VetSheet

卡馬西平

Carbamazepine

5H-Dibenz[b,f]azepine-5-carboxamide

抗癲癇藥 / 神經痛鎮痛藥 / 行為修飾劑PO狗馬

別名: Tegretol · Carbatrol · Epitol · Equetro · G-32883 · carbamazepinum · karbamatsepiini · karbamazepinas

由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本

4-8 mg/kg PO q12hPO· q12h
— 🐕

劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。

各物種劑量

🌎 NA — North America🌍 EU — Europe

狗

適應症劑量途徑頻次療程地區
As a psychotherapeutic agent4-8 mg/kg PO q12hPOq12h—🌎 NA
  • As a psychotherapeutic agent: Not commonly used, but may have some utility in dogs that seem to have amygdalar hyperactivity; sometimes used in conjunction with SSRIs to control explosive aggression.

馬

適應症劑量途徑頻次療程地區
For photic head shaking10 mg/kg PO q6h or 29 mg/kg PO q12hPOq6h or q12h—🌎 NA
  • For photic head shaking: May be helpful in some horses that do not respond to cyproheptadine.

劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。

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概覽

卡馬西平（Carbamazepine）是一種二苯并氮雜䓬亞胺類衍生物，化學結構上與三環類抗憂鬱藥丙咪嗪（imipramine）相關。

​臨床要點：​ 雖然在人類醫學中廣泛用作主要的抗癲癇藥和情緒穩定劑，但其在獸醫學（特別是犬隻）中的實用性受到其快速肝臟自體誘導（autoinduction）的嚴重限制。犬隻在治療幾天後代謝該藥物的速度極快，使得維持治療血清濃度變得極其困難。

由於這種藥代動力學的限制，它很少用於動物的癲癇控制。相反，在獸醫學中，它主要保留用於：

  • 犬隻的​行為醫學​（例如，控制杏仁核過度活躍或爆發性攻擊行為，通常與 SSRI 併用）。
  • 馬匹的​神經病理性疼痛​或特定的神經系統疾病，如對賽庚啶（cyproheptadine）等其他治療無效的​光照性甩頭症（photic head shaking）​。

作用機制

Carbamazepine primarily acts by blocking voltage-gated sodium channels in neuronal membranes.

  • ​Mechanism:​ Binds preferentially to the inactive state of sodium channels → delays their recovery → inhibits repetitive neuronal firing and stabilizes hyperexcited neural membranes.
  • It also decreases the synaptic transmission of excitatory impulses and may reduce the release of the excitatory neurotransmitter glutamate.
  • Structurally related to tricyclic antidepressants, it also possesses mild anticholinergic, antidiuretic, and muscle relaxant properties.

安全性與警告

禁忌症

  • Patients receiving MAO Inhibitors (e.g., selegiline) within the past 14 days
  • Patients with a history of bone marrow depression
  • Known hypersensitivity to carbamazepine or tricyclic antidepressants

不良反應

  • Sedation and lethargy
  • Ataxia (unsteadiness)
  • Gastrointestinal upset (vomiting, anorexia)
  • Hepatotoxicity (elevated liver enzymes)
  • Blood dyscrasias (rare but possible bone marrow suppression)

注意事項

Use with extreme caution due to extensive drug interactions (it is a potent inducer of hepatic enzymes). In dogs, it rapidly induces its own metabolism (autoinduction), making long-term therapeutic dosing difficult. May interfere with thyroid function tests (decreased values) and some pregnancy tests, though veterinary significance is unclear.

藥物相互作用

Azole Antifungals (e.g., Ketoconazole, Itraconazole)

May increase plasma levels or effects of carbamazepine

Calcium Channel Blockers (e.g., Diltiazem, Verapamil)

May increase plasma levels or effects of carbamazepine; Carbamazepine may also decrease their effects

Cimetidine

May increase plasma levels or effects of carbamazepine

Danazol

May increase plasma levels or effects of carbamazepine

Grapefruit Juice

May increase plasma levels or effects of carbamazepine

Isoniazid

May increase plasma levels or effects of carbamazepine; Carbamazepine may also increase effects of Isoniazid

Macrolides (e.g., Erythromycin, Clarithromycin)

May increase plasma levels or effects of carbamazepine

MAO Inhibitors (e.g., Selegiline)

Contraindicated; discontinue MAOI at least 14 days prior to carbamazepine

Niacin

May increase plasma levels or effects of carbamazepine

SSRI Antidepressants (e.g., Fluoxetine)

May increase plasma levels or effects of carbamazepine

Tricyclic Antidepressants (e.g., Clomipramine, Amitriptyline)

May increase plasma levels or effects of carbamazepine; Carbamazepine may also decrease their effects, though it can increase Clomipramine levels

Valproic Acid

May increase plasma levels or effects of carbamazepine; Carbamazepine may decrease its effects and increase risk for phenobarbital toxicity

Barbiturates (e.g., Phenobarbital)

May decrease plasma levels or effects of carbamazepine

Cisplatin

May decrease plasma levels or effects of carbamazepine

Doxorubicin

May decrease plasma levels or effects of carbamazepine

Felbamate

May decrease plasma levels or effects of carbamazepine

Phenytoin

May decrease plasma levels or effects of carbamazepine

Primidone

May decrease plasma levels or effects of carbamazepine

Rifampin

May decrease plasma levels or effects of carbamazepine

Theophylline

May decrease plasma levels or effects of carbamazepine

Acetaminophen

Carbamazepine may decrease its effect by lowering serum concentrations

Benzodiazepines

Carbamazepine may decrease its effect by lowering serum concentrations

Bupropion

Carbamazepine may decrease its effect by lowering serum concentrations

Buspirone

Carbamazepine may decrease its effect by lowering serum concentrations

Cyclosporine

Carbamazepine may decrease its effect by lowering serum concentrations

Doxycycline

Carbamazepine may decrease its effect by lowering serum concentrations

Glucocorticoids

Carbamazepine may decrease its effect by lowering serum concentrations

Lamotrigine

Carbamazepine may decrease its effect by lowering serum concentrations

Levothyroxine

Carbamazepine may decrease its effect by lowering serum concentrations

Methadone

Carbamazepine may decrease its effect by lowering serum concentrations

Mirtazapine

Carbamazepine may decrease its effect by lowering serum concentrations

Non-depolarizing muscle blockers (e.g., Atracurium)

Carbamazepine may decrease its effect by lowering serum concentrations

Praziquantel

Carbamazepine may decrease its effect by lowering serum concentrations

Topiramate

Carbamazepine may decrease its effect by lowering serum concentrations

Tramadol

Carbamazepine may decrease its effect by lowering serum concentrations

Zonisamide

Carbamazepine may decrease its effect by lowering serum concentrations

Trazodone

Carbamazepine may decrease its effect by lowering serum concentrations

Warfarin

Carbamazepine may decrease its effect by lowering serum concentrations

監測

  • Complete Blood Count (CBC)
  • Liver function tests
  • Clinical efficacy and behavioral changes

藥物動力學

半衰期

狗Initially ~15 hours, but drops to 1-2 hours after chronic dosing due to autoinduction.

吸收

Variable and relatively slow oral absorption.

分佈

Widely distributed into tissues; highly protein-bound.

代謝

Extensively metabolized in the liver. In dogs, it is a potent inducer of hepatic microsomal enzymes and rapidly induces its own metabolism (autoinduction) within days of starting therapy.

排除

Excreted primarily in the urine as metabolites.

過量

Overdose can lead to significant CNS depression, severe ataxia, tremors, seizures, respiratory depression, and cardiovascular abnormalities (tachycardia, hypotension). Treatment is primarily supportive and symptomatic, including gastric decontamination if caught early, IV fluids, and respiratory support. Seizures should be treated with standard anticonvulsants (e.g., diazepam, phenobarbital).

可用產品

劑型

  • Oral Tablets
  • Oral Chewable Tablets
  • Extended-Release Tablets/Capsules
  • Oral Suspension

人用標示

  • Carbamazepine Oral Tablets: 100 mg (regular and chewable), & 200 mg (Tegretol, Epitol, generic)
  • Carbamazepine Oral Tablets or Capsules Extended-Release (12-hour) (Tegretol XR, Carbatrol, Equetro, generic)
  • Carbamazepine Oral Suspension (Tegretol, generic)

各地核准狀態

暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

儲存與穩定性

Store below 30°C (86°F) in airtight containers, as humid conditions can reduce potency by up to one-third. Protect from light. Compounded oral suspension (40 mg/mL in simple syrup) retains >90% potency for 90 days stored at both 5°C and 25°C, but must be protected from light and shaken vigorously before use.

飼主須知

您的獸醫師為您的寵物開立了卡馬西平（Carbamazepine）。請仔細閱讀以下資訊：

  • ​標示外使用（Off-Label Use）：​ 此藥物在獸醫學中屬於「標示外使用」。它並不常用，您的獸醫師是根據您寵物特定的行為或神經系統需求而開立的。
  • ​嚴格遵守給藥時間：​ 務必完全按照指示給藥。因為動物代謝這種藥物的速度非常快，漏服一次可能會導致藥效喪失。它通常需要頻繁給藥。
  • ​觀察事項：​ 觀察您的寵物是否有嗜睡、步態不穩（共濟失調）或腸胃不適（嘔吐、食慾不振）的跡象。

​重要提示：​ 如果發現任何異常行為、嚴重嘔吐或眼睛/牙齦發黃（黃疸），請立即向您的獸醫師報告，因為這些可能是肝臟壓力或不良反應的徵兆。

VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠方最新藥品說明書。