From the Guidelines
For a dementia patient currently on Tegretol (carbamazepine) extended release 100 mg twice daily for emotional lability, the next appropriate dose increase would typically be to 200 mg twice daily. This approach is based on the principles of geriatric psychopharmacology, which emphasize starting with a low dosage and increasing it slowly while monitoring for side effects 1. When increasing the dose, it's crucial to monitor for side effects such as dizziness, drowsiness, unsteady gait, and confusion, which can be particularly problematic in elderly patients with dementia.
- Key considerations include:
- Monitoring blood levels periodically, especially after dose adjustments, to ensure the concentration remains within the therapeutic range and to avoid toxicity
- Regular monitoring of liver function and complete blood counts
- Taking the medication with food to reduce gastrointestinal side effects
- Making further adjustments only under close medical supervision, as higher doses increase the risk of adverse effects in this vulnerable population. It's also important to consider the potential for drug interactions and the presence of other conditions, such as depression, which is common in patients with Alzheimer’s disease and may require the use of additional medications like selective serotonin reuptake inhibitors 1.
From the Research
Dose Escalation for Tegretol Extended Release
The current dose of Tegretol extended release is 100 mg twice a day for emotional lability and a dementia patient. To determine the next dose up, we need to consider the available evidence.
Available Evidence
- A study published in 1995 2 investigated the effect of carbamazepine on agitation and emotional lability associated with severe dementia. The study found that carbamazepine treatment resulted in clinically relevant improvement in nine out of 15 patients.
- Another study published in 2002 3 discussed the use of anticonvulsants, including carbamazepine, in the treatment of bipolar affective disorder. The study highlighted the importance of gradual dose increase and monitoring of drug blood levels.
- A literature review published in 2008 4 summarized the available data on the use of anticonvulsant mood stabilizers, including carbamazepine, in the treatment of behavioral and psychological symptoms of dementia. The review found that while anticonvulsant mood stabilizers may be beneficial in some patients, they cannot be recommended for routine use due to the risk of adverse effects.
Dose Escalation Considerations
- The usual maintenance dose of Tegretol extended release is 200-400 mg twice a day 3.
- Gradual dose increase is recommended to minimize the risk of adverse effects 3.
- Monitoring of drug blood levels and liver function is also recommended 3.
Possible Next Dose Up
- Based on the available evidence, the next dose up for Tegretol extended release could be 200 mg twice a day, with gradual increase as needed and tolerated.
- However, it is essential to consider the individual patient's response to treatment and adjust the dose accordingly, taking into account the risk of adverse effects 4, 3, 2.