Carbamazepine should be used with caution by:
It should not be used by: patients with acute porphyria (a blood disorder), people with heart problems, people with problems with their bone marrow, people who have taken drugs called monoamine oxidase inhibitors (MAOIs), used to treat depression, within the last 14 days.
Also see list of precautions and interactions.
Store below 25ºC in a tightly closed container.
Carbamazepine is used to prevent or control fits, reduce severe face pain, and control mood swings.
It is an anti-convulsant.
It is used to prevent or stop certain types of seizures (fits) in patients with epilepsy, to reduce severe facial pain caused by the nerve disorder trigeminal neuralgia, and to control serious mood disorders (manic depression) in patients who do not respond to treatment with lithium.
In general this drug is used to prevent certain types of epileptic seizures (fits) known as tonic-clonic seizures (previously known as grand mal seizures) and partial seizures. Tonic-clonic seizures are generalised seizures that affect the whole brain, resulting in unconsciousness, muscle spasms, and convulsions. Partial seizures affect only part of the brain and usually do not result in unconsciousness. Partial seizures may lead to generalised seizures. Carbamazepine is not used for seizures that result in absences (brief periods where you appear not to be aware of your surroundings), also known as petit mal seizures. Carbamazepine relieves the facial pain caused by disturbance of the facial trigeminal nerve (a condition known as trigeminal neuralgia). Carbamazepine is also used to treat manic depression, a condition that results in severe and dramatic mood swings.
Benefits of being on this drug can include preventing or controlling certain types of seizures caused by epilepsy, reducing the sudden stabbing pain caused by trigeminal neuralgia, and preventing or controlling the mood swings that occur in manic depression.
Listed below are the typical uses of carbamazepine.
- Control and prevention of seizures (fits) due to certain types of epilepsy (generalised and partial seizures known as grand mal seizures); treatment of severe face pain, a disorder known as trigeminal neuralgia (this is a painful nerve condition that causes sudden, sharp, stabbing pains in the face)
On occasion your doctor may prescribe this medicine to treat a condition not on the above list. Such conditions are listed below.
- The control of serious mood disorders (manic depression) in patients who do not respond to treatment with lithium
HOW TO USE/TAKE
How often do I take it?
- This medication can be taken orally as tablets, modified release tablets, chewable tablets, or as a solution (liquid), usually two or three times a day. It can be taken during, after, or between meals. Tablets should be swallowed with a drink (if needed, tablets can first be broken into two pieces). Modified release tablets must be swallowed whole and must not be chewed or crushed. Chewable tablets should be chewed before swallowing and a drink should be taken afterwards to rinse out your mouth and make sure all parts of the tablet are swallowed. If taking carbamazepine liquid, the bottle should be shaken before measuring out the dose. Carbamazepine is also available as a suppository. Suppositories are inserted into the back passage (rectum) and should never be swallowed. Suppositories are used for short periods of treatment only (up to 7 days), generally because you are temporarily unable to swallow medication (for example after a surgical operation or if unconscious).
- Take this medication orally usually two to three times each day, during, after, or between meals.
- Use this medication regularly or for duration of prescription in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- It may take some time before the full benefit of this drug takes effect, depending on the dose given and the severity of the condition.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- Because of the way carbamazepine works, some foods may need to be avoided, such as grapefruit and grapefruit juice. Also, carbamazepine can make you feel dizzy or drowsy, especially at the start of treatment or when the dose is changed. If you are affected in this way, you should not drive or operate machinery. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.
CARBAMAZEPINE SIDE EFFECTS
Known side effects include:
- Leucopenia (a reduced number of the cells which fight infection making it easier to catch infections)
- Feeling unsteady or finding it difficult to control movements
- Feeling or being sick
- Changes in liver enzyme levels (usually without any symptoms)
- Skin reactions which may be severe
- Changes in the blood including an increased tendency to bruise or bleed
- Fluid retention and swelling
- Weight increase
- Low sodium in the blood which might result in confusion
- Double or blurred vision
- Dry mouth.
If any of these persist or you consider them severe then inform your doctor.
Stop taking carbamazepine and tell your doctor immediately if you develop any of the following symptoms:
- Serious skin reactions such as rash, red skin, blistering of the lips, eyes or mouth, or skin peelingaccompanied by fever (this may be more common in patients of Chinese or Thaiorigin)
- Mouth ulcers or unexplained bruising or bleeding
- Sore throat or high temperature, or both
- Yellowing of your skin or the whites of your eyes
- Swollen ankles, feet or lower legs
- Any signs of nervous illness or confusion
- Pain in your joints and muscles, a rash across the bridge of the nose and cheeks and problemswith breathing (these may be the signs of a rare reaction known as lupus erythematosus)
- Fever, skin rash, joint pain, and abnormalities in blood and liver function tests (these may be thesigns of a multi-organ sensitivity disorder)
- Bronchospasm with wheezing and coughing, difficulty in breathing, feeling faint, rash, itching orfacial swelling (these may be the signs of a severe allergic reaction)
- Pain in the area near the stomach.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking carbamazepine, tell your doctor or pharmacist if you are allergic to it, or to oxcarbazepine or phenytoin, have a known sensitivity to related drugs (e.g. tricyclic antidepressants), or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: a history of previous bone marrow depression, acute porphyria (a blood disorder), or atrioventicular conduction abnormalities (heart abnormalities).
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- Drinking alcohol may affect you more than usual. Discuss with your doctor whether you should stop drinking.
The elderly: carbamazepine should be used with caution in the elderly due to potential drug interactions. Also, high doses of carbamazepine could result in agitation or confusion in elderly patients.
Pregnancy and breast-feeding - please ensure you read the detailed information below
Carbamazepine is suitable to take during pregnancy. If you become pregnant while on carbamazepine you must tell your doctor straightaway. While pregnant, it is important that your epilepsy is well controlled, but this should be carefully weighed against the possible risk to the unborn child, particularly during the first three months of pregnancy. Whenever possible, carbamazepine should be the only anti-epileptic drug you take during pregnancy because the risk of abnormalities in the newborn child is higher in if you are treated with a combination of more than one anti-epileptic drug. Ask your doctor or pharmacist if you have any doubts or questions about this.
- First trimester: suitable for doctors to consider prescribing
- Second trimester: suitable for doctors to consider prescribing
- Third trimester: suitable for doctors to consider prescribing
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
You may breastfeed while taking carbamazepine but you must inform your doctor as soon as possible if you think that your baby is experiencing adverse reactions because you are taking carbamazepine e.g. excessive sleepiness or allergic skin reactions.
Ask your doctor or pharmacist if you have any doubts or questions about this.
It is sensible to limit use of medication during pregnancy and breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Before using this medicine, tell your prescriber of all the medicines you are taking including prescription medicines and medicines you have bought over the counter without a prescription. Tell your prescriber if you are taking vitamins or complementary remedies such as herbal products, as these can also interact with medicines.
If you are taking more than one medicine, these may interact with each other. Your prescriber may decide to use medicines which interact with each other if the benefit outweighs the risks. In these cases, the dose of your medicines may need to be adjusted or you may be monitored more closely.
The following medicines may interact with carbamazepine:
- Hormone contraceptives
- Hormone replacement therapy
- Any medicines for depression or anxiety
- Anticoagulants to stop your blood clotting
- Painkillers containing paracetamol, dextropropoxyphene, tramadol, or methadone
- Other medicines to treat epilepsy
- Medicines for high blood pressure or heart problems
- Antihistamines (medicines to treat allergy such as hayfever, itch, etc)
- Diuretics (water tablets)
- Cimetidine or omeprazole (medicines to treat gastric ulcers)
- Isotretinoin (a medicine for the treatment of acne)
- Metoclopramide (an anti-sickness medicine)
- Acetazolamide (a medicine to treat glaucoma, increased pressure in the eye)
- Danazol or gestrinone (treatments for endometriosis)
- Theophylline or aminophylline (for the treatment of asthma)
- Ciclosporin (used after transplant operations, but also sometimes in the treatment of arthritis or psoriasis)
- Drugs to treat schizophrenia
- Cancer drugs
- The anti-malarial drug, mefloquine
- Drugs to treat HIV
- Thyroxine used to treat hypothyroidism
- Muscle relaxants
- Bupropion used to help stop smoking
- A herbal remedy called St John's wort or hypericum
- Drugs or supplements containing vitamin B (nicotinamide)
This information does not contain all possible interactions. Therefore, tell your prescriber of all the products you are using before taking this medicine.
If you have a question or want to discuss anything about your medicine, speak to your local pharmacist.
There is no specific antidote for carbamazepine overdose. The signs and symptoms of overdosage involve the central nervous system, the cardiovascular system, or the respiratory system. Management of symptoms due to overdosage varies according to the patient’s condition and may include admission to hospital. Relapse and worsening of symptoms may occur 2 to 3 days after the overdose.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of carbamazepine or an intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.