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Carbamazepine (kar ba MAZ e peen) has been approved by the FDA to treat focal (partial) seizures with complex symptomatology (psychomotor, temporal lobe). Patients with these seizures appear to show greater improvement than those with other types.

Carbamazepine has also been approved to treat generalized tonic-clonic seizures (grand mal) and mixed seizure patterns which include the above, or other focal or generalized seizures. Absence seizures (petit mal) do not appear to be controlled by carbamazepine.

Your epilepsy treatment should always be discussed with your healthcare provider before use. Based on their judgment and knowledge, a drug may be prescribed for other epilepsy types not included in the indications. For more information, please see the prescribing information.

How can you take carbamazepine? (Available formulations)

Carbamazepine is available as a tablet, a chewable tablet, an oral suspension, an extended-release tablet, and an extended-release capsule. Carbamazepine tablets are taken with food, extended-release tablets are taken whole with food, the extended-release capsule can be taken with or without food, and the oral suspension can be taken with meals but should not be taken with any other liquid medicines.

Who should not take carbamazepine?

If you are allergic to carbamazepine, tricyclic compounds, or any of the inactive ingredients, then you should not take it. If you have a history of bone marrow depression, then you should not take carbamazepine. You should not take carbamazepine with nefazodone. Use of carbamazepine is not recommended with monoamine oxidase (MAO) inhibitors and MAO inhibitors should be discontinued for a minimum of 14 days, or longer if the clinical situation permits.

Other considerations may influence whether you should take carbamazepine. Tell your healthcare provider if you:

  • have or have had depression, mood problems, or suicidal thoughts or behavior.
  • have or ever had heart problems.
  • have or ever had blood problems.
  • have or ever had liver problems.
  • have or ever had kidney problems.
  • have or ever had allergic reactions to medicines.
  • have or ever had increased pressure in your eye.
  • drink grapefruit juice or eat grapefruit.
  • are pregnant or plan to become pregnant.
  • are breastfeeding or plan to breastfeed.

What is important to know about taking carbamazepine?

Do not stop taking carbamazepine suddenly unless directed to do so by your healthcare provider.

As with all antiseizure medications, carbamazepine should be withdrawn gradually to minimize the risk of causing or worsening seizures or status epilepticus. You should not stop using carbamazepine suddenly unless your healthcare provider tells you to stop the medicine because of a serious side effect.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Taking carbamazepine with certain other medicines may cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider. Especially tell your healthcare provider if you take: drugs that cause sleepiness or dizziness, alcohol, monoamine oxidase inhibitors, or nefazodone.

Boxed warning

Carbamazepine is approved by the FDA because it is safe and effective for the majority of people who take it. However, there are risks associated with all medicines. Some side effects caused by carbamazepine can be very serious, and even life-threatening. It is important to be informed about these serious reactions and to be aware of their symptoms.

Risk of serious rash

Carbamazepine may cause life-threatening allergic reactions called Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). These allergic reactions may cause severe damage to the skin and internal organs. The risk of SJS or TEN is highest in people of Asian ancestry who have a genetic (inherited) risk factor. If you are Asian, your healthcare provider will usually order a test to see if you have the genetic risk factor before prescribing carbamazepine. If you do not have this genetic risk factor, your healthcare provider may prescribe carbamazepine, but there is still a slight risk that you will develop SJS or TEN. Call your healthcare provider immediately if you develop a painful rash, hives, blistering or peeling of the skin, easy bruising, mouth sores, or fever during your treatment with carbamazepine. SJS or TEN usually occurs during the first few months of treatment with carbamazepine

Aplastic anemia and agranulocytosis

Carbamazepine may decrease the number of blood cells (aplastic anemia) or white blood cells (agranulocytosis) produced by your body. In rare cases, the number of blood cells may decrease enough to cause serious or life-threatening health problems. Tell your healthcare provider if you have ever had bone marrow depression or any other blood disorders, especially if it was caused by another medication. If you experience any of the following symptoms, call your healthcare provider immediately: sore throat, fever, chills, or other signs of infection that come and go or do not go away; shortness of breath; fatigue; unusual bleeding or bruising such as heavy menstrual bleeding, nose bleeds, or bleeding gums; tiny red or purple dots or spots on the skin; or mouth sores.

Women or those who are/plan to become pregnant
Use in pregnancy

Carbamazepine can cause fetal harm when administered to a pregnant individual. In animal studies, there were instances of developmental issues at clinically relevant doses. However, having a seizure during pregnancy could harm both the pregnant individual and the baby. Tell your healthcare provider right away if you become pregnant. Do not start or stop taking seizure medication during pregnancy without your healthcare provider’s advice.

If you become pregnant while taking carbamazepine, talk to your healthcare provider about registering with the North American Antiepileptic Drug (NAAED) Pregnancy Registry. The purpose of this registry is to collect information about the safety of antiseizure medicine during pregnancy. You can enroll in this registry by calling 1-888-233-2334.

Use during breastfeeding

Carbamazepine and its metabolite are present in breast milk. Because of the potential for serious adverse reactions in nursing infants from carbamazepine, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the pregnant individual. Talk to your healthcare provider about the risks. Your healthcare provider will consider the developmental and health benefits of breastfeeding along with your need for carbamazepine and the potential effect on the infant from carbamazepine or from your epilepsy.

Effect on birth control and fertility

Carbamazepine may decrease the effectiveness of hormonal contraceptives, including birth control pills, injections, implants, skin patches, and vaginal rings. To prevent pregnancy while using carbamazepine, use a barrier form of birth control: condom, diaphragm, cervical cap, or contraceptive sponge.

What are the side effects of carbamazepine?

Common side effects

The most common side effects that were reported in studies of carbamazepine are dizziness, drowsiness, unsteadiness, nausea, and vomiting.

Rare, but serious side effects
Other serious reactions, including serious blood or liver problems

Rare but life-threatening reactions involving the immune system or multi-organ hypersensitivity, which can cause serious blood or liver problems have been reported with carbamazepine use. You may or may not have a rash with these types of reactions. Call your healthcare provider right away if you experience fever, frequent infections, severe muscle pain, swelling of your face, eyes, lips, or tongue, swollen lymph glands, unusual bruising or bleeding, weakness, fatigue, yellowing of your skin, or the white part of your eyes, trouble walking or seeing, seizures happening more often, or pain/tenderness in the area toward the top of your stomach (enlarged liver/spleen).

Suicidal thoughts or behaviors

Studies have found that people who take antiseizure medications including carbamazepine may have suicidal thoughts or behaviors, which occur in approximately 1 in 500 patients. If you experience any thoughts or impulses to hurt yourself, you should contact your healthcare provider immediately.

Hypersensitivity

Hypersensitivity reactions to carbamazepine have been reported in patients who previously experienced this reaction to anticonvulsants including phenytoin, primidone, and phenobarbital. If such history is present, benefits and risks should be carefully considered and, if carbamazepine is initiated, the signs and symptoms of hypersensitivity should be carefully monitored. Patients should be informed that about a third of patients who have had hypersensitivity reactions to carbamazepine also experience hypersensitivity reactions with oxcarbazepine.