Carbamazepine
Finlepsin retard contains carbamazepine, a tricyclic compound with mainly anticonvulsant, neurotropic, and psychotropic effects. It also has analgesic effects, e.g., in cases of trigeminal neuralgia and other paroxysmal pains. The mechanism of the anticonvulsant effect of carbamazepine is only partially understood. The drug probably blocks the spread of abnormal bioelectric discharges in the brain.
When not to take Finlepsin retard:
If any of the above points apply to the patient, they should inform their doctor before taking Finlepsin retard.If the patient suspects that they may be allergic to the medicine, they should consult a doctor.
Before starting treatment with Finlepsin retard, the patient should discuss it with their doctor or pharmacist.
If any of these points apply to the patient, they should inform their doctor:
Do not stop taking Finlepsin retard without consulting a doctor first. Suddenly stopping the medicine may cause a sudden increase in seizures.
A small number of people taking antiepileptic drugs, including those containing carbamazepine, have thought about harming themselves or committing suicide. If the patient ever has such thoughts, they should immediately contact their doctor.
During treatment with Finlepsin retard during pregnancy, there is a risk of harmful effects on the unborn child. If the patient is of childbearing age, they should use effective contraception while taking Finlepsin retard and for two weeks after taking the last dose (see "Pregnancy and breastfeeding").
There have been reports of severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis) during carbamazepine treatment. The rash is often accompanied by ulcers in the mouth, throat, nose, genitals, and conjunctivitis (red and swollen eyes). These severe rashes are often preceded by flu-like symptoms such as fever, headache, and bone pain. The rash can progress to blistering. The greatest risk of severe skin reactions is in the first few months of treatment.
Severe skin reactions are more common in patients of Asian origin. The risk of reaction in people of Chinese or Thai origin can be predicted by testing their blood. The doctor should advise the patient whether blood tests are necessary before starting treatment with carbamazepine.
If a rash or other skin symptoms occur, the patient should stop taking carbamazepine and contact their doctor immediately.
Finlepsin retard should be taken during meals or after meals, with a sufficient amount of liquid (e.g., a glass of water). The tablet can also be dissolved in water, as the prolonged-release properties are maintained in the suspension.
While taking Finlepsin retard, the patient should not consume alcohol, as it may unpredictably change the effect of carbamazepine.
The patient should tell their doctor or pharmacist about all medicines they are currently taking or have recently taken, as well as any medicines they plan to take.
Medicines that may increase carbamazepine levels in the blood:
Medicines that may increase the levels of the active metabolite 10,11-epoxide of carbamazepine in the blood:
Medicines that may decrease carbamazepine levels in the blood:
Effect of carbamazepine on the levels of other medicines in the blood:
Hormonal contraceptives, e.g., pills, patches, injections, or implants:
Finlepsin retard may affect the effectiveness of hormonal contraceptives and reduce their effectiveness in preventing pregnancy. The patient should discuss this with their doctor, who will discuss the most suitable type of contraception during treatment with Finlepsin retard.
Combination therapy requiring special attention:
It has been reported that concomitant use of carbamazepine and levetiracetam increases the toxic effect of carbamazepine on the liver.
It has been reported that concomitant use of carbamazepine and isoniazid increases its toxic effect on the liver.
Concomitant administration of carbamazepine and lithium salts or metoclopramide, as well as carbamazepine and neuroleptics (e.g., haloperidol, thioridazine), may lead to an increase in unwanted neurological symptoms (in the case of neuroleptics, even at therapeutic levels in the blood).
Concomitant use of carbamazepine and certain diuretics (hydrochlorothiazide, furosemide) may cause symptomatic hyponatremia (decreased sodium levels in the blood).
Carbamazepine may antagonize the effect of muscle relaxants that do not cause depolarization (e.g., pancuronium). If necessary, they should be used in higher doses, carefully observing the patients due to the possibility of faster-than-usual reversal of neuromuscular blockade.
Similar to other psychotropic medicines, carbamazepine may reduce alcohol tolerance. It is therefore recommended that patients abstain from alcohol during treatment.
Note that the above comments also apply to cases where the mentioned medicines have been discontinued recently.
Pregnancy
Before taking any medicine, the patient should consult a doctor or pharmacist.
Finlepsin retard may be used during pregnancy only after the doctor has weighed the benefits of therapy and the associated risk.
Finlepsin retard may cause serious birth defects. If the patient takes Finlepsin retard during pregnancy, the risk of birth defects in the child is three times higher than in women who do not take antiepileptic drugs. Serious birth defects, including neural tube defects (spina bifida), facial defects such as cleft lip and palate, head defects, heart defects, and genital defects, have been reported.
If the patient takes Finlepsin retard during pregnancy, the unborn child should be closely monitored.
In infants born to mothers who took Finlepsin retard during pregnancy, developmental problems (brain development) have been reported. Some studies have shown that carbamazepine has a negative effect on the development of the nervous system in children exposed to carbamazepine in the womb, while others have not found such an effect. The impact on neurological development cannot be ruled out.
If the patient is of childbearing age and does not plan to become pregnant, they should use effective contraception during treatment with Finlepsin retard. Finlepsin retard may affect the effectiveness of hormonal contraceptives, such as birth control pills, and reduce their effectiveness in preventing pregnancy. The patient should discuss this with their doctor, who will discuss the most suitable type of contraception during treatment with Finlepsin retard. If the patient stops taking Finlepsin retard, they should continue to use effective contraception for two weeks after stopping the medicine.
If the patient is of childbearing age and plans to become pregnant, they should consult their doctor before stopping contraception and becoming pregnant, so that their treatment can be changed to a different one that will protect the unborn child from exposure to carbamazepine.
If the patient is or thinks they may be pregnant, they should immediately tell their doctor. The patient should not stop taking Finlepsin retard until they have discussed it with their doctor. Stopping the medicine without consulting a doctor may cause seizures, which can be dangerous for the patient and their unborn child. The doctor may decide to change the treatment.
If the patient takes Finlepsin retard during pregnancy, there is also a risk of bleeding problems in the patient after giving birth. The doctor may prescribe a medicine to the patient and the child to prevent this.
In the case of pregnancy, the doctor should reduce the doses of the medicine to the minimum necessary to prevent seizures. This is especially important between the 20th and 40th days of pregnancy. The doctor should also avoid combining carbamazepine with other antiepileptic drugs and other agents in general, as this increases the risk of complications.
Since carbamazepine induces liver enzymes and may cause folate deficiency, it is recommended to take folic acid supplements before becoming pregnant and during pregnancy.
Breastfeeding
Carbamazepine passes into breast milk in small amounts. If the doctor agrees, breastfeeding can be continued. If side effects occur, such as the infant not gaining weight or showing excessive sedation and increased need for sleep, breastfeeding should be stopped, and the doctor should be notified.
In the initial period of treatment with carbamazepine, side effects such as dizziness, drowsiness, gait disturbances, or headaches may occur. These symptoms occur after taking high doses and during combination therapy with other medicines that affect the central nervous system. This may significantly impair the ability to drive vehicles and operate machinery.
Note that alcohol consumption further impairs alertness and prolongs reaction time.
This medicine should always be taken exactly as prescribed by the doctor or pharmacist. In case of doubts, the patient should consult their doctor or pharmacist.
If the doctor has not prescribed otherwise, the patient should follow the recommendations below.
Not following them may cause the medicine to not work properly.
Treatment with carbamazepine should be started with small doses, individually adjusted according to the patient's clinical condition. The dose is then gradually increased to achieve the optimal maintenance dose.
The daily dose is usually given in 1 or 2 single doses and ranges from 400 to 1200 mg of carbamazepine. The maximum daily dose (in exceptional cases) should not exceed 1600 mg due to the increased incidence of side effects at higher doses.
The dose should be determined based on the level of the medicine in the blood, especially in combination therapy. Therapeutic levels of carbamazepine range from 4 to 12 μg/mL.
In individual cases, the required dose may differ significantly from the recommended initial and maintenance doses (e.g., due to increased or decreased metabolism of the medicine under the influence of inducing or inhibiting enzymes in combination therapy).
If possible, monotherapy with one antiepileptic drug should be used.
Treatment should be supervised by a specialist.
When switching from other antiepileptic drugs to carbamazepine, the dose of the discontinued drug should be gradually reduced.
In the treatment of seizures, the following general dosage regimen is recommended:
* Note:
Pharmaceutical forms other than prolonged-release tablets (suspensions, syrups, or tablets) are available for children under 6 years of age for initial and maintenance dosing. It is not recommended to give prolonged-release tablets to children under 6 years of age due to the lack of experience.
Daily initial dose | Daily maintenance dose | |
Adults |
| 200-600 mg in the morning, 400-600 mg in the evening |
Children* | see NOTE | |
| 100 mg in the evening | 200 mg in the morning, 200-400 mg in the evening |
| 100 mg in the evening |
|
Recommended dose
Epilepsy
In the treatment of epilepsy in adults, the initial dose is 0.5 to 1 prolonged-release tablet of Finlepsin 200 retard or 0.5 tablet of Finlepsin 400 retard (equivalent to 100 to 200 mg of carbamazepine per day) and should be slowly increased to a maintenance dose of 1.5 to 3 tablets of Finlepsin 400 retard (equivalent to 600 to 1200 mg of carbamazepine). The maintenance dose in children is 10-20 mg of carbamazepine per kilogram of body weight per day.
Recommended dosage regimen: see above.
Trigeminal neuralgia / glossopharyngeal neuralgia
The daily dose of carbamazepine is usually 200 to 400 mg. The dose is increased until the pain disappears, usually to 400 or 800 mg per day in 1 or 2 divided doses. In some cases, maintenance treatment can be continued with a reduced dose - 1 tablet of Finlepsin 200 retard or 0.5 tablet of Finlepsin 400 retard (equivalent to 200 mg of carbamazepine) taken twice a day (equivalent to 400 mg of carbamazepine). After the pain disappears, the dose can be gradually reduced and the medicine stopped after a few weeks of treatment, if there is no recurrence of pain. In case of recurrence of pain, maintenance treatment should be continued.
Pain in diabetic neuropathy
The usual daily dose is 600 mg (1 tablet of Finlepsin 200 retard in the morning and 2 tablets of Finlepsin 200 retard in the evening or 1 tablet of Finlepsin 400 retard in the evening). In exceptional cases, the dose can be increased to 3 tablets of Finlepsin 200 retard (600 mg) twice a day (1200 mg per day) or 1.5 tablets of Finlepsin 400 retard (600 mg) twice a day (1200 mg per day).
Trigeminal neuralgia in multiple sclerosis
The average daily dose is 1 to 2 tablets of Finlepsin 200 retard taken twice a day (equivalent to 400 to 800 mg of carbamazepine) or 0.5 to 1 tablet of Finlepsin 400 retard taken twice a day (equivalent to 400 to 800 mg of carbamazepine).
Prevention of seizures in alcohol withdrawal syndrome in hospital conditions
The usual daily dose is 600 mg (200 mg in the morning, 400 mg in the evening). In severe cases, the initial dose can be increased to 3 tablets of Finlepsin 200 retard or 1.5 tablets of Finlepsin 400 retard taken twice a day (equivalent to 1200 mg of carbamazepine per day).
It is not recommended to use carbamazepine in combination with sedative and hypnotic medicines.
It is possible to use carbamazepine with other substances commonly used in the treatment of alcohol withdrawal syndrome. The doctor should regularly monitor carbamazepine levels in the blood.
The doctor's special attention is required, as side effects from the central and peripheral nervous system may occur.
Prevention of bipolar affective disorders
The initial dose is 200 to 400 mg (1 to 2 tablets of Finlepsin 200 retard or 0.5 to 1 tablet of Finlepsin 400 retard) per day. The maintenance dose is usually the same as the initial dose. The maintenance dose can be increased if necessary to 800 mg per day. Preventive treatment of affective disorders is long-term.
Warning!
In patients with severe cardiovascular disease, liver disease, or renal failure, as well as in the elderly, a reduced dose of the medicine may be sufficient.
Method of administration
Prolonged-release tablets of Finlepsin retard can be divided into equal doses.
They should be taken with a sufficient amount of liquid (e.g., a glass of water) during meals or after meals.
The tablet can be dissolved in water, as the prolonged-release properties are maintained in the suspension.
In some cases, it has been shown that a daily dose divided into 4 to 5 doses is effective. However, pharmaceutical forms other than prolonged-release tablets are suitable for this purpose.
The duration of treatment depends on the indications and the individual patient's response. Under no circumstances should the patient stop treatment on their own.
Antiepileptic treatment is usually long-term. The dose, duration of treatment, and discontinuation of therapy are determined individually for each patient by a specialist doctor (neurologist). Usually, a reduction in dose and discontinuation of treatment can only be considered after a seizure-free period of 2 to 3 years. Treatment is discontinued by gradually reducing the dose over a period of 1 to 2 years. In children, weight gain should be monitored during this period. Pathological changes in the EEG recording should not worsen.
In the treatment of neuralgia, the maintenance dose should be such that it ensures complete relief from pain for several weeks. By carefully reducing the dose, it should be checked whether the symptoms disappear on their own. In case of recurrence of pain, maintenance treatment should be continued.
In the treatment of pain in diabetic neuropathy and non-epileptic seizures in multiple sclerosis, the same principles apply as in the treatment of neuralgia.
Treatment of alcohol withdrawal syndrome with carbamazepine should be discontinued within 7 to 10 days by gradually reducing the dose of the medicine.
After an overdose of Finlepsin retard, an intensification of side effects may occur. The first symptoms of poisoning occur 1 to 3 hours after taking the medicine and are mainly disorders of the nervous system. Cardiovascular disorders are mild. Severe disorders may only occur after very high doses.
The following may occur: inhibition of the central nervous system, disorientation, drowsiness, agitation, tremors, seizures (tonic-clonic seizures), respiratory disorders, cardiovascular disorders - decreased blood pressure (increased blood pressure may also occur), tachycardia, conduction disorders, changes in consciousness, and even cardiac arrest.
In laboratory tests, leukocytosis (increased white blood cell count), leukopenia (decreased white blood cell count), neutropenia (decreased number of neutrophils), ketonuria (presence of ketone bodies in the urine), and glycosuria (presence of glucose in the urine) have been reported in individual cases.
There is no specific antidote for carbamazepine.
Treatment of overdose with Finlepsin retard depends on the complications that occur and is usually carried out in hospital conditions.
Overdose of carbamazepine should be treated symptomatically; the harmful substance should be removed as soon as possible by inducing vomiting and/or gastric lavage, and absorption should be reduced by administering activated charcoal or laxatives.
Life-supporting functions should be maintained in the intensive care unit, cardiac function should be monitored, blood levels of the medicine should be tested, and electrolyte disturbances should be corrected if the patient's condition requires it.
In case of seizures, treatment with an appropriate anticonvulsant medicine should be started. According to the literature, barbiturates are not recommended due to the risk of respiratory depression, especially in children.
If a dose is missed, the medicine should be continued according to the established schedule.
A double dose should not be taken to make up for the missed dose.
Like all medicines, Finlepsin retard can cause side effects, although not everybody gets them.
Dose-dependent side effects usually disappear within a few days of starting treatment or after reducing the dose. Neurological reactions may indicate an overdose of the medicine or significant fluctuations in the level of the medicine in the blood. In such a case, it is recommended to monitor the level of the medicine and divide the total dose.
The incidence of side effects is higher in combination therapy than in monotherapy.
Dizziness, drowsiness, sedation, fatigue, ataxia (lack of coordination, clumsiness, gait disturbance), headaches, double vision, poor well-being, vomiting, or allergic reactions may occur frequently.
In elderly patients, restlessness and disorientation may occur.
The following side effects may occur during treatment with carbamazepine:
Very common (may occur in more than 1 in 10 patients):
leukopenia, dizziness, ataxia, drowsiness, poor well-being, vomiting, increased activity of the liver enzyme gamma-glutamyltranspeptidase (usually clinically insignificant), allergic skin inflammation, hives (including severe forms).
Common (may occur in up to 1 in 10 patients):
headaches, double vision, accommodation disorders (blurred vision), dryness of the mucous membranes of the mouth, loss of appetite, increased activity of alkaline phosphatase (a group of enzymes found in the liver, bones, intestines, and kidneys), thrombocytopenia, eosinophilia, hyponatremia, which causes fluid retention, edema, weight gain, and decreased osmolality of the blood. In rare cases, this has led to vomiting, headaches, and rarely - disorientation, lethargy, and other neurological abnormalities.
Uncommon (may occur in up to 1 in 100 patients):
involuntary movements (tremors, dystonia, tics), nystagmus, diarrhea or constipation, increased activity of liver enzymes - aminotransferases, exfoliative dermatitis, erythroderma (inflammatory and redness of the entire skin, often with shedding of the epidermis).
Rare (may occur in up to 1 in 1000 patients):
leukocytosis, lymphadenopathy, folate deficiency, hypersensitivity of the late type with fever, rash, vasculitis, lymph node swelling, arthralgia, changes in the number of leukocytes, eosinophilia, hepatosplenomegaly, or changes in liver test results, as well as effects on other organs such as lungs, kidneys, pancreas, heart muscle, and colon.
Very rare (may occur in less than 1 in 10,000 patients):
agranulocytosis, aplastic anemia, pancytopenia, aplastic anemia, anemia, megaloblastic anemia, porphyria, reticulocytosis, hemolytic anemia, aseptic meningitis with clonic seizures and eosinophilia, anaphylactic reactions and angioedema, increased prolactin secretion with symptoms (or asymptomatic) galactorrhea, gynecomastia in men, changes in thyroid function (decreased FT4, T3, T4 activity) and increased TSH activity; changes in bone metabolism (decreased calcium and 25-hydroxycholecalciferol levels in the blood), which in rare cases can lead to bone damage (osteoporosis/osteomalacia); increased cholesterol, HDL, and triglyceride levels, exacerbation of a latent psychotic syndrome, changes in taste, malignant neuroleptic syndrome (a life-threatening complication that occurs mainly in people taking neuroleptic medicines), loss of lens transparency, conjunctivitis, increased intraocular pressure, hearing disturbances (tinnitus, increased or decreased hearing sensitivity, changes in tone perception), bradycardia, arrhythmia, atrioventricular block, sometimes with loss of consciousness or fainting (heart rhythm and conduction disorders), collapse, congestive heart failure, exacerbation of coronary artery disease, thrombophlebitis, embolic episodes.
Frequency not known (frequency cannot be estimated from the available data):
high levels of ammonia in the blood (hyperammonemia). Symptoms of hyperammonemia may include irritability, disorientation, vomiting, loss of appetite, and drowsiness.
There are reports that carbamazepine exacerbates the symptoms of multiple sclerosis.
Like other antiepileptic medicines, carbamazepine may increase the frequency of seizures. Seizures of the "absence" type (a special type of seizure that begins in both hemispheres of the brain) may be intensified or triggered.
There are reports of bone disorders, including osteopenia, osteoporosis, and fractures. The patient should contact their doctor or pharmacist if they are taking long-term antiepileptic therapy, have osteoporosis, or are taking steroids.
If side effects occur, including any side effects not listed in the leaflet, the patient should tell their doctor, pharmacist, or nurse. Side effects can be reported directly to the Department of Monitoring of Adverse Reactions to Medicinal Products, Urząd Rejestracji Produktów Leczniczych, Wyrobów Medycznych i Produktów Biobójczych, Al. Jerozolimskie 181C, 02-222 Warsaw, Tel.: +48 22 49 21 301, Fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl.
Side effects can also be reported to the marketing authorization holder.
By reporting side effects, more information can be collected on the safety of the medicine.
The medicine should be stored out of sight and reach of children.
The medicine should be stored at a temperature below 30°C.
Finlepsin retard should not be used after the expiry date stated on the packaging.
Medicines should not be disposed of via wastewater or household waste. The patient should ask their pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.
White to yellowish, round, flat, leaf-shaped tablets with a score line on both sides, smooth surface, intact edges, and a uniform appearance.
The tablet can be divided into equal doses.
Finlepsin 200 retard: 50 tablets in a cardboard box.
Finlepsin 400 retard: 30 or 50 tablets in a cardboard box.
Teva Pharmaceuticals Polska Sp. z o.o.
ul. Emilii Plater 53, 00-113 Warszawa
tel.: (22) 345 93 00
Teva Operations Poland Sp. z o.o.
ul. Mogilska 80, 31-546 Kraków
Need help understanding this medicine or your symptoms? Online doctors can answer your questions and offer guidance.