Carbamazepine - instructions for use, dose, side effects, contraindications

Excipients: potato starch, lactose monohydrate (sugar milk), magnesium stearate, sodium starch glycolate (sodium carboxymethyl starch, primogel), povidone (Kollidon 30), talc.

Description:

Tablets white or white with a yellowish tint of color, flat-cylindrical, with a facet and risk.

Pharmacotherapeutic group:Antiepileptic remedy

ATX: & nbsp

N.03.A.F.01 Carbamazepine

Pharmacodynamics:

Carbamazepine is a derivative of dibenzazepine and has antiepileptic, psychotropic, antidiuretic, weak m-cholinoblocking action.

As an antiepileptic agent stabilizes membranes of overexcited neurons, suppresses serial discharges of neurons and reduces the synaptic transmission of exciting impulses. This effect is achieved, presumably, due to blockade of sodium channels, as a result of which the repeated occurrence in the depolarized neurons of sodium-dependent action potentials is prevented.Reduces the release of the neurotransmitter glutamate. The psychotropic effect of carbamazepine, apparently, is due to the inhibition of the exchange of dopamine and norepinephrine.

Reduces the frequency of seizures, anxiety, depression, irritability and aggressiveness in patients with epilepsy. The effect on cognitive function in epileptic patients is variable.

Prevents the occurrence of paroxysmal pain in neuralgia.

With alcohol withdrawal syndrome increases the threshold of convulsive readiness, reduces the increased nervous excitability, tremor, gait disturbance.

Used to treat affective disorders as an antipsychotic and normotimic agent. When diabetes insipidus reduces diuresis and thirst.

Pharmacokinetics:

Absorption - slow, but fairly complete (eating does not significantly affect the speed and degree of absorption). After a single dose, the maximum concentration in the blood plasma is achieved through 12 hours; equilibrium concentration is achieved through 1-2 of the week. There are significant interindividual differences in the values of equilibrium concentrations in the therapeutic range. Relationship with blood plasma proteins 70-80%.

The concentration of unchanged carbamazepine in the cerebrospinal fluid and in the saliva is proportional to the amount of the active substance unbound with the proteins (20-30%). Concentration in breast milk is 25-60% of that in plasma. Penetrates through the placental barrier.

Metabolised in the liver, mainly along the epoxide pathway with the formation of metabolites: active - carbamazepine-10,11-epoxide and low-activity - 9-hydroxy-methyl-10-carbamoylacridan. The main isoenzyme, providing biotransformation of carbamazepine in carbamazepine-10,11-epoxide, is CYP3A4. The content of carbamazepine-10,11-epoxide is about 30% of the level of carbamazepine in plasma. Biotransformation of carbamazepine-10,11-epoxide in carbamazepine-10,11-trans-diol takes place with the help of microsomal enzyme epoxide hydrolase. Another way of carbamazepine metabolism is the formation of various monohydroxylated derivatives, and N-glucuronides. The half-life after one-time administration averages about 36 hours (ranging from 25 to 65 hours), after repeated administration - 16-24 hours. In patients receiving additional antiepileptic drugs inducing liver enzymes, an average of 9-10 hours.It is excreted as inactive metabolites mainly by the kidneys (approximately 70%) and the intestines (about 30%). About 2% is excreted by the kidneys in the form of unchanged carbamazepine and 1% in the form of carbamazepine-10,11-epoxide.

Children, due to the faster removal of carbamazepine, may require the use of higher doses of the drug at a rate of 1 kg of body weight, compared with adults.

There is no evidence that the pharmacokinetics of carbamazepine change in elderly patients. Data on the pharmacokinetics of carbamazepine in patients with impaired renal or hepatic function are absent.

Indications:

Epilepsy, except for absences, myoclonic and flaccid seizures (monotherapy or as part of complex therapy):

- complex and simple partial seizures (with or without loss of consciousness) with or without secondary generalization;

- generalized tonic-clonic seizures;

- Mixed forms of epileptic seizures.

Acute manic conditions and maintenance therapy of bipolar affective disorders in order to prevent exacerbations or reduce the severity of clinical manifestations.

In complex therapy of alcohol withdrawal syndrome.

Neuralgia of the trigeminal nerve (idiopathic, with multiple sclerosis); idiopathic neuralgia of the glossopharyngeal nerve.

Pain syndrome with diabetic neuropathy.

Polyuria and polydipsia in diabetes insipidus of central genesis.

Contraindications:

Hypersensitivity to any of the components of the drug or a chemical-like drug (tricyclic antidepressants).

Atrioventricular block.

Oppression of the bone marrow hemopoiesis in the anamnesis.

Acute "intermittent" porphyria.

Simultaneous administration of monoamine oxidase inhibitors (MAO) and within 2 weeks after their withdrawal.

Children under 5 years.

Breastfeeding period.

Carefully:Low level of leukocytes or platelets; mixed forms of epileptic seizures, including absences; elderly age; cardiac, hepatic or kidney failure; increased intraocular pressure; hyponatremia of breeding; hypothyroidism; hyperplasia of the prostate; active alcoholism (increased central nervous system depression, increased carbamazepine metabolism),oppression of bone marrow hematopoiesis against the background of taking medications (in the anamnesis); pregnancy (increased risk of development of intrauterine development disorders, including malformations).

Pregnancy and lactation:

In women of reproductive age carbamazepine should be used whenever possible in the form of monotherapy (using the lowest effective dose) - the incidence of congenital anomalies in newborns born to women who undergo combined antiepileptic treatment is higher than those who received each of these drugs as monotherapy.

At the onset of pregnancy (when deciding whether to prescribe carbamazepine during pregnancy), it is necessary to carefully compare the expected benefits of therapy and its possible complications, especially in the first 3 months of pregnancy. It is known that children born to mothers with epilepsy are predisposed to violations of intrauterine development, including malformations. Carbamazepine, like all other antiepileptic drugs, is capable of increasing the risk of these disorders.There are isolated reports of cases of congenital diseases and malformations, including non-vertebral arches (spina bifida), hypospadias. Patients should be provided with information on the possibility of increasing the risk of malformations and the ability to undergo antenatal diagnostics.

Antiepileptic drugs increase the deficiency of folic acid, often observed during pregnancy, which can contribute to an increase in the frequency of birth defects in children (before and during pregnancy an additional folic acid supplement is recommended). In order to prevent increased bleeding in newborns, in the last weeks of pregnancy, as well as newborns, vitamin K1 is recommended.

Carbamazepine penetrates into breast milk, it is necessary to compare the benefits and possible undesirable consequences of breastfeeding in conditions of continuing therapy. Mothers accepting carbamazepine, can breast-feed their children, provided that the child will be monitored for the development of possible adverse reactions (eg, severe drowsiness, allergic skin reactions).

Dosing and Administration:

Inside, regardless of food intake with a small amount of liquid.

Epilepsy: whenever possible, carbamazepine should be administered as a monotherapy. Treatment begins with a small daily dose, which is then slowly increased until an optimal effect is achieved. The addition of carbamazepine to already conducted antiepileptic therapy should be carried out gradually.

For adults, the initial dose is 100-200 mg 1-2 times a day. Then the dose is slowly increased to 400 mg 2-3 times a day. The maximum daily dose of 2000 mg.

For children under 5 years of age, the initial dose of 20-60 mg per day with an increase of 20-60 mg every two days. In children from 5 years of age, the initial dose is 100 mg / day, followed by an increase of 100 mg per week. The maintenance dose for children is 10-20 mg / kg body weight per day for 2-3 doses.

Neuralgia of the trigeminal or glossopharyngeal nerves: an initial dose of 200-400 mg / day, then gradually increase the dose by no more than 200 mg per day until the pain ceases (on average, 600-800 mg), then reduced to the lowest effective dose.

In the treatment of elderly patients, the initial dose is 100 mg 2 times a day.

Alcohol abstinence syndrome: the average dose is 200 mg 3 times a day.In severe cases, in the early days, the dose can be increased to 400 mg 3 times a day. At the beginning of treatment for severe phenomena, withdrawal is prescribed in combination with detoxification therapy, sedatives and hypnotics.

Polyuria and polydipsia in diabetes insipidus: the average dose for adults is 200 mg 2-3 times a day. In children, the dose is selected based on body weight and age.

Pain syndrome in diabetic neuropathy: 200 mg 2 to 4 times a day.

Acute manic conditions and maintenance therapy of bipolar affective disorders: daily dose of 400-1600 mg (average daily dose of 200-600 mg) in 2-3 divided doses per day. In acute cases, the dose is increased quickly enough. With maintenance therapy, increasing the dose should be gradual and small.

Side effects:

Mental disorders: hallucinations (visual or auditory), depression, anorexia, anxiety, aggressive behavior, agitation, disorientation, increased psychosis.

Disturbances from the nervous system: Dizziness, ataxia, drowsiness, fatigue, headache, diplopia, accommodation disturbances, tremors, muscle dystonia, tics, eye, orofacial dyskinesia, oculomotor disturbances, dysarthria, horeoatetoidnye disorders, peripheral neuropathy,paresthesia, paresis, taste disorders, malignant neuroleptic syndrome.

From the skin and its appendages: Allergic dermatitis, urticaria, exfoliative dermatitis, erythroderma, systemic lupus erythematosus, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis, photosensitivity reaction, erythema multiforme and nodosum, a violation of skin pigmentation, purpura, acne, sweating, hair loss. It reported rare cases of hirsutism, but the causal relationship of this complication of drug-remains unclear.

On the part of the hematopoiesis systemleukopenia, thrombocytopenia, eosinophilia, leukocytosis, lymphadenopathy, folic acid deficiency, agranulocytosis, aplastic anemia, pancytopenia, anemia, true erythrocyte aplasia, megaloblastic anemia, variegate porphyria, late cutaneous porphyria, acute "intermittent" porphyria, reticulocytosis, hemolytic anemia.

From the hepatobiliary system: raising the level of gamma-glutamyl transpeptidase, increased levels of alkaline phosphatase, increased activity "liver" enzymes, hepatitis (cholestatic, parenchymal (hepatocellular) or mixed type), jaundice, granulomatous hepatitis, hepatic insufficiency.

From the gastrointestinal tract: nausea, vomiting, dry mouth, diarrhea, constipation, abdominal pain, glossitis, stomatitis, pancreatitis.

Hypersensitivity reactions: multi-organ hypersensitivity delayed type with fever, skin rashes, vasculitis, lymphadenopathy, signs resembling lymphoma, arthralgia, leukopenia, eosinophilia, hepatosplenomegaly and altered liver function (these manifestations occur in various combinations). Other organs (lungs, kidneys, pancreas, myocardium, large intestine) may also be involved. Aseptic meningitis with myoclonus and peripheral eosinophilia, anaphylactic reactions, angioedema.

From the side of the cardiovascular system: intracardiac conduction disorders, increase or decrease of arterial pressure, bradycardia, arrhythmia, atrioventricular blockade with syncope, collapse, congestive heart failure, exacerbation of coronary heart disease, thrombophlebitis, thromboembolism.

From the endocrine system and metabolism: edema, fluid retention, weight gain,hyponatremia and decreased plasma osmolarity due to an effect similar to that of antidiuretic hormone, which in rare cases leads to water intoxication (hyponatremia of dilution), accompanied by lethargy, vomiting, headache, disorientation and neurologic disorders; increased prolactin levels, accompanied or not accompanied by galactorrhea, gynecomastia; changes in thyroid function indices - decrease in thyroid hormone levels (T3, free and bound T4) and increase in thyroid-stimulating hormone level, which is usually not accompanied by clinical manifestations; disorders of bone tissue metabolism (decrease in calcium and 25-hydroxycolecalciferol in the blood plasma), which leads to osteomalacia; increased cholesterol concentrations, including high-density lipoprotein cholesterol and triglycerides.

From the genitourinary system: interstitial nephritis, renal insufficiency, albuminuria, hematuria, oliguria, azotemia, frequent urination, urinary retention, sexual function disorders, spermatogenesis disorders.

From the sense organs: disorders of taste sensations, clouding of the lens, increased intraocular pressure, conjunctivitis; hearing disorders.

From the side musculoskeletal system: arthralgia, muscle pain, muscle weakness, muscle spasms.

From the respiratory system: hypersensitivity reactions characterized by fever, dyspnea, pneumonitis, or pneumonia.

Change in the results of laboratory studies: gand Igogmaglobulinemia.

Overdose:

Symptoms

Symptoms usually reflect abnormalities from the central nervous system, cardiovascular and respiratory system.

From the side of the central nervous system and sensory organs: depression of functions of the central nervous system, disorientation, drowsiness, excitation, hallucinations, fainting, coma, visual disturbances (fog before the eyes), dysarthria, nystagmus, ataxia, dyskinesia, hyperreflexia (at the beginning), hyporeflexia (later), convulsions, psychomotor disorders, myoclonus, hypothermia, mydriasis.

From the side of the cardiovascular system: tachycardia, lowering blood pressure (BP), sometimes raising blood pressure, violation of intraventricular conduction with expansion of the QRS complex, cardiac arrest.

On the part of the respiratory system: respiratory depression, pulmonary edema.

From the digestive system: nausea and vomiting, delayed evacuation of food from the stomach, decreased motility of the colon.

From the urinary system: urine retention, oliguria or anuria, fluid retention, hyponatremia of dilution.

Laboratory indicators: leukocytosis or leukopenia, hyponatremia, metabolic acidosis, hyperglycemia and glucosuria, increase in the muscle fraction of creatine phosphokinase.

Treatment

There is no specific antidote. Treatment is based on the clinical condition of the patient. Hospitalization, determination of carbamazepine plasma concentration (for confirmation of poisoning with this drug and assessment of the degree of overdose), gastric lavage, the appointment of activated charcoal (late evacuation of gastric contents can lead to delayed absorption on days 2 and 3 and the re-emergence of symptoms of intoxication during the recovery period ). Intense diuresis, hemodialysis and peritoneal dialysis are ineffective (dialysis is indicated by a combination of severe poisoning and kidney failure).In young children, there may be a need for exchange blood transfusion. Symptomatic supportive treatment in the intensive care unit, monitoring of heart function, body temperature, corneal reflexes, kidney and bladder function, correction of electrolyte disorders. With a decrease in blood pressure: the position with the lowered head end, plasma substitutes, with ineffectiveness - are intravenously administered dopamine or dobutamine; with heart rhythm disturbances, - treatment is selected individually; with convulsions - are introduced benzodiazepines (for example, diazepam), with caution (because of the possible increase in respiratory depression) other anticonvulsant drugs (for example, phenobarbital). With the development of hyponatremia of dilution (water intoxication) - restriction of the introduction of fluids and slow intravenous infusion of 0.9% NaCl solution (may contribute to the prevention of cerebral edema). It is recommended to carry out hemosorption on carbon sorbents.

Interaction:

Simultaneous use with inhibitors CYP3A4 can lead to an increase in the concentration of carbamazepine in plasma.Joint application of inducers CYP3A4 can lead to an acceleration of the metabolism of carbamazepine and to a possible decrease in its concentration in the plasma. Cancellation of simultaneous inductors CYP3A4 can reduce the rate of biotransformation of carbamazepine and lead to an increase in the level of carbamazepine in blood plasma. When used concomitantly with drugs metabolized CYP3A4, it is possible to induct the metabolism and reduce their concentration in the plasma.

Preparations, which can increase the concentration of carbamazepine or carbamazepine-10,11-epoxide in plasma: dextropropoxyphene, ibuprofen, danazol, macrolide antibiotics (for example, erythromycin, troleandomycin, josamycin, clarithromycin), fluoxetine, fluvoxamine, nefazodone, paroxetine, trazodone, viloxazine, styipentol, vigabatrin, azoles (e.g., itraconazole, ketoconazole, fluconazole, voriconazole), loratadine, terfenadine, loxapine, olanzapine, quetiapine, isoniazid, HIV protease inhibitors (eg, ritonavir), acetazolamide, verapamil, diltiazem, omeprazole, oxybutynin, dantrolene, ticlopidine, nicotinamide (in adults, only in high doses), cimetidine, desipramine, pridomine, valproic acid.

Drugs that can reduce the concentration of carbamazepine in plasma: felbamate, oxcarbazepine, phenobarbital, fensuximide, phenytoin, phosphenytoin, primidon, progabide, theophylline, aminophylline, isotretinoin, rifampicin, cisplatin, doxorubicin; vegetative preparations containing St. John's wort, and possibly also clonazepam, valproic acid or valpromid.

The effect of carbamazepine on the plasma concentration of drugs used as concomitant therapy

Carbamazepine can reduce plasma concentrations or reduce or even completely eliminate the effects of the following drugs: methadone, paracetamol, phenazone (antipyrine), tramadol, doxycycline, oral anticoagulants (warfarin, fenprokumone, dicoumarol, acenocoumarol), bupropion, citalopram, trazodone, tricyclic antidepressants (imipramine, amitriptyline, nortriptyline, clomipramine), clobazam, clonazepam, ethosuximide, felbamate, lamotrigine, oxcarbazepine, primidon, tiagabine, topiramate, valproic acid, zonisamide, itraconazole, praziquantel, imatinib, clozapine, haloperidol, bromperidol, olanzapine, quetiapine, risperidone, ziprasidone, used in the therapy of HIV infection (indinavir, ritonavir, saquinavir), alprazolam, midazolam, theophylline, calcium channel blockers of the dihydropyridine group (eg, felodipine), digoxin, oral contraceptive means (alternative methods of contraception are necessary), glucocorticosteroids (for example, prednisolone, dexamethosone), ciclosporin, everolimus, levothyroxine sodium, estrogens and / or progesterone. It has been reported that in patients receiving carbamazepine phenytoin plasma levels may either rise or fall, and mephenytoin level - increase (in rare cases).

Combinations that should be taken into account

It is possible to enhance hepatotoxicity caused by isoniazid, when used simultaneously with carbamazepine.

In the case of co-administration with levetiracetam, the toxic effect of carbamazepine may be increased.

The combined use of carbamazepine and lithium or metoclopramide, as well as carbamazepine and neuroleptics (haloperidol,thioridazine) may lead to an increase in the incidence of unwanted neurological reactions (in the case of the latter combination - even with therapeutic concentrations of active substances in the blood plasma). The simultaneous use of carbamazepine with certain diuretic drugs (hydrochlorothiazide, furosemide) can lead to hyponatremia, accompanied by clinical manifestations.

Carbamazepine can, antagonize the action of nondepolarizing muscle relaxants (for example, pancuronium bromide). If such a combination of drugs is used, it may be necessary to increase the dose of these muscle relaxants; it is necessary to carefully monitor patients, as possible a faster than expected termination of muscle relaxants.

Carbamazepine may reduce the tolerability of alcohol. In this regard, the patient is recommended to abandon the use of alcohol.

Joint reception with grapefruit juice can increase the level of carbamazepine in plasma.

Simultaneous administration of carbamazepine with phenothiazine, phenobarbital, felbamate, fensuximide, fosphenytoin, progabide, aminophylline, isotretinoin, pimozide,molindone, haloperidol, maprotiline, clozapine, tricyclic antidepressants, rifampicin, tetracycline, cisplatinum, doxorubicin, primidon, theophylline, valproic acid, herbal preparations containing St. John's Wort, can lead to a decrease in the concentration of carbamazepine in the blood plasma and a decrease in its anticonvulsant effect. MAO inhibitors increase the risk of developing hyperpyretic crises, hypertensive crises, seizures, fatal outcome (prior to the appointment of carbamazepine, MAO inhibitors should be withdrawn at least 2 weeks or, if the clinical situation permits, even for a longer period). Accelerates the metabolism of indirect anticoagulants, hormonal contraceptive drugs, folic acid; prazikvantela, can enhance the elimination of thyroid hormones. Accelerates the metabolism of drugs for general anesthesia (enflurane, halothane, ftorotan) with an increased risk of hepatotoxic effects; enhances the formation of nephrotoxic metabolites of methoxyflurane. Enhances hepatotoxic act isoniazid. Myelotoxic drugs increasehematotoxicity of the drug.

Special instructions:

Before the start of treatment, and periodically during the treatment should be carried out clinical blood tests (including counting the number of platelets, reticulocytes, as well as the concentration of iron in the blood serum), general urine tests and determination of the level of urea in the blood. The drug has a weak anticholinergic activity. Therefore, in the case of using the drug in patients with increased intraocular pressure, constant monitoring of this indicator is necessary.

It is recommended to periodically determine the concentration of carbamazepine in the blood plasma in cases of increased incidence of epileptic seizures, in the treatment of children, in pregnant women, in case of its use as part of complex therapy, development of pronounced side effects.

There are some reports of violations of male fertility and / or violations of spermatogenesis. However, the causal relationship of these disorders with taking the drug has not been proven to date.

Cross-reactive hypersensitivity reactions can occur between carbamazepine and phenytoin or oxcarbazepine.

Monotherapy epilepsy begins with the appointment of small doses, individually increasing them to achieve the desired therapeutic effect. When transferring a patient to carbamazepine should gradually reduce the dose of the previously prescribed antiepileptic drug until its complete cancellation. A sudden discontinuation of carbamazepine may provoke epileptic seizures. If it is necessary to abruptly terminate treatment, the patient should be transferred to another antiepileptic drug under the guise of the drug shown in such cases (for example, diazepam administered intravenously or rectally, or phenytoin administered intravenously). Several cases of vomiting, diarrhea and / or reduced nutrition, seizures and / or respiratory depression in newborns whose mothers have been taken carbamazepine simultaneously with other anticonvulsant drugs (perhaps these reactions are manifestations in the newborn's syndrome of "withdrawal"). Before the appointment of carbamazepine and in the process of treatment, it is necessary to study the liver function, especially in patients whose history includes information on liver diseases, as well as in elderly patients.In case of strengthening of already existing violations of the liver function or when there is an active liver disease, the drug should be immediately canceled.

Before starting treatment, it is also necessary to conduct a blood test (including platelet count, reticulocyte count), serum iron concentration, general urine analysis, urea concentration in the blood, electroencephalography, serum electrolyte concentration (and periodically during treatment, as possible development of hyponatremia). Subsequently, these indicators should be monitored during the first month of treatment weekly, and then monthly.

Carbamazepine should be immediately withdrawn when allergic reactions or symptoms are suspected to indicate the development of Stevens-Johnson syndrome or Lyell syndrome. Slightly expressed skin reactions (isolated macular or maculopapular exanthema) usually pass for several days or weeks, even with continued treatment or after a decrease in the dose of the drug (the patient at this time should be under close medical supervision).

It should take into account the possibility of activation of latent psychoses, and in elderly patients - the possibility of developing disorientation or arousal. There are reports of women developing bleeding in the period between menstruation in cases when oral contraceptives were used simultaneously. Carbamazepine may adversely affect the reliability of oral contraceptives Therefore, women of reproductive age should be treated with alternative methods oft pregnancy.

Carbamazepine should be used only under medical supervision. It is necessary to inform patients about the early signs of toxicity inherent in probable hematologic disorders, as well as symptoms from the skin and liver. The patient is informed of the need to consult a doctor immediately if there are undesirable reactions such as fever, sore throat, rash, ulceration of the oral mucosa, an unreasonable appearance of bruises, hemorrhages in the form of petechiae or purpura.In most cases, a transient or persistent decrease in the number of platelets and / or leukocytes is not a harbinger of the onset of aplastic anemia or agranulocytosis. Nevertheless, before the start of treatment, and also periodically during the treatment, clinical blood tests should be performed, including counting the number of platelets and, possibly, reticulocytes, as well as determining the concentration of iron in the blood serum.

Non-progressive asymptomatic leukopenia does not require withdrawal, but treatment should be discontinued if progressive leukopenia or leukopenia occurs, accompanied by clinical symptoms of an infectious disease.

Before the beginning of treatment it is recommended to conduct an ophthalmological examination, including examination of the fundus by a slit lamp and measurement of intraocular pressure, if necessary. In the case of prescribing, patients with increased intraocular pressure require constant monitoring of this indicator.

It is recommended to abandon the use of ethanol.

Although the relationship between the dose of carbamazepine, its concentration and clinical efficacy or tolerability is very low,nevertheless regular determination of the concentration of carbamazepine can be useful in the following situations: with a sharp increase in the frequency of seizures; to check whether the patient is taking the drug properly; during pregnancy; when treating children or adolescents; if there is a suspicion of impaired absorption of the drug; if there is a suspicion of the development of toxic reactions in the event that the patient takes several medicines.

Effect on the ability to drive transp. cf. and fur:

During the treatment period, it is necessary to refrain from engaging in potentially dangerous activities that require a high concentration of attention and speed of psychomotor reactions.

Form release / dosage:

Tablets of 200 mg.

Packaging:For 10, 15, 25 or 30 tablets in a contour mesh box made of polyvinylchloride film and aluminum foil printed lacquered.

For 3, 5 contour cell packs of 10 tablets or 2, 4 contourcell packs of 15 tablets, or 2 contourcell packs of 25 tablets, or 1, 2 contour packs of 30 tablets together with the instructions for use are placed in a pack of cardboard.

Storage conditions:

In a dry, protected from light place at a temperature of no higher than 25 ° C. Keep out of the reach of children.

Shelf life:3 years.

Do not use after expiry date.

Terms of leave from pharmacies:On prescription

Registration number:P N002633 / 01

Date of registration:01.07.2008

Expiration Date:Unlimited

The owner of the registration certificate:CANONFARMA PRODUCTION, CJSC CANONFARMA PRODUCTION, CJSC Russia

Manufacturer: & nbsp

CANONFARMA PRODUCTION, CJSC Russia

Representation: & nbspCANONFARMA PRODUCTION CJSC CANONFARMA PRODUCTION CJSC Russia

Information update date: & nbsp07.12.2017

Illustrated instructions

Instructions

Carbamazepine (Carbamazepine)