Tudo sobre carbamazepina (Tegretol)

This video is about everything you need to know about carbamazepine in the treatment of neuropathic pain, but first I would like to remind you that this channel discusses the main diagnoses and treatments related to chronic pain, so if you are interested in this subject, consider subscribing and, if you like this information, like this because it helps our work a lot. The first point is that carbamazepine, available in pharmacies in generic form or as a reference drug, called Tegretol, is a medication in the class of anticonvulsants. As an anticonvulsant, it has the property of stabilizing neurons that cause seizures and also has the property of stabilizing some neurons that cause certain types of pain, which is what we will talk about from now on. What happens is the painful stimulus needs to travel through some neurons to reach the brain. This transmission of the impulse from one neuron to another is done through the release of various chemical substances in that region, which, ultimately, are influenced—now a very technical matter—by ion channels, sodium channels, calcium channels, potassium channels, among others. Carbamazepine acts fundamentally by blocking sodium channels, although it influences other ion channels, but mainly sodium channels. This is how it achieves its nerve-stabilizing effect. The most commonly used presentations of tablets are two: the regular-release tablet and the delayed-release tablet. The dose of carbamazepine for pain would then be from 200 to 1200 mg per day and works as follows. The regular-release tablet can be taken once, twice, or eventually three times a day. Usually, the slow-release tablet is taken once or twice a day. We prefer to start treatment with a nighttime dose to minimize some side effects during the day, especially drowsiness. I will talk about the side effects a little later. Now, a very important question: Which patients can benefit most from using this type of medication, carbamazepine? Patients with shock-like neuropathic pain. Let me explain. Neuropathic pain can manifest in various ways; some patients have burning pain, or pain that is a little more continuous. For this type of patient, pregabalin, which I've already mentioned on this channel, usually has a slightly better effect. Now, sometimes in some diseases like trigeminal neuralgia, glossopharyngeal neuralgia, or some types of diabetic neuropathy, it can then manifest with shock-like pains, in crises. For this type of pain, carbamazepine usually has a better effect when compared to pregabalin. Every medication has some contraindications for its use, that is, there are some patients who cannot use it at all. In the case of carbamazepine, these are: allergy to the medication, naturally, a history of bone marrow problems that produce blood cells, liver failure, right, so, serious liver problems, and some cardiac arrhythmias. Another very important point is the side effects; I am very sincere when I say that carbamazepine is, in fact, one of the medications that has the most side effects, it is necessary to be very attentive to them. Of course, I'm not going to talk about the entire package insert here, because it has a multitude of side effects. I'm going to talk about the most worrying and even the most frequent ones. Some of the more serious side effects, which we absolutely don't want to see, are agranulocytosis, which means an abrupt decrease in the production of blood cells by the bone marrow, and can cause very intense anemia and low sodium levels in the blood. This can even cause mental confusion and seizures. Hepatotoxicity, which means liver damage, and Stevens-Johnson syndrome, which are quite serious lesions that occur on the patient's skin. Every medication has its particularities, and I'm bringing up the most important ones regarding carbamazepine.