Carbamazepine depresses activity in the nucleus ventralis of the thalamus, reduces synaptic propagation of excitatory impulses or decreases summation of temporal stimulation leading to neural discharge by limiting influx of Na ions across cell membrane or other unknown mechanisms. It stimulates the release of antidiuretic hormone (ADH) and potentiates its action in promoting reabsorption of water.
Adult: Initially, 100-200 mg once daily or bid, gradually increased by increments of up to 200 mg daily every wk. Maintenance: 0.8-1.2 gm daily in divided doses. Max: 2 gm daily.
Child: 10-20 mg/kg daily in divided doses. Alternatively, <1 yr 100-200 mg daily. Max: 35 mg/kg daily; 1-5 yr 200-400 mg daily. Max: 35 mg/kg daily; >5-10 yr 400-600 mg daily. Max: 1 gm daily; >10-15 yr 0.6-1 gm daily. Max: 1 gm daily.
Prophylaxis of bipolar disorder:
Adult: Initially, 400 mg daily in divided doses, increased gradually as necessary. Maintenance: 400-600 mg daily in divided doses. Max: 1.6 gm daily.
Adult: Initially, 100-200 mg bid, increased gradually as needed. Maintenance: 400-800 mg daily in divided doses. Max: 1.2 gm daily.