Treatment Guidelines

1. Pretreatment Evaluations. CBC with differential and platelets, liver function tests, EKG, electrolytes, creatinine and physical exam.

2. Carbamazepine requires two weeks to take effect, but a therapeutic trial should last four to eight weeks before evaluating efficacy.

3. Obtain serum levels (target is 8-12 • g/mL) along with a CBC, liver function tests and electrolytes weekly for a month. The WBC should be monitored more frequently if the white count begins to drop.

4. After the first month, levels may be drawn less frequently.

5. Carbamazepine induces its own metabolism and carbamazepine levels will decline between three and eight weeks. At this time, the carbamazepine dose may need to be increased to maintain a therapeutic blood level of 8-12 • g/mL.

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