What is a significant consideration when prescribing carbamazepine to older adults?

The consideration regarding carbamazepine use in older adults that stands out is the risk of hyponatremia due to the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH). Carbamazepine is known to potentially cause or exacerbate electrolyte imbalances, particularly hyponatremia, which can have serious consequences in older adults including confusion, seizures, and potentially life-threatening complications. Older adults may also have a decreased ability to regulate sodium levels due to age-related changes in kidney function, making them more susceptible to the effects of medications that can influence sodium balance.

It's important to monitor sodium levels closely in these patients and to consider alternative treatment options if the risk is deemed too significant. This concern will guide prescribing practices, ensuring that benefits of treatment outweigh the risks for this vulnerable population.