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Excerpt 2
John H. Greist, MD and James W. Jefferson, MD

Carbamazepine & Bipolar Disorder: A Guide

(Excerpt 1)

What is carbamazepine?
Carbamazepine (pronounced kar-ba-maz-�-e-peen) is a medication approved by the United States Food and Drug Administration (FDA) for treatment of various types of epilepsy and for the treatment of pain due to a neurological condition known as trigeminal neuralgia. In December, an extended-release preparation (Equetro) became the only FDA-approved carbamazepine preparation for treating acute manic and mixed episodes of bipolar I disorder. Over a decade ago, carbamazepine was approved by Canadian authorities for treatment of acute mania and for "prophylaxis" or prevention of recurrences of both manic and depressive episodes.

Carbamazepine has actually been used by clinicians to treat bipolar disorder both acutely for mania and long-term to prevent recurrences for several decades. Doctors are allowed to use medication "off-label" if they feel there is sufficient evidence to support safety and effectiveness and if better established treatments have been ineffective or not tolerated. For example, an "on-label" use of carbamazepine would be for epilepsy, while an "off-label" use in the United States would be for long-term maintenance in bipolar disorder.

Carbamazepine is taken by mouth in the form of tablets, capsules, or liquid—all of which require a doctor's prescription. Generic and brand name preparations are available in the United States and Canada (Tegretol and others) in the form of tablets (200 milligrams), chewable tablets (100 and 200 milligrams), and a liquid suspension (100 milligrams per 5 milliliters). Finally, extended-release formulations are available in the United States (Carbatrol and Equetro—100, 200, and 300 milligram capsules; Tegretol-XR—100, 200, and 400 milligram tablets) and in Canada (Tegretol-CR—200 and 400 milligram tablets).