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carbamazepine (Carbella / Carnexiv)

✓ Approved

Ligand Pharmaceuticals · SCN1A · Small Molecule

What is carbamazepine?

carbamazepine is a small molecule developed by Ligand Pharmaceuticals. It is approved for therapeutic indications via injectable (others) or intravenous (iv).

Drug Profile

Brand NamesCarbella, Carnexiv
CompanyLigand Pharmaceuticals
Drug ClassSmall Molecule
Molecular TargetSCN1A, SCN2A, SCN3A
RouteInjectable (Others), Intravenous (IV)
StatusApproved
Sources: ClinicalTrials.gov, Ligand Pharmaceuticals

Mechanism of Action

Molecular Targets

carbamazepine acts on 3 molecular targets:

SCN1Asodium voltage-gated channel alpha subunit 1 (DEE6B, FEB3)
SCN2Asodium voltage-gated channel alpha subunit 2 (Na(v)1.2, BFNIS)
SCN3Asodium voltage-gated channel alpha subunit 3 (Nav1.3, NAC3)
Want deeper analysis?Noah AI can explain complex mechanisms and compare to similar drugs.

Therapeutic Indications

carbamazepine is developed for 1 unique indication across 1 therapeutic area.

Therapeutic AreaConditionPhase
Nervous system disordersGeneralised tonic-clonic seizure✓ Approved

Related Research Articles

PubMedAnnals of Indian Academy of Neurology2026-05-22

Idiopathic Limb Myokymia in Children: First Reported Cases Involving the Extensor Digitorum Brevis and Flexor Hallucis Brevis Muscles.

Işikay Sedat S

Idiopathic limb myokymia is an uncommon presentation of peripheral nerve hyperexcitability, characterized by spontaneous, continuous, grouped motor unit discharges in the absence of an identifiable structural, metabolic, or autoimmune cause. Although peripheral nerve hyperexcitability is frequently associated with voltage-gated potassium channel complex antibodies, antibody-negative cases are well recognized and are thought to reflect functional membrane instability or ion channel dysfunction at the level of the distal motor axon. Pediatric presentations are rare, particularly when limited to intrinsic foot muscles. We report two cases of pediatric patients with isolated distal lower limb myokymia. A 13-year-old girl presented with persistent involuntary toe movements. Needle electromyography (EMG) demonstrated typical myokymic discharges, consisting of rhythmic or semi-rhythmic, grouped motor unit potentials firing at 2-60 Hz in the extensor digitorum brevis muscle. A 15-year-old boy exhibited continuous contractions of the right foot, localized to the flexor hallucis brevis muscle, with similar myokymic discharges confirmed on EMG. Comprehensive evaluation, including laboratory and neuroimaging studies, excluded secondary etiologies in both cases, supporting a diagnosis of exclusion. Both patients were treated with carbamazepine, a sodium channel blocker aimed at reducing axonal hyperexcitability, resulting in complete clinical resolution within 1 month, with no recurrence during follow-up. These cases emphasize that focal intrinsic foot muscle myokymia can occur in children without detectable autoimmune markers and likely reflects localized motor axon hyperexcitability. Recognition of characteristic EMG features is critical to differentiate myokymia from fasciculations, neuromyotonia, or other movement disorders and to guide appropriate therapy.

PMID 42172142
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PubMedEnvironmental pollution (Barking, Essex : 1987)2026-05-22

Diversity of contaminants of emerging concern in a semi-arid groundwater system.

El Meknassi Chifae C, Tweed Sarah S, Baduel Christine C, Nguyen Tuyet T N TTN et al.

A total of 65 groundwater sites within a semi-arid aquifer were analysed for 77 contaminants of emerging concern (CECs), including 33 pharmaceuticals and personal care products (PPCPs), 17 pesticides, and 27 industrial compounds. Only 2 sites showed no detections. Detection frequencies were 90% for PPCPs, 44% for pesticides, and 67% for industrial compounds. Common CECs included ethyl-paraben, fluconazole, sulfamethoxazole, PFOS, PFOA, and BTSA. Total CEC concentrations ranged from below detection to 1898 ng L-1, where antimicrobials (fluconazole ≤ 208 ng L-1, median: 5.3 ng L-1), antibiotics (sulfamethoxazole ≤ 31.4 ng L-1, median: 3.6 ng L-1), and stimulants (caffeine ≤ 233 ng L-1, median: 2.9 ng L-1) were most prevalent. Industrial CECs were also frequent (e.g., BTSA ≤ 285.5 ng L-1, median: 44.5 ng L-1). Pesticides occurred at 29% of sites, mainly metolachlor (≤ 22 ng L-1, median: 0.9 ng L-1) and 2,4-D (≤ 3.1 ng L-1, median: 0.7 ng L-1). Spatial and statistical analyses linked wastewater treatment plants (WWTPs) as key CEC sources. CEC diversity was greatest within 3 km of WWTPs, and importantly, carbamazepine, caffeine, and BTSA were identified as highly persistent and mobile compounds, extending up to 18 km downgradient. This long-range transport demonstrates their role as powerful indicators of regional-scale groundwater contamination and reveals a significant risk of far-field pollution beyond immediate source areas. Spearman correlations revealed few significant links between CECs and proximity to hotspots, suggesting diffuse pollution from urban, industrial, and irrigation sources. Depth to groundwater had no effect on CEC presence, indicating aquifer-wide vulnerability. These findings highlight widespread, persistent contamination in drought-impacted semi-arid aquifers, driven largely by WWTPs and urban runoff, emphasizing the need for integrated groundwater protection strategies.

PMID 42167528
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PubMedEnvironmental pollution (Barking, Essex : 1987)2026-05-22

The occurrence and removal of antibiotic residues and antibiotic resistance genes in the largest European constructed wetland at Orhei (Moldova).

Wolacewicz Mikolaj M, Decewicz Przemyslaw P, Valdes Maria Eugenia ME, Iaconi Oana-Simina OS et al.

Constructed wetlands (CWs) are increasingly promoted as low-cost, nature-based solutions for wastewater treatment, particularly in low- and middle-income countries (LMICs), yet their performance in removing pharmaceutical compounds, antibiotic resistance genes (ARGs), and bacterial pathogens remains insufficiently characterized under real-field-scale conditions. Here, we investigated the fate of pharmaceutical compounds (including antibiotic residues), wastewater bacterial communities, and the associated ARGs in the largest European passive treatment system, the vertical-flow CW of Orhei (Moldova), serving nearly 26,000 inhabitants. Metagenomic profiling revealed 783 bacterial families, with a reduction from 33 families in raw sewage to 25 in the final effluent and clear enrichment of autochthonous wetland taxa. A total of 150 ARG types conferring resistance to 16 antibiotic classes were detected. The cumulative ARG load decreased by approximately 78% from influent to effluent. ARGs conferring resistance to fosfomycin, nitroimidazoles, rifamycins, streptothricin, oxazolidinones, and pleuromutilins were not detected in the final effluent, suggesting effective removal to below the detection limit of the applied metagenomic method, while sulfonamide resistance genes (sul1, sul2) persisted across all stages. Out of 29 antibiotic residues analyzed, 13 (including two sulfamethoxazole metabolites) were detected, together with 14 non-antibiotic pharmaceuticals (out of 30 residues analyzed). The removal of individual antibiotics ranged between 85 and 100%, and for other pharmaceuticals between 34 and 100%, although some compounds (e.g., carbamazepine, 10,11-epoxycarbamazepine, alprazolam) showed negative removals. Environmental risk assessment (risk quotients, RQ) indicated no significant risk to freshwater biota (RQ < 0.1) for all detected compounds in the treated effluent. Results demonstrated that a large-scale CW in the LMIC context can substantially reduce antibiotic residues and ARGs, supporting its role as an effective, nature-based component of One Health-oriented wastewater management.

PMID 42167521
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PubMedBrain injury2026-05-21

A systematic review on pharmacotherapy of post-traumatic attention impairments.

Kim Sonya S, Sood Pallavi P, Gopaul Urvashy U, Mohapatra Bijoyaa B et al.

Attention impairment is common in post-traumatic brain injury. We synthesized evidence on pharmacological treatments for adults with attention deficits in the acute-to-chronic phases. We searched Ovid MEDLINE and Cochrane Library (1946-December 2024). Two reviewers screened studies, extracted data, and assessed study quality. Risk of bias was assessed using the Cochrane Risk of Bias tool and the PEDro scale for RCTs. Levels of evidence (LoE) were determined by the Sackett framework. Twenty-nine studies met inclusion criteria across five drug classes and 14 medications. Results of LoE 1 were mixed: Methylphenidate improved classroom attention/processing speed, and exhibited neutral outcome; amantadine showed no improvement (LoE 1, 4, 5). MLC901 (a multi-herb antioxidant) improved complex attention (LoE 1). Donepezil improved sustained (LoE 1) and divided attention (LoE 4). Physostigmine/lecithin (LoE 1) and antidepressants (LoE 1, 3, 5) had mixed effects; growth hormone (LoE 4), and L-carnitine (LoE 1) showed no effect. Anticonvulsants impaired cognition (LoE 1). Methylphenidate showed the strongest evidence at lower doses. Donepezil and MLC901 showed potential benefits. Phenytoin and carbamazepine showed adverse effects on cognition. Standardized attention outcome measures and other high-quality alternative clinical trials with larger study samples are recommended to overcome the current limitations.

PMID 42165308
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PubMedEpilepsia open2026-05-21

Progressive myoclonus epilepsy in Down syndrome with Alzheimer's disease: An 11-year longitudinal study and proposed diagnostic red flags.

d'Orsi Giuseppe G, Calò Ezio E, Di Claudio Maria Teresa MT, Ferro Carmela Pia CP et al.

Individuals with Down syndrome (DS) face an ultra-high risk of Alzheimer's disease (AD). Within this continuum, Progressive Myoclonus Epilepsy (PME) has emerged as a marker of advanced neurodegeneration. Building on our 2014 characterization of this syndrome, we aimed to define its long-term natural history and pathological substrate. We conducted an 11-year longitudinal study of the original cohort of 12 DS patients with PME. Clinical progression was monitored via a three-stage model. Two additional illustrative cases (aged 50 and 58 years) underwent 18F-Flutemetamol PET to document in vivo amyloid load. The study reached a 100% mortality rate. Median survival from myoclonus onset was 4.2 years (95% CI: 3.8-4.6). All patients progressed to the terminal phase within 2.5 ± 1.1 years. Both Amyloid-PET-scanned patients revealed a massive cortical burden (Global Z-scores up to 11.55). Iatrogenic clinical worsening due to sodium channel blockers or phenobarbital was observed in 38% of cases. The high uniformity of these findings allowed for the proposal of diagnostic criteria based on a mandatory DS-AD association, a core clinical triad (myoclonus, ataxia, seizures), and supportive biomarkers. PME-DS appears to be driven by an amyloid-related excitatory-inhibitory imbalance. Massive amyloid-beta deposition in motor cortices impairs GABAergic interneurons, triggering cortical hyperexcitability. Thus, the onset of myoclonus serves as a functional marker of peak amyloid burden and terminal neurodegeneration. PME-DS with AD represents a severe electroclinical phenotype within the AD-DS continuum, likely overlapping with the widely recognized LOMEDS (Late-Onset Myoclonic Epilepsy in Down Syndrome). Myoclonus onset serves as a definitive "red flag" of a severe amyloid-driven excitatory-inhibitory imbalance and peak cortical burden, predicting rapid progression to terminal stage (median survival 4.2 years). Standardizing the proposed diagnostic criteria is essential for accurate prognostic counseling and, crucially, to avoid iatrogenic pitfalls in pharmacological management, particularly regarding the use of sodium channel blockers. This study followed 12 adults with Down syndrome who developed a severe form of epilepsy linked to Alzheimer's disease. We found that when people with Down syndrome develop jerking movements (myoclonus), it signals advanced brain changes and predicts a rapid decline, with most patients surviving only about 4 years. Brain scans showed a massive buildup of abnormal proteins in the brain. Importantly, certain common seizure medications (like phenytoin and carbamazepine) made symptoms worse in over one-third of patients. Recognizing this pattern early helps doctors provide better care, avoid harmful medications, and prepare families for what to expect.

PMID 42166529
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PubMedEnvironmental science & technology2026-05-20

Revealing the Kinetics of Fe(V/IV) Intermediates in Ferrate-Driven Contaminant Oxidation Using Dual-Probe Compounds.

Li Zhanbo Z, Jiang Yanjun Y

Ferrate (Fe(VI)) is a promising oxidant for removing trace organic contaminants (TrOCs) in water treatment, yet the reaction kinetics of its short-lived intermediates, Fe(V) and Fe(IV), remain insufficiently resolved. A dual-probe kinetic framework employing methyl phenyl sulfoxide (PMSO) and diphenyl sulfoxide (Ph2SO) was established to independently resolve the reactivity of these coexisting species. The second-order rate constants of Fe(VI), Fe(V), and Fe(IV) with the probes were first determined, revealing that buffer composition exerted a pronounced influence on Fe(V) reactivity, whereas effects on Fe(VI) and Fe(IV) were substantially weaker. Using the dual-probe approach, the kinetic parameters, including time-integrated exposures (CT values), rate constants, and relative oxidation contributions, of high-valent iron species were determined in the oxidation of two representative TrOCs, sulfamethoxazole (SMX) and carbamazepine (CBZ). Fe(V) was the dominant oxidant in borate buffer, while phosphate complexation markedly suppressed its reactivity, increasing the relative contribution of Fe(VI); Fe(IV) contributed minimally in both systems. This study provides mechanistic insight into the distinct roles of high-valent iron species and establishes a methodologically transferable kinetic framework for resolving Fe(V) and Fe(IV) reactivity under controlled aqueous conditions.

PMID 42160503
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