Carbamazepine

By Medically reviewed by hellodoktor

Generic Name: Carbamazepine Brand Name(s): Carbamazepine. Avability: Rx Pregnancy Category: D

Uses

What is Carbamazepine used for?

Carbamazepine is used to prevent and control seizures. This medication is known as an anticonvulsant or anti-epileptic drug. It is also used to relieve certain types of nerve pain (such as trigeminal neuralgia). This medication works by reducing the spread of seizure activity in the brain and restoring the normal balance of nerve activity.

How should I take Carbamazepine?

Take this medication by mouth with food as directed by your doctor.

The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. Keep taking this medication even if you feel well.

Do not stop taking this medication without consulting your doctor. Some conditions (such as seizures) may become worse when this drug is suddenly stopped. Your dose may need to be gradually decreased.

Tell your doctor if your condition does not get better or if it gets worse.

How do I store Carbamazepine?

Carbamazepine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Carbamazepine in the bathroom or the freezer. There may be different brands of Carbamazepine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Carbamazepine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Carbamazepine?

Before taking carbamazepine, tell your doctor or pharmacist if you are allergic to it; or to other anti-seizure medications (such as phenobarbital, phenytoin) or tricyclic antidepressants (such as amitriptyline, desipramine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: decreased bone marrow function (bone marrow depression), blood disorders (such as porphyria, anemia), glaucoma, heart disease (such as coronary artery disease, heart failure, irregular heartbeat), kidney disease, liver disease, mental/mood disorders (such as depression), mineral imbalances (such as low levels of sodium or calcium in the blood ).

This drug may make you dizzy or drowsy. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana.

This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Get medical help right away if you get sunburned or have skin blisters/redness.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially, confusion, unsteadiness, or irregular heartbeat. Confusion and unsteadiness can increase the risk of falling. Older adults may also be at greater risk of developing a type of mineral imbalance (low levels of sodium in the blood), especially if they are also taking “water pills” (diuretics).

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. However, since untreated seizures are a serious condition that can harm both a pregnant woman and her unborn baby, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, discuss with your doctor right away the benefits and risks of using this medication during pregnancy. If you are pregnant, prenatal care that includes tests for birth defects is recommended. Since birth control pills, patches, implants, and injections may not work if used with this medication, discuss reliable forms of birth control with your doctor.

This medication passes into breast milk. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Carbamazepine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Carbamazepine. Carbamazepine is pregnancy risk category D according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Carbamazepine?

Nausea, vomiting, dizziness, drowsiness, constipation, dry mouth, or unsteadiness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

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.

Tell your doctor right away if you have any serious side effects, including: headaches that are severe or don’t go away, signs of liver problems (such as nausea/vomiting that doesn’t stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine), signs of kidney problems (such as change in the amount of urine), mouth sores, fainting, fast/slow/irregular heartbeat, unusual eye movements (nystagmus), vision changes (such as blurred vision), joint pain, swelling of the ankles/feet, pain/redness/swelling of the arms or legs, numbness/tingling of the hands/feet, signs of low levels of sodium in the blood (such as extreme drowsiness, mental/mood changes including confusion, seizures).

A small number of people who take anticonvulsants for any condition (such as seizure, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Carbamazepine?

Some products that may interact with this drug include: certain azole antifungals (isavuconazonium, voriconazole), orlistat.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

Other medications can affect the removal of carbamazepine from your body, which may affect how carbamazepine works. Examples include macrolide antibiotics (such as erythromycin), rifamycins (such as rifabutin), St. John’s wort, among others.

Carbamazepine can speed up the removal of other drugs from your body, which may affect how they work. Examples of affected drugs include artemether/lumefantrine, boceprevir, certain drugs used to prevent blood clots (anticoagulants such as apixaban, rivaroxaban), certain calcium channel blockers (such as nifedipine, nimodipine), nefazodone, HIV NNRTIs (such as delavirdine, efavirenz, etravirine, rilpivirine), praziquantel, ranolazine, among others.

This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use reliable backup birth control methods while taking this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana, antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), and narcotic pain relievers (such as codeine, hydrocodone).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This medication may interfere with certain lab tests (such as thyroid function, some pregnancy tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

Carbamazepine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Carbamazepine?

Carbamazepine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.

What health conditions may interact with Carbamazepine?

Carbamazepine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Carbamazepine.

What is the dose of Carbamazepine for an adult?

Usual Adult Dose for Epilepsy

Initial dose: 200 mg orally 2 times a day (immediate and extended release) or 100 mg orally 4 times a day (suspension)

Increase dose at weekly intervals by adding up to 200 mg/day using a 2 times a day regimen of extended release or a 3 times a day or 4 times a day regimen of the other formulations.

Maintenance dose: 800 to 1200 mg/day.

Dosage generally should not exceed 1200 mg/day.

However, doses up to 1600 mg/day have been used in rare instances.

Use: Epilepsy:

-Partial seizures with complex symptomatology (psychomotor, temporal lobe)

-Generalized tonic-clonic seizures (grand mal)

-Mixed seizure patterns which include the above, or other partial or generalized seizures

Usual Adult Dose for Trigeminal Neuralgia

-Initial dose: 100 mg orally 2 times a day (immediate or extended release) or 50 mg orally 4 times a day (suspension)

-May increase by up to 200 mg per day using increments of 100 mg every 12 hours (immediate or extended release), or 50 mg 4 times a day (suspension), only as needed to achieve freedom from pain. Do not exceed 1200 mg per day.

-Maintenance dose: 400 to 800 mg per day

Comments:

-Some patients may be maintained on as little as 200 mg per day while others may require as much as 1200 mg per day.

-At least once every 3 months throughout the treatment period, attempts should be made to reduce the dose to the minimum effective level or to discontinue the drug.

Use:

-True trigeminal Neuralgia

-Beneficial results have also been reported in glossopharyngeal neuralgia

Dose Adjustments

Dosage should be adjusted to the needs of the individual patient. A low initial daily dosage with a gradual increase is advised. As soon as adequate control is achieved, the dosage may be reduced very gradually to the minimum effective level.

Dialysis

This drug is slightly dialyzed by hemodialysis. The dialysis clearance averages 54 mL/min. Using a Cobe Century II hollow tube dialyzer with a cuprophane membrane, 10% of a dose is removed during 4 hour of hemodialysis.

Hemoperfusion has been reported to be useful in the removal of carbamazepine during acute overdose.

Other Comments

Administration advice:

-Tablets (including the chewable and extended release forms) and the suspension should be taken with meals. The extended release capsules can be taken with or without food.

-The controlled-release tablets may be halved, but should be swallowed without chewing, crushing, or dividing a controlled-release half tablet. If necessary, the capsules can be opened and the contents sprinkled over food, such as a teaspoonful of applesauce or other similar food products. Capsules should not be crushed or chewed.

-The oral suspension is particularly useful for patients who have difficulty swallowing or who need careful dosage adjustments. The oral suspension should be shaken prior to administration.

-Abrupt dose reduction or withdrawal may precipitate convulsions or status epilepticus. If this drug has to be withdrawn abruptly in a patient with epilepsy, the changeover to the new antiepileptic agent should be made under cover of a suitable agent (such as intravenous diazepam or intravenous phenytoin).

-Damaged tablets or extended-release tablets without a release portal should not be consumed.

-When converting patients from conventional tablets and liquid to modified-release tablets, the total daily dose may need to be increased. When converting patients from the oral route to rectal suppositories, the dosage should be increased by 25%. Final dosages should always be based upon individual response and plasma levels.

Monitoring:

-Baseline and periodic complete urinalysis and BUN determinations are recommended for patients treated with this drug because of observed renal dysfunction.

-Liver function tests should be performed prior to initiating therapy with this drug and routinely thereafter, especially in patients with a history of liver disease and in elderly patients. Therapy should be withdrawn immediately in cases of aggravated liver dysfunction or acute liver disease.

-Complete blood counts (including platelets and possible reticulocytes) and serum iron should be obtained prior to initiating therapy with this drug and routinely thereafter. If the white blood cell or platelet count is definitely low or decreased during treatment, the patient and the complete blood count should be closely monitored.

What is the dose of Carbamazepine for a child?

Usual Pediatric Dose for Epilepsy

Less than 6 years of age:

-Initial dose: 10 to 20 mg/kg/day orally in 2 to 3 divided doses (tablets) or 4 divided doses (suspension)

-Increase dose at weekly intervals to achieve optimal clinical response administered 3 or 4 times a day.

-Maximum dose: 35 mg/kg/day

-If satisfactory response not achieved, measure plasma levels to determine if in therapeutic range.

-Comments: The manufacturer makes no recommendation regarding the safety of doses above 35 mg/kg/24 hours.

6 to 12 years of age:

-Initial dose: 100 mg orally 2 times a day (immediate or extended release tablets) or 50 mg orally 4 times a day (suspension)

-Increase dose at weekly intervals in 100 mg per day increments using a 2 times a day regimen of extended release or a 3 times a day or 4 times a day regimen of the other formulations.

Maintenance dose: 400 to 800 mg per day

Maximum dose: 1000 mg per day

Greater than 12 years of age:

-Initial dose: 200 mg orally 2 times a day (immediate and extended release) or 100 mg orally 4 times a day (suspension)

-Increase dose at weekly intervals in 200 mg per day increments using a 2 times a day regimen of extended release or a 3 times daily to 4 times daily regimen of the other formulations.

-Maintenance dose: 800 to 1200 mg per day

-Dosage generally should not exceed 1000 mg in children 12 to 15 years and 1200 mg/day in patients older than 15 years.

-Doses up to 1600 mg/day have been used in rare instances.

Use: Epilepsy:

-Partial seizures with complex symptomatology (psychomotor, temporal lobe)

-Generalized tonic-clonic seizures (grand mal)

-Mixed seizure patterns which include the above, or other partial or generalized seizures

How is Carbamazepine available?

Carbamazepine is available in the following dosage forms and strengths:

  • Oral tablet, chewable,
  • Oral suspension,
  • Oral tablet,
  • Oral tablet, extended release,
  • Oral capsule, extended release,
  • Compounding powder.

Applies to the following strengths: 100 mg; 100 mg/5 mL; 200 mg; 400 mg; 300 mg

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Carbamazepine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: August 16, 2018 | Last Modified: September 12, 2019

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