A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?
a. Ask the provider whether another medica-tion can be used for this patient, because the patient is showing signs of toxicity.
b. Contact the provider to request a complete blood count (CBC) to evaluate for other, more serious side effects.
c. Reassure the patient that these effects oc-cur early in treatment and will resolve over time.
d. Review the patient's chart for cytochrome P450 enzymes to see whether an increased dose is needed.
C
Carbamazepine can cause several neurologic side effects early in treatment, including vertigo and headaches. These resolve with continued drug use. These side effects are not related to drug toxicity. A CBC should be obtained at baseline and periodically thereafter. Carbamazepine can cause changes in hematologic laboratory values. The side effects reported by this patient are not associated with hematologic side effects. Carbamazepine induces cytochrome P450 enzymes and can accelerate its own metabolism, which would reduce the amount of drug and decrease side effects, so an increased dose is not appropriate.
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