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Carbamazepine

Carbamazepine

Carbamazepine is used to manage certain types of seizures, alone or in combination with other medications. It is also used to treat the nerve pain of Trigeminal Neuralgia and to treat acute mania and prevention of bipolar (manic-depressive) disorders.

Available form

Tablet, Capsule, Tablet, Tablet, Suspension

Dosage

25mg/ml, 50mg/ml, 100mg, 100mg/5ml, 200mg, 400mg

Manufacturers

Apotex, Mint Pharmaceuticals, Pharmascience, Sandoz, Taro Pharmaceuticals, Teva

Branded drugs

Tegretol, Tegretol Cr

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Carbamazepine information

Dosage

Side Effects

Available Form

Contraindications

Precautions

Warnings

Directions of use

Recommended doses of carbamazepine vary greatly, depending on the condition being treated and the age and circumstances of the person being treated.

Seizure disorder: The starting dose for adults and children over 12 years of age is 100 mg to 200 mg once or twice daily. Depending on the effectiveness of the medication, the doctor may increase the dose gradually up to 1,600 mg daily in divided doses. Most people achieve the best response at daily doses between 800 mg and 1,200 mg.

The starting dose for children between 6 and 12 years of age is 100 mg daily in divided doses and increased by 100 mg daily until the best response is achieved. The daily maximum dose for children is 1,000 mg daily in divided doses.

If carbamazepine is being added to medications that are already being taken for seizures, the starting doses may be lower.

Trigeminal neuralgia pain: The starting dose of carbamazepine for treating the pain of trigeminal neuralgia is 100 mg taken twice daily. The dose is increased to a maximum of 1,200 mg daily, depending on the effectiveness of the medication.

Mania and bipolar disorders: The usual starting dose for the treatment of mania and bipolar disorders is 200 mg to 400 mg daily, taken in divided doses. The daily dose is then increased as instructed by the doctor to a maximum of 1,600 mg daily. If other medications, such as lithium, are being taken, the starting dose will be lower.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Carbamazepine should be taken with meals whenever possible.

The controlled release tablets should be swallowed whole with some liquid during or after a meal. They should not be crushed or chewed.

When taking carbamazepine suspension, shake the medication bottle well before measuring the dose of medication. An oral syringe should be used to measure each dose of the liquid, as it provides a more accurate measurement than household teaspoons.

It is important to take Carbamazepine exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store all forms of Carbamazepine at room temperature, away from humidity, and out of reach of children. The chewable tablets and liquid should be protected from light.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Carbamazepine. If you are concerned about side effects, discuss the risks and benefits of Carbamazepine with your doctor.

The following side effects have been reported by at least 1% of people taking Carbamazepine. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

abdominal pain
Acne
clumsiness or unsteadiness
Constipation
dizziness
drowsiness
dryness of mouth or throat
hair or nail changes
headache
increased sensitivity of skin to sunlight (skin rash, itching, redness, or severe Sunburn)
increased sweating
loss of appetite
memory loss
nausea
red eyes
ringing in the ears
sexual problems (males)
taste changes
vomiting
weight gain

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

behavioural changes (e.g., confusion, agitation, or hostility)
blood pressure changes
blurred vision
breast enlargement
continuous "back-and-forth" eye movements
decreased coordination
difficulty speaking or slurred speech
double vision
fainting
Glaucoma (increased pressure in the eye, eye pain)
hallucinations (seeing or hearing things that are not there)
increase in seizures
irregular, pounding heartbeat
muscle or stomach cramps
numbness, tingling, pain, or weakness in hands and feet
painful swelling and redness along a vein
reddish-purple bumps on skin (may be itchy)
severe headache
severe nausea and vomiting
signs of allergic skin reaction (e.g., skin rash, Hives, or itching)
signs of Anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
signs of bleeding (e.g., black, tarry stools, blood in urine or stools, pinpoint-sized red spots on skin, unusual bruising, bleeding that does not stop easily)
signs of a blood clot in the arm or leg (tenderness, pain, swelling, warmth, or redness in the arm or leg) or lungs (difficulty breathing, sharp chest pain that is worst when breathing in, coughing, coughing up blood, sweating, or passing out)
signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
signs of infection (e.g., cough or hoarseness, sore throat, chills, Fever, swollen or painful glands, unusual tiredness or weakness)
signs of inflammation of the colon (e.g., abdominal pain, Diarrhea, fever)
signs of liver damage (e.g., darkening of urine, pale stools, yellow eyes or skin)
signs of low sodium in the blood (e.g., muscle twitching, confusion, increased seizures, unusual drowsiness)
signs of Meningitis not caused by infection (e.g., headache [severe], throbbing, or with stiff neck or back)
signs of pancreatitis (inflammation of the pancreas; e.g., severe upper abdominal pain, loss of appetite, vomiting)
signs of porphyria (e.g., darkening of urine, severe abdominal pain, excessive sweating)
signs of urinary problems (e.g., sudden decrease in amount of urine, blood in the urine, pain on urination)
swelling of face, hands, feet, or lower legs
symptoms of Lupus (e.g., fever, general feeling of being unwell, joint pain, confusion, muscle aches, skin rash)
trembling or loss of muscle coordination
weakness

Check with your doctor immediately if any of the following side effects occur:

rapid development of signs of anemia or bleeding, sometimes combined with fever
rapid development of signs of liver or other organ damage
signs of an allergic reaction (e.g., wheezing, tightness in chest, troubled breathing, shortness of breath, or cough)
signs of neuroleptic malignant syndrome (e.g., high fever, muscle stiffness, sweating, racing or irregular heartbeat, altered consciousness)
signs of severe skin reactions (e.g., blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)
sores, ulcers, or white spots on lips or in the mouth

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Carbamazepine.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take Carbamazepine.

Anemia: Carbamazepine may cause low levels of red blood cells. If you experience symptoms of reduced red blood cell count (anemia), such as shortness of breath, feeling unusually tired or pale skin, contact your doctor as soon as possible.

Your doctor will do blood tests regularly to monitor the number of specific types of blood cells, including red blood cells, in your blood.

Birth control: Carbamazepine, like other anticonvulsants, may reduce the effectiveness of birth control pills. Women taking carbamazepine should use an alternative, non-hormonal birth control method such as condoms. If you become pregnant while taking Carbamazepine, contact your doctor immediately.

Bleeding: Carbamazepine may cause a reduced number of platelets in the blood, which can make it difficult to stop cuts from bleeding. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.

Bone strength: Long term use of antiepileptics has been associated with a risk of weakened or brittle bones. If you have Osteoporosis, are at risk for developing osteoporosis, or have a history of disease affecting your bones, discuss with your doctor how Carbamazepine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Carbamazepine, and whether any special monitoring is needed.

Cancer: Some studies indicate a possible risk of developing cancer with long term use of carbamazepine. Discuss the potential benefits and possible risks of taking Carbamazepine with your doctor.

Depression: Carbamazepine has been known to cause mood swings and symptoms of depression. If you have depression or a history of depression, discuss with your doctor how Carbamazepine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Carbamazepine, and whether any special monitoring is needed. If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, or notice them in a family member who is taking Carbamazepine, contact your doctor as soon as possible.

Drowsiness/reduced alertness: Carbamazepine may cause dizziness and drowsiness. People taking carbamazepine should avoid operating hazardous machinery (including cars) until they are certain that the medication does not affect their mental alertness, judgment, or physical coordination.

Heart disease: If you have Coronary Artery Disease, organic heart disease, or Congestive Heart Failure, discuss with your doctor how Carbamazepine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Carbamazepine, and whether any special monitoring is needed.

Hypersensitivity syndrome: A Anaphylaxis (severe allergic reaction) called hypersensitivity syndrome has occurred for some people with the use of carbamazepine. This reaction involves a number of organs in the body and may be fatal if not treated quickly. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering.

Glaucoma: Carbamazepine may cause the symptoms of glaucoma (increased pressure in the eye) to become worse. If you have glaucoma, discuss with your doctor how Carbamazepine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Carbamazepine, and whether any special monitoring is needed. Report any changes in vision to your doctor as soon as possible while you are taking Carbamazepine.

Periodic eye examinations are recommended for people who take Carbamazepine.

Infection: Carbamazepine can reduce the number of cells that fight infection in the body (white blood cells). If you notice signs of an infection, such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness, contact your doctor. Let your doctor know if you are experiencing more frequent infections than normal. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Kidney function: If you have Kidney Disease or decreased kidney function, discuss with your doctor how Carbamazepine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Carbamazepine, and whether any special monitoring is needed.

Liver function: Carbamazepine can cause decreased liver function and may cause liver failure. If you have liver problems, discuss with your doctor how Carbamazepine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Carbamazepine, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Carbamazepine.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Lupus: In rare cases, carbamazepine can cause lupus. If you experience symptoms such as fever, facial rash or joint pain, or your lupus symptoms worsen while taking Carbamazepine, contact your doctor.

Neuroleptic malignant syndrome (NMS): Carbamazepine, like other medications used to treat some psychiatric illnesses, can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Psychiatric issues: Carbamazepine may activate certain mental disorders or cause confusion and agitation for seniors. When used to treat bipolar disorder, some people have experienced worsening of their symptoms of depression, feeling unlike themselves, or they may want to hurt themselves or others. People should be closely monitored by their doctor for emotional and behavioural changes.

Skin reactions: Although uncommon, carbamazepine has been linked to serious skin reactions. If you experience symptoms of a serious skin reaction (such as skin rash; redness of the skin; skin peeling; or blisters on the lips, eyes, or mouth) with fever, chills, headache, cough, or body aches, contact your physician immediately.

Stopping the medication: Suddenly stopping carbamazepine can cause seizures. Before stopping Carbamazepine, discuss with your doctor how you should gradually reduce the dose.

Suicidal thoughts and behaviour: Some people taking anti-seizure medications may have suicidal thoughts or behaviour. If this happens to you or you notice this in a family member who is taking Carbamazepine, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking Carbamazepine.

Low Thyroid hormones: Carbamazepine can cause thyroid hormones to be removed from the body more quickly than usual. This is most noticeable if you take thyroid replacement therapy. If you have an underactive thyroid, discuss with your doctor how Carbamazepine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Carbamazepine, and whether any special monitoring is needed. Your doctor may want to test your thyroid function with blood tests when you first start taking carbamazepine.

Pregnancy: Women with Epilepsy who are pregnant or intend to become pregnant need special care. The potential benefits of carbamazepine must be weighed against its risks, particularly during the first 3 months of pregnancy. If needed to prevent major seizures, do not stop taking the medication. Usually, women with epilepsy who are pregnant should be treated with only one medication to prevent seizures.

Additional folic acid supplementation may be advisable for women taking carbamazepine, as Carbamazepine may contribute to a lack of folic acid in the body. Talk to your doctor about the benefits and risks of using carbamazepine during pregnancy.

Breast-feeding: Carbamazepine passes into breast milk. If you are a breast-feeding mother and are taking carbamazepine, it may affect your baby. If a mother taking carbamazepine breast-feeds her infant, the infant must be observed for possible side effects (e.g., drowsiness or skin rash). The benefits of breast-feeding should be weighed against the possible risks to the infant. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using carbamazepine to treat trigeminal neuralgia or psychiatric disorders in children have not been established. The use of Carbamazepine for these conditions in this age group is not recommended.

Seniors: People over the age of 65 years may require lower doses of Carbamazepine.

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