A review on carbamazepine in the treatment of epilepsy

Epilepsy is a chronic, debilitating neurological disorder defined by recurrent, unprovoked seizures and substantially reduces the quality of life of patients with the disease. Carbamazepine (CBZ) is one of the most commonly prescribed antiepileptic drugs (AEDs) for the management of focal and generalized tonic-clonic seizures. It mainly provides therapeutic effects by stabilizing hyperexcitable neuronal membranes and preventing repetitive firing through voltage gated sodium channel blockade. Although carbamazepine shows undeniable effectiveness, its clinical significance is limited by the emergence of dose-dependent adverse effects, drug resistance, metabolic interactions, and genetic variations of individual patients.

During the course of this review, we examine, in detail, the historical background of carbamazepine, its chemical structure, pharmacokinetics, mechanism of action, therapeutic efficacy and clinical applications in epilepsy management. Also, it reviews the drug's safety profile, including its adverse events, drug-drug interactions and contraindications. It also highlights recent inventions in drug delivery systems when embedding CBZ such as lipid nanocarriers and other new formulations that might be used to enhance CBZ bioavailability to improve therapeutic results and reduce side effects. In addition, the role of pharmacogenomics in personalizing CBZ therapy is reviewed along with interindividual differences in drug metabolism and tailored treatment.

While a mainstay in the management of epilepsy, research continues to assess the best formulation of CBZ, better side effects as well as alternative strategies with a goal of optimized seizure control. Through a critical review of the current literature, this review presents new perspectives on the role of carbamazepine in the management of epilepsy, highlighting recent trends, emerging challenges, and future research and clinical perspectives.