment were investigated. Regarding suicidal behavior, a trend in favor of lithium was found. The data on patients' satisfaction were significantly in favor of carbamazepine. In conclusion, lithium appears to be superior to carbamazepine in classical bipolar cases and might have additional impact on proneness to suicide. The distinctly larger group of patients with nonclassical features might profit more from carbamazepine which seems to be well accepted by the patients. Hence, treatment alternatives to lithium a re desirable for the majority of bipolar patients. Copyright (C) 2000 S. Karger AG, Basel

Removal of Carbamazepine from Drinking Water

Due to the increasing prevalence of prescription medication over the past few decades, pharmaceuticals have accumulated in various water sources. This has become a public health concern because many pharmaceuticals have limited research on the effects of chronic low-level exposure. According to the World’s Health Organization (WHO), traces of pharmaceuticals products have been reported in different water sources such as surface waters, wastewater, groundwater, and drinking water.[1] One pharmaceutical of interest that has been detected in water sources is carbamazepine. Carbamazepine (CBZ) is a common pharmaceutical prescribed for the treatment of seizure disorders, neuropathic pain, and various psychological disorders. It’s mechanism of action is “sodium channel blocking,” which is the impairment of conduction of sodium ions in sodium channels. This, in effect, reduces nervous-system conductivity in key areas related to the treated disorders mentioned above.[2] Carbamazepine is also not easily biodegradable and current conventional treatment methods in some drinking water and wastewater facilities do not adequately remove carbamazepine and other pharmaceuticals from treated water. While carbamazepine is not federally regulated by the Environmental Protection Agency (EPA) under the Safe Water Drinking Act (SWDA) at this time, it does have the potential for producing adverse health effects in humans. Therefore, being proactive in finding ways to remove carbamazepine and compounds like it should be encouraged. The Carbamaza-Clean team designed a bench scale unit as well as an in-home treatment system using granular activated carbon (GAC) to effectively remove carbamazepine from water. GAC was chosen for this design because it is inexpensive and does not create by-products that are harmful to human health. Several experiments were conducted to determine the efficiency of the removal of carbamazepine using two different GACs: coconut shell GAC (CSGAC) and bituminous coal GAC (BGAC). A packed bed column was constructed to determine if both carbons could reduce the concentration of carbamazepine from 1 ppm to 1 ppb or lower. The CSGAC packed bed was able to lower the concentration below 1 ppb at a packed bed length of 4.4 ft, while the BGAC only required half that (2.2 ft). Both carbons can remove carbamazepine to the desired concentration; however, the costs vary. An economic analysis was performed to determine the costs of the carbons. The CSGAC system would cost $990 for the first year and$589.68 for each following year. The BGAC system would cost $639 for the first two years, and then$200 every two years following the initial capital investment

Differential treatment of bipolar disorder with old and new antiepileptic drugs

Although lithium remains the preferred medication for bipolar disorders, new investigations suggest that only 60 to 80% of patients have a good response with a classical presentation. The antiepileptics carbamazepine and valproate are important alternatives. Several studies have shown that lithium, carbamazepine and valproate are effective in pure mania. Mixed mania and rapid cycling respond, however, well to valproate. One disadvantage of carbamazepine is its enzyme inducing property with the consequence of a decrease of plasma levels of other psychotropic medications and a worsening of psychopathology. First data indicate a good antimanic and antidepressive efficacy of the new antiepileptic drug lamotrigine

Carbamazepine-responsive paroxysmal nausea and vomiting in a patient with meningeal carcinomatosis

In neurology, paroxysmal syndromes are well-known, eg, as manifestations of multiple sclerosis. We report a patient with meningeal carcinomatosis, who presented with therapyrefractory nausea and vomiting. The clinical suspicion of a paroxysmal syndrome prompted a trial of carbamazepine, which resulted in complete cessation of the symptoms. In cancer patients with central nervous system (CNS) involvement and therapy-refractory symptoms with sudden onset, carbamazepine treatment should be considered

Encapsulation of water insoluble drugs in mesoporous silica nanoparticles using supercritical carbon dioxide

Mesoporous silica nanoparticles MCM – 41 were synthesized with two dimensional hexagonal p6mm symmetry, high specific surface area(~ 980m2/g) narrow pore size and an average particle size of 186 nm. The produced nanoparticles were used to encapsulate carbamazepine through a supercritical carbon dioxide process combined with various organic solvents. Supercritical processing was found to provide increased drug encapsulation. The loaded MCM - 41 nanoparticles were analyzed using X–ray diffraction and differential scanning calorimetry (DSC) to investigate the crystalline state of the encapsulated carbamazepine and it was found to be dependent on the nature of the organic solvent. Carbamazepine showed increased dissolution rates under sink conditions. Viability studies of Caco – 2 cells demonstrated negligible cytotoxicity for the MCM–41 nanoparticles