LACK OF CARBAMAZEPINE TOXICITY IN FRAIL NURSING-HOME PATIENTS - A CONTROLLED-STUDY

OBJECTIVE: To assess the effects of carbamazepine and placebo on measu res of toxicity in frail nursing home patients. DESIGN: A nonrandomize d, double-blind, placebo-controlled crossover study. SETTING: Two nurs ing homes in Rochester, New York. PARTICIPANTS: Twenty-five subjects ( mean age 84.5 years) with dementia. INTERVENTION: Carbamazepine and pl acebo during two 5-week periods separated by a 2-week washout. The mod al dose for each patient was 300 mg/day. MEASUREMENTS: Adverse experie nces, comorbid events, and physical signs and symptoms were assessed c ontinuously, and laboratory data were examined at the beginning and en d of each treatment period. RESULTS: One subject died with a pneumonia (and elevated white blood cell count), and one subject developed prob able carbamazepine-induced ties. There was a minimal drop in hematocri t and a slight elevation of liver enzymes, none of which was clinicall y significant. There was otherwise no excess of adversity or comorbid events on carbamazepine versus placebo, and there was no change in ele ctrolytes or other laboratory measures. CONCLUSION: The findings indic ate that carbamazepine in this dose range was well tolerated for the 5 -week treatment period in this frail sample. These data supplement the literature regarding carbamazepine toxicity, which is devoid of contr olled studies in older subjects.