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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

PubMedEpilepsy & behavior : E&B2026-07-24

Infertility treatment in women with epilepsy: A systematic review.

Alshaqi Ola O, Maisenbacher Mathias M, Nofal Yazan Y, Sane Caroline C et al.

The impact of assisted reproductive technologies (ART) on seizure control in women with epilepsy remains incompletely understood. A systematic review was conducted according to PRISMA guidelines. EMBASE, MEDLINE, CINAHL, Scopus, and the Cochrane Library were searched from inception to March 2025. Eligible studies included observational studies and case-based reports involving women undergoing infertility treatment. A total of 1216 publications were identified, of which four studies met the inclusion criteria, including case reports, a case series, and a cohort study. These studies included 16 women aged 25-46 years undergoing infertility treatment, all but one of whom had epilepsy. Interventions involved in vitro fertilization (IVF), ovulation induction, and hormonal therapies. Patients were treated with a range of antiseizure medications (ASMs), including carbamazepine, clobazam, lamotrigine, levetiracetam, oxcarbazepine, valproate, and zonisamide, either as monotherapy or in combination. Seizure frequency was generally stable, with most patients maintaining baseline seizure control. Seizure exacerbations were uncommon and primarily associated with hormonal therapy and reduced ASM levels, particularly reduced lamotrigine levels. Reported events included breakthrough seizures in the setting of decreased lamotrigine concentrations, seizure clusters associated with follitropin beta, and a new-onset seizure following dehydroepiandrosterone exposure. Across studies, multiple ART attempts resulted in live births with different ASM regimens, as well as in patients not receiving ASMs. Available evidence suggests that ART is feasible in women with epilepsy, with most patients maintaining stable seizure control. Hormonal therapy may affect ASM pharmacokinetics and seizure threshold, thereby warranting close monitoring. Larger prospective studies are needed to better define ASM-specific effects and optimize care.

PMID 42492305
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PubMedThe Science of the total environment2026-07-24

Identification of organic micropollutants and transformation processes in an agricultural and urban river catchment applying target and non-target analysis.

Buss Johanna J, Achten Christine C

The presence of organic micropollutants in highly modified lowland rivers is a growing concern for the environment and human health. This study employs both target and non-target analysis over two years with high spatiotemporal resolution in the Münstersche Aa River which is influenced by both agricultural and urban land use to identify major stressors, their input pathways and the impact of low-flow conditions. Treated wastewater is the major input pathway for pharmaceuticals, illicit drugs as well as for pesticides and biocides. Moreover, urban and agricultural non-point sources contribute to the input of organic micropollutants. Database search identified sartans as a therapeutic class of pharmaceuticals of interest in the river and spatiotemporal analysis for two years showed wastewater treatment plants as the major input source with highest concentrations of >1 μg/L in summer at low-flow conditions for the sartans. Thereby, mean concentrations of candesartan and valsartanic acid as well as the carbamazepine metabolite 10,11-dihydro-10,11-dihydroxycarbamazepine exceeded health orientation values. For the first time, the UV protection agent 2-[4-(Diethylamino)-2-hydroxybenzoyl] benzoic acid (DHHB) was tentatively identified in a river. Fold change analysis at Lake Aasee, which is a small, shallow reservoir lake in the Münstersche Aa River system, stagnant at low and flowing at high discharge, revealed that elimination and associated formation processes are responsible for the changing occurrence of features at the inflow and outflow of the lake. The exact mechanisms need to be further evaluated. The present study provides valuable insights to stressors in high modified water bodies and shows that fold change analysis after non-target data processing is a valuable tool to gain insights into transformation processes in lakes and rivers which can aid in prioritizing research in the future.

PMID 42492224
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PubMedEpileptic disorders : international epilepsy journal with videotape2026-07-24

The effectiveness of adding on or switching antiseizure medications after the first fails to control focal epilepsy: A systematic review of randomized controlled trials.

Egesa Isaac J IJ, Mbizvo Gashirai G, Maden Michelle M, Spain Thomas T et al.

Focal epilepsy constitutes 60-70% of epilepsy, and up to half of patients do not achieve seizure freedom with their first antiseizure medication (ASM). When the first ASM fails, evidence guiding whether to switch or add-on another ASM and which ASMs to use is limited. This review synthesized evidence from randomized controlled trials (RCTs) on the comparative effectiveness of subsequent ASMs after first ASM failure in focal epilepsy. Following a pre-registered protocol (PROSPERO: CRD42025603003) and PRISMA guidelines, we included RCTs involving children or adults with focal epilepsy who failed first ASM therapy for any reason. The primary outcomes were seizure remission and responder rate (≥50% reduction in seizure frequency). Searches were conducted across major databases in February 2025. Risk ratios with 95% confidence intervals were calculated in R. Meta-analysis was not performed due to heterogeneity. Six RCTs (961 participants) published between 1998 and 2012 met inclusion criteria, assessing seven ASMs under add-on or switch strategies. Trial duration ranged from 12 to 52 weeks; most were judged high risk of bias (ROB-2). Seizure remission end-point was assessed at a short-term endpoint of 3 months. Remission rates ranged from 11 to 43% for add-on and 8-43% for switch trials; response rates were 34-63% and 38-76%, respectively. Valproate showed higher responder rates than primidone (RR 1.52, 95% CI 1.01-2.28) in an add-on trial, while lamotrigine had a lower responder rate than valproate (RR 0.74, 95% CI 0.55-0.99) in one trial. In a switch strategy, lamotrigine showed lower treatment failure rates than valproate (RR 0.61; 95% CI 0.45-0.83) and fewer adverse effects than carbamazepine and valproate. Evidence guiding treatment decisions after the first ASM failure remains limited and outdated. Seizure outcomes were modest and comparable across treatment strategies, with few significant differences between ASMs. The small number of trials, short follow-up for endpoints, and methodological heterogeneity across trials constrain interpretation and clinical applicability. Leveraging observational data with causal inference methods, alongside pragmatic trials evaluating machine-learning-guided ASM selections, is needed to address this evidence gap and improve seizure management.

PMID 42495800
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PubMedGeriatrics (Basel, Switzerland)2026-07-24

Hyponatraemia in Neck of Femur Fracture: A Narrative Review of Epidemiology, Pathophysiology, and Outcomes.

Heidari Amirmohammad A, Heidary Kiana K, Leelo Hussain Aladdin HA, Ahmed Mohamed H MH

Background: Hyponatraemia is the commonest electrolyte disturbance encountered in older adults admitted with neck of femur (NOF) fracture. It is now recognised both as associated with fragility fracture and as an independent prognostic indicator for adverse post-operative outcomes. Methods: Narrative review of the literature, with emphasis on cohort studies, meta-analyses and mechanistic investigations pertinent to hip fracture in adults. Results: Admission hyponatraemia affects approximately 13-20% of NOF patients, twice the prevalence observed in age-matched community-dwelling elders and broadly comparable to general geriatric inpatients. A further 20-30% develop in-hospital, predominantly post-operative, hyponatraemia. Mild hyponatraemia (130-135 mmol/L) accounts for 75-85% of cases. Pathophysiology is multifactorial: hypovolaemia from the fracture haematoma, fasting and pre-admission "long lie"; drug effects (thiazides, selective serotonin reuptake inhibitors (SSRIs), proton pump inhibitors, carbamazepine, opioids); and non-osmotic arginine vasopressin (AVP) release driven by pain, nausea and peri-operative stress. Chronic hyponatraemia is hypothesised to contribute to fracture risk through three convergent mechanisms, direct sodium-dependent stimulation of osteoclastogenesis with AVP-mediated bone resorption, subtle cerebral dysfunction producing gait and attention deficits, and sarcopenia, although much of this mechanistic evidence derives from animal and in vitro studies rather than from patients with hip fracture. Hyponatraemia is reproducibly associated with longer length of stay, delayed surgery, and an adjusted 30-day mortality hazard of approximately 1.15-1.40. A dose-response relationship with severity is demonstrable; pre-operative correction has not been shown to improve outcomes in any randomised trial. Conclusions: Hyponatraemia in NOF fracture is consistently a consequence of the acute event and, at minimum, a robust marker of frailty and adverse prognosis. Whether it also causally contributes to fracture risk remains unproven, since the supporting human evidence is entirely observational and mechanistic, each contributing study carries methodological weaknesses that warrant caution, and no interventional study has established causality. Where hyponatraemia is mild and isolated, current evidence does not support delaying surgery; moderate and severe hyponatraemia warrant individualised assessment, with cautious correction proceeding alongside surgical planning rather than postponing it. Given the absence of interventional evidence, no correction strategy can yet be recommended to improve fracture or surgical outcomes. Prospective trials of targeted correction strategies and rehabilitation outcomes are overdue.

PMID 42496351
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PubMedClinical case reports2026-07-23

Seronegative Morvan Syndrome Presenting With Agrypnia Excitata and Peripheral Nerve Hyperexcitability: A Phenotype-Supported Diagnostic and Therapeutic Approach in a Resource-Limited Setting.

Taha Hatem Mousa HM, Taha Khaled Hatem KH

We report a 63-year-old Palestinian man with seronegative Morvan syndrome presenting with the complete clinical triad: continuous neuromyotonia with visible myokymia, severe insomnia consistent with agrypnia excitata phenotype (2-3 h/night; Insomnia Severity Index [ISI] 24/28, validated Arabic version), tachycardia (118 bpm), profuse diaphoresis, and 13-kg weight loss. Electromyography (EMG) demonstrated characteristic myokymic (40-150 Hz) and neuromyotonic (> 150 Hz) discharges across 12 muscles without denervation. Brain MRI, CSF analysis, and comprehensive malignancy screening were unremarkable. Validated cell-based assays confirmed seronegativity for CASPR2 and LGI1 in both serum and CSF. A phenotype-supported diagnosis was pursued integrating the clinical triad, electrophysiological confirmation, and systematic exclusion of mimics. Combined immunotherapy (intravenous methylprednisolone, prednisone taper, azathioprine) and symptomatic treatment (carbamazepine, melatonin) resulted in marked clinical improvement at 6 months: Medical Research Council (MRC) sum score 48 → 58/60, creatine kinase (CK) 928 → 185 U/L, ISI 24 → 4, and sleep restored to 7-8 h/night, with no significant adverse effects. This case illustrates a phenotype-supported diagnostic approach applicable in resource-limited settings where first-line biological therapies are unavailable.

PMID 42487658
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PubMedWater research2026-07-23

Engineering interface-confined electronic bridge via Mo-S-Fe-O-Mo structure to boost Fenton-like performance for Efficient Porous Aquifer Decontamination.

Wang Nana N, Xu Ximeng X, Wu Zizhen Z, Li Mingyu M et al.

The constrained persulfate affinity and sluggish Fe(II)/Fe(III) cycling limit Fe-based Fenton catalysts for in-situ groundwater remediation. Herein, an interface-confined Mo-S-Fe-O-Mo electron bridge was designed and constructed onto the Fe-based catalyst surface, enabling electronic coupling between Fe and Mo sites via O- and S- bridges. The obtained catalyst exhibits outstanding performance in activating peroxymonosulfate (PMS) to degrade diverse organic pollutants with extraordinary utilization efficiency and sustaining long-term stability. The degradation rate of carbamazepine reached to 3.78 min-1, increasing by 56 times compared with the other systems. Theoretical analyses reveal that the Fe-centered electron bridge enhances the electron delocalization of the bridge Fe site through the lateral pulling effect of the adjacent electronegative Mo sites, thereby facilitating PMS adsorption and subsequent electron transport. Furthermore, the bidirectional Mo-S-Fe-O-Mo bridge accelerates Mo-to-Fe electron transfer, promoting Fe(II)/Fe(III) redox cycling. Consequently, both radical and non-radical oxidation regimes are enhanced, resulting in a much higher and long-lasting pollutants removal capability. After rheological tuning, the catalyst suspension migrates smoothly through porous media and remediate simulated contaminated-aquifer via the Fenton reaction. This work provides guidance for synthesizing Fenton-like catalysts through incorporating structural features, offering a novel promotion strategy for groundwater remediation.

PMID 42485901
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