Doctors have prescribed carbamazepine to people over 65 for many years with good results. Seniors do have a few special problems, however:

• Lower doses required, because elderly patients metabolize carbamazepine more slowly than younger adults. A 100-mg Carbatrol capsule once a day may be an appropriate dose for many seniors, especially as initial therapy.
• More possibilities for drug interactions. Usually seniors can continue to take all their medications, including carbamazepine, if the dosages are changed to compensate for the effects of interactions.
• Greater susceptibility to side effects. Some common side effects of carbamazepine, such as sleepiness or unsteadiness, may exacerbate pre-existing problems. Because Carbatrol produces more even blood levels than shorter-acting forms of carbamazepine, side effects are likely to be reduced at the same dosage.
• Greater danger of injury from falls or other accidents resulting from side effects.
• Need for more frequent monitoring of patients with glaucoma for mild pressure increases.
• Hyponatremia is much more common in seniors (especially those taking diuretics) than in young people who take carbamazepine. It is usually asymptomatic, but if severe it could be associated with seizures or cardiac arrhythmias. Early symptoms are dizziness, headache, sleepiness, and upset stomach. Fluid restriction may help, but seniors should also be cautioned about dehydration.
• Confusion or agitation has occasionally been reported in seniors taking carbamazepine. This is probably similar to the effect reported with the use of tricyclic antidepressants, a related group of medications.

Older patients and their family members should be especially encouraged to report any changes in health or behavior promptly.