What is the most important information I should know about carbamazepine?
You should not take carbamazepine if you have a history of bone marrow suppression, or if you are allergic to carbamazepine or to an antidepressant such as amitriptyline, desipramine, doxepin, imipramine, or nortriptyline.
TELL YOUR DOCTOR ABOUT ALL OTHER MEDICINES YOU USE. Some drugs can raise or lower your blood levels of carbamazepine, which may cause side effects or make carbamazepine less effective. Carbamazepine can also affect blood levels of certain other drugs, making them less effective or increasing side effects.
Carbamazepine may cause serious blood problems or a life-threatening skin rash. Call your doctor if you have a fever, unusual weakness, bleeding, or a skin rash (no matter how mild).
Do not stop taking carbamazepine without asking your doctor first, even if you feel fine.
If you are pregnant, do not start or stop taking carbamazepine without your doctor's advice.
What is carbamazepine?
Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain.
Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. Carbamazepine is also used to treat bipolar disorder.
Carbamazepine may also be used for purposes not listed in this medication guide.
What should I discuss with my healthcare provider before taking carbamazepine?
You should not take carbamazepine if you have a history of bone marrow suppression, or if you are allergic to carbamazepine or to an antidepressant such as amitriptyline, desipramine, doxepin, imipramine, or nortriptyline.
Do not use carbamazepine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include furazolidone, isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.
Carbamazepine may cause severe or life-threatening skin rash, and especially in people of Asian ancestry. Your doctor may recommend a blood test before you start the medication to determine your risk.
To make sure carbamazepine is safe for you, tell your doctor if you have any of these conditions:
- heart disease, high blood pressure, high cholesterol or triglycerides;
- liver or kidney disease;
- glaucoma;
- a thyroid disorder;
- lupus;
- porphyria; or
- a history of mental illness, psychosis, or suicidal thoughts or actions.
You may have thoughts about suicide while taking carbamazepine. Tell your doctor if you have symptoms of depression or suicidal thoughts. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Follow your doctor's instructions about taking seizure medication if you are pregnant. Do not start or stop taking this medicine without your doctor's advice, and tell your doctor right away if you become pregnant. Carbamazepine may cause harm to an unborn baby, but having a seizure during pregnancy could harm both mother and baby. The benefit of preventing seizures may outweigh any risks to the baby.
Carbamazepine can make birth control pills or implants less effective. Use a barrier form of birth control (such as a condom or diaphragm with spermicide) to prevent pregnancy while taking carbamazepine.
Carbamazepine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using carbamazepine.
How should I take carbamazepine?
Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole.
You may open the extended-release capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.
Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
The chewable tablet must be chewed before you swallow it.
It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and call your doctor promptly if this medicine seems to stop working as well in preventing your seizures.
While using carbamazepine, you may need frequent blood tests at your doctor's office.
Do not stop taking carbamazepine without asking your doctor first, even if you feel fine. You may have increased seizures or unpleasant withdrawal symptoms if you stop using carbamazepine suddenly.
Store at room temperature away from moisture, heat, and light.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking carbamazepine?
This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Drinking alcohol can increase some of the side effects of carbamazepine, and can also increase your risk of seizures.
Avoid exposure to sunlight or tanning beds. Carbamazepine can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
Grapefruit and grapefruit juice may interact with carbamazepine and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.
What are the possible side effects of carbamazepine?
Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Report any new or worsening symptoms to your doctor, such as: sudden mood or behavior changes, depression, anxiety, insomnia, or if you feel agitated, hostile, restless, irritable, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have:
- the first sign of any skin rash, no matter how mild;
- slow, fast, or pounding heartbeats;
- feeling light-headed or short of breath;
-
blood problems --sudden weakness or ill feeling, fever, chills, pale skin, sore throat, bleeding gums, nosebleeds;
-
liver problems --nausea, upper stomach pain, itching, tiredness, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
-
low levels of sodium in the body --headache, confusion, slurred speech, severe weakness, feeling unsteady;
-
severe skin reaction --fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Common side effects may include:
- dizziness, loss of coordination, problems with walking;
- nausea, vomiting; or
- drowsiness.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect carbamazepine?
Sometimes it is not safe to use certain medications at the same time. Some drugs can raise or lower your blood levels of carbamazepine, which may cause side effects or make carbamazepine less effective. Carbamazepine can also affect blood levels of certain other drugs, making them less effective or increasing side effects.
Taking carbamazepine with other drugs that make you sleepy or slow your breathing can increase these effects. Ask your doctor before taking carbamazepine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Many drugs can interact with carbamazepine. Not all possible interactions are listed here. TELL YOUR DOCTOR ABOUT ALL OTHER MEDICINES YOU USE, and any you start or stop using during treatment with carbamazepine, especially:
- theophylline;
- birth control pills or hormone replacement therapy;
- an antibiotic, or drugs to treat tuberculosis;
- antifungal medication such as fluconazole or ketoconazole;
- a blood thinner such as warfarin, Coumadin;
- cancer medicines;
- a diuretic or "water pill";
- heart or blood pressure medication;
- HIV or AIDS medications;
- medication to treat depression or mental illness, such as aripiprazole or lithium;
- medicines to prevent organ transplant rejection;
- other seizure medications, such as valproic acid;
- steroid medication; or
- thyroid replacement medication.
This list is not complete and many other drugs can interact with carbamazepine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.
Where can I get more information?
Your pharmacist can provide more information about carbamazepine.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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