Carbamazepine (oral)

What is the most important information I should know about carbamazepine?

You should not take this medicine if you have a history of bone marrow suppression, or if you are allergic to an antidepressant such as amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), or nortriptyline (Pamelor).

Do not take carbamazepine if you have taken an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam) in the past 14 days.

There are many other medicines that could cause a drug interaction if you take them together with carbamazepine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors.

FDA pregnancy category D. Do not use carbamazepine without telling your doctor if you are pregnant. It could harm the unborn baby.

Carbamazepine can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking carbamazepine.

Do not stop using carbamazepine without first talking to your doctor, even if you feel better. You may have increased seizures or unpleasant side effects if you stop using carbamazepine suddenly. You will need to use less and less before you stop the medication completely.

Patients of Asian ancestry may have a higher risk of developing a rare but serious skin reaction to carbamazepine. Your doctor may recommend a blood test before you start the medication to determine your risk of this skin reaction.

Carbamazepine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol, which can increase some of the side effects of carbamazepine. It may also increase the risk of seizures.

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, other seizure medicines, and medicine for depression or anxiety can add to sleepiness caused by carbamazepine. Tell your doctor if you regularly use any of these other medicines.

What is carbamazepine?

Carbamazepine is in a group of drugs called anticonvulsants. 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 other purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking carbamazepine?

Do not use this medication if you are allergic to carbamazepine or to certain antidepressants such as amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.

Do not use carbamazepine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

Patients of Asian ancestry may have a higher risk of developing a rare but serious skin reaction to carbamazepine. Your doctor may recommend a blood test before you start the medication to determine your risk of this skin reaction.

You should not take carbamazepine if you have a history of bone marrow suppression, or if you are also taking nefazodone (Serzone - no longer available in the U.S.).

Before taking carbamazepine, tell your doctor if you are allergic to any drugs, or if you have:

• a history of serious side effects from any drug;
• liver or kidney disease;
• porphyria;
• heart disease or heart block;
• lupus;
• a history of mental illness; or
• glaucoma.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take carbamazepine.

FDA pregnancy category D. Do not use carbamazepine without telling your doctor if you are pregnant. It could harm the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Carbamazepine can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking carbamazepine.

Carbamazepine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Older adults may be more sensitive to the side effects of this medicine.

How should I take carbamazepine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take this medicine with a full glass of water.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

You may open the extended-release capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow this mixture 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. To be sure you get the correct dose, measure the liquid with a marked 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. Do not take other liquid medicines at the same time.

The carbamazepine chewable tablet must be chewed before you swallow it.

Carbamazepine can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Your liver function may also need to be tested. Do not miss any scheduled appointments.

Carbamazepine can cause eye changes. Your doctor may recommend having your eyes checked regularly while you are taking this medicine.

Do not stop taking the medication even if you feel better. It is important to take carbamazepine regularly to prevent seizures from recurring. Get your prescription refilled before you run out of medicine completely. Call your doctor promptly if this medicine does not seem to be working as well in preventing your seizures.

Carry an ID card or wear a medical alert bracelet stating that you are taking carbamazepine, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking carbamazepine.

Grapefruit and grapefruit juice may interact with carbamazepine and cause unwanted side effects. Do not change the amount of grapefruit products in your diet without first talking to your doctor.

It may take up to 4 weeks of using this medicine before your symptoms improve. Do not stop using carbamazepine without first talking to your doctor, even if you feel better. You may have increased seizures or unpleasant side effects if you stop using carbamazepine suddenly. You will need to use less and less before you stop the medication completely.

Store carbamazepine at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include shallow breathing, fast heartbeat, nausea, vomiting, urinating less or not at all, muscle twitches, restlessness, tremors, slurred speech, staggering walk, and feeling light-headed or fainting.

What should I avoid while taking carbamazepine?

Carbamazepine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol. It can increase some of the side effects of carbamazepine, and can also increase your risk of seizures.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Carbamazepine can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, other seizure medicines, and medicine for depression or anxiety can add to sleepiness caused by carbamazepine. Tell your doctor if you regularly use any of these other medicines.

What are the possible side effects of carbamazepine?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
• pale skin, easy bruising or bleeding, unusual weakness;
• white patches or sores inside your mouth or on your lips;
• feeling short of breath, even with mild exertion;
• swelling of your ankles or feet;
• nausea, stomach pain, loss of appetite, jaundice (yellowing of the skin or eyes); or
• urinating less than usual.

Less serious side effects may include:

• feeling dizzy, drowsy, or unsteady;
• mild nausea, vomiting, diarrhea, constipation, stomach pain;
• confusion, headache, blurred vision;
• feeling agitated or depressed;
• ringing in your ears;
• dry mouth, swollen tongue; or
• joint or muscle pain, leg cramps.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect carbamazepine?

There are many other medicines that could cause a drug interaction if you take them together with carbamazepine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other 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 condition prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2003 Cerner Multum, Inc. Version: 8.03. Revision date: 01/02/2008.