Zeptol-CR
Generic Name
Carbamazepine
Manufacturer
Eskayef Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| zeptol cr 200 mg tablet | ৳ 7.00 | ৳ 70.00 |
Description
Overview of the medicine
Zeptol-CR 200 mg tablet contains Carbamazepine, an anticonvulsant and mood-stabilizing medication. It is used to treat various types of epilepsy, trigeminal neuralgia, and bipolar disorder. The controlled-release formulation allows for less frequent dosing and smoother plasma levels.
Uses & Indications
Dosage
Adults
Epilepsy: Initially 200 mg orally twice daily, gradually increasing by 200 mg/day at weekly intervals until optimal response (usually 800-1200 mg/day). Trigeminal neuralgia: Initially 100 mg orally twice daily, gradually increasing by 100 mg increments until pain relief (usually 400-800 mg/day). Bipolar disorder: Initially 200 mg orally twice daily, gradually increasing to 400-1200 mg/day.
Elderly
Lower initial doses and slower titration may be required due to potential increased sensitivity to side effects and altered pharmacokinetics.
Renal_impairment
No specific dose adjustment recommended for mild-moderate renal impairment; caution with severe impairment. Monitor drug levels.
How to Take
Take orally with food to reduce gastrointestinal upset. Controlled-release tablets should be swallowed whole; do not crush, chew, or break them.
Mechanism of Action
Carbamazepine primarily acts by stabilizing inactivated voltage-gated sodium channels, preventing repetitive firing of action potentials in hyperexcited neurons. It may also affect calcium channels and enhance GABAergic transmission.
Pharmacokinetics
Onset
Anticonvulsant effect: hours to days. Trigeminal neuralgia: 24-72 hours. Bipolar disorder: days to weeks.
Excretion
Primarily excreted in urine (72%) and feces (28%), mainly as metabolites.
Half life
Initial half-life: 25-65 hours. After chronic administration (autoinduction): 12-17 hours.
Absorption
Slow and variable absorption from the gastrointestinal tract, especially with controlled-release formulations. Peak plasma concentrations are reached in 4-12 hours for CR formulations.
Metabolism
Extensively metabolized in the liver, primarily by CYP3A4 to an active metabolite (carbamazepine-10,11-epoxide).
Side Effects
Contraindications
- History of bone marrow depression
- Hypersensitivity to carbamazepine or tricyclic antidepressants
- Co-administration with MAO inhibitors (within 14 days)
- History of hepatic porphyria
Drug Interactions
Warfarin
Reduced anticoagulant effect due to enzyme induction.
MAO Inhibitors
Concurrent use contraindicated due to risk of severe hypertensive crisis.
Grapefruit Juice
Increased carbamazepine levels due to CYP3A4 inhibition.
Oral Contraceptives
Reduced efficacy of contraceptives, leading to breakthrough bleeding or unintended pregnancy.
Lamotrigine, Valproic Acid
Altered plasma levels of both drugs, increased risk of side effects.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include dizziness, ataxia, drowsiness, nausea, vomiting, nystagmus, tremor, urinary retention, cardiac arrhythmias, and coma. Management involves supportive care, gastric lavage, activated charcoal, and monitoring vital signs. Hemodialysis may be considered in severe cases.
Pregnancy & Lactation
Pregnancy Category D. May cause fetal harm including neural tube defects; risk vs. benefit must be carefully considered. Excreted in breast milk, use with caution; monitor infant for side effects.
Side Effects
Contraindications
- History of bone marrow depression
- Hypersensitivity to carbamazepine or tricyclic antidepressants
- Co-administration with MAO inhibitors (within 14 days)
- History of hepatic porphyria
Drug Interactions
Warfarin
Reduced anticoagulant effect due to enzyme induction.
MAO Inhibitors
Concurrent use contraindicated due to risk of severe hypertensive crisis.
Grapefruit Juice
Increased carbamazepine levels due to CYP3A4 inhibition.
Oral Contraceptives
Reduced efficacy of contraceptives, leading to breakthrough bleeding or unintended pregnancy.
Lamotrigine, Valproic Acid
Altered plasma levels of both drugs, increased risk of side effects.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include dizziness, ataxia, drowsiness, nausea, vomiting, nystagmus, tremor, urinary retention, cardiac arrhythmias, and coma. Management involves supportive care, gastric lavage, activated charcoal, and monitoring vital signs. Hemodialysis may be considered in severe cases.
Pregnancy & Lactation
Pregnancy Category D. May cause fetal harm including neural tube defects; risk vs. benefit must be carefully considered. Excreted in breast milk, use with caution; monitor infant for side effects.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date.
Availability
Pharmacies, hospitals, clinics
Approval Status
Approved by major regulatory bodies (e.g., FDA, DGDA)
Patent Status
Generic available (Patent expired for original compound)
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established carbamazepine's efficacy in epilepsy, trigeminal neuralgia, and bipolar disorder. Controlled-release formulations were developed to improve tolerability and reduce dosing frequency.
Lab Monitoring
- Complete blood count (CBC) with differential before and periodically during treatment
- Liver function tests (LFTs) before and periodically during treatment
- Serum carbamazepine levels (especially during dose adjustments or suspected toxicity)
- Electrolytes (especially sodium)
Doctor Notes
- Monitor CBC, LFTs, and sodium levels regularly.
- Counsel patients on symptoms of serious skin reactions and hematologic abnormalities.
- Caution in elderly patients and those with cardiac conduction disturbances.
- Advise patients about potential drug interactions, especially with oral contraceptives and grapefruit juice.
Patient Guidelines
- Do not stop taking this medication suddenly without consulting your doctor, as it may worsen your condition.
- Report any skin rash, fever, sore throat, or easy bruising/bleeding to your doctor immediately.
- Avoid driving or operating machinery until you know how this medicine affects you, as it can cause dizziness or drowsiness.
- Avoid alcohol consumption while taking this medication.
Missed Dose Advice
If a dose is missed, take it as soon as remembered, unless it is almost time for the next dose. Do not double the dose to catch up.
Driving Precautions
May cause dizziness, drowsiness, blurred vision, or ataxia. Patients should be warned about the potential for impaired ability to drive or operate machinery.
Lifestyle Advice
- Maintain a regular sleep schedule.
- Avoid excessive caffeine.
- Stay hydrated.
- Carry an identification card stating your condition and medication.
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