Carbamazepine and Neuropathy
(kar ba maz' e
Why is this medication prescribed?
Carbamazepine is used
alone or in combination with other medications to treat
certain types of seizures in patients with epilepsy. It
is also used to treat trigeminal neuralgia (a condition
that causes facial nerve pain). Carbamazepine
extended-release capsules (Equetro brand only) are used
to treat episodes of mania (frenzied, abnormally excited
or irritated mood) or mixed episodes (symptoms of mania
and depression that happen at the same time) in patients
with bipolar I disorder (manic-depressive disorder; a
disease that causes episodes of depression, episodes of
mania, and other abnormal moods).Carbamazepine is in a
class of medications called anticonvulsants. It works by
reducing abnormal excitement in the brain.
How should this medicine be used?
as a tablet, a chewable tablet, an extended-release
(long-acting) tablet, an extended-release capsule, and a
suspension (liquid) to take by mouth. The regular
tablet, chewable tablet, and liquid are usually taken
two to four times a day with meals. The extended-release
tablet is usually taken twice a day with meals. The
extended-release capsule is usually taken twice a day
with or without meals. To help you remember to take
carbamazepine, take it at around the same times every
day. Follow the directions on your prescription label
carefully, and ask your doctor or pharmacist to explain
any part you do not understand. Take carbamazepine
exactly as directed. Do not take more or less of it or
take it more often than prescribed by your doctor.
extended-release tablets whole; do not split, chew, or
crush them. The extended-release capsules may be opened
and the beads inside sprinkled over food, such as a
teaspoon of applesauce or similar food. Do not crush or
chew the extended-release capsules or the beads inside
Shake the liquid well
before each use to mix the medication evenly.
Your doctor will
start you on a low dose of carbamazepine and gradually
increase your dose.
It may take a few
weeks or longer before you feel the full benefit of
carbamazepine. Continue to take carbamazepine even if
you feel well. Do not stop taking carbamazepine without
talking to your doctor. If you have a seizure disorder
and you suddenly stop taking carbamazepine, your
seizures may become worse. Your doctor will probably
decrease your dose gradually.
Other uses for this medicine
Carbamazepine is also
sometimes used to treat mental illnesses, depression,
posttraumatic stress disorder, drug and alcohol
withdrawal, restless legs syndrome, diabetes insipidus,
certain pain syndromes, and a disease in children called
chorea. Talk to your doctor about the possible risks of
using this medication for your condition.
This medication may
be prescribed for other uses; ask your doctor or
pharmacist for more information.
What special precautions should I
- tell your doctor and pharmacist
if you are allergic to carbamazepine, amitriptyline
(Elavil), amoxapine (Asendin), clomipramine (Anafranil),
desipramine (Norpramin), doxepin (Adapin, Sinequan),
imipramine (Tofranil), nortriptyline (Aventyl,
Pamelor), other medications for seizures such as
phenobarbital (Luminal, Solfoton) or phenytoin (Dilantin),
protriptyline (Vivactil), trimipramine (Surmontil),
or any other medications.
- you should know that
carbamazepine is the active ingredient in several
products that have different names and may be
prescribed to treat different conditions. Check the
list of brand names at the beginning of this
document carefully. All of the products listed
contain carbamazepine and you should not take more
than one of them at the same time.
- do not take carbamazepine if you
are taking monoamine oxidase (MAO) inhibitors,
including isocarboxazid (Marplan), phenelzine (Nardil)
selegiline (Eldepryl); and tranylcypromine (Parnate),
or have stopped taking them within the past 2 weeks.
- tell your doctor and pharmacist
what other prescription and nonprescription
medications, vitamins, nutritional supplements, and
herbal products you are taking. Be sure to mention
any of the following: acetaminophen (Tylenol);
acetazolamide (Diamox); alprazolam (Xanax);
anticoagulants ('blood thinners') such as warfarin (Coumadin);
antidepressants such as amitriptyline (Elavil),
bupropion (Wellbutrin, Zyban), buspirone (BuSpar),
citalopram (Celexa), clomipramine (Anafranil),
desipramine (Norpramin), fluoxetine (Prozac, Sarafem),
fluvoxamine (Luvox), mirtazapine (Remeron),
nortriptyline (Pamelor); antifungals such as
itraconazole (Sporanox) and ketoconazole (Nizoral);
cimetidine (Tagamet); cisplatin (Platinol);
clarithromycin (Biaxin); clonazepam (Klonopin);
clozapine (Clozaril); cyclosporine (Neoral,
Sandimmune); daltopristin and quinupristin (Synercid);
danazol (Danocrine); delavirdine (Rescriptor);
diltiazem (Cardizem, Dilacor, Tiazac); doxorubicin (Adriamycin,
Rubex); doxycycline (Vibramycin); erythromycin (E.E.S.,
E-Mycin, Erythrocin); felodipine (Plendil);
haloperidol (Haldol); HIV protease inhibitors
including atazanavir (Reyataz), indinavir (Crixivan),
lopinavir (in Kaletra), nelfinavir (Viracept),
ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase,
Invirase); isoniazid (INH, Nydrazid); levothyroxine
(Levoxyl, Synthroid); lithium (Lithobid); loratadine
(Claritin); lorazepam (Ativan); certain medications
to treat malaria such as chloroquine (Aralen) and
mefloquine (Lariam); medications for anxiety or
mental illness; other medications for seizures such
as ethosuximide (Zarontin), felbamate (Felbatol),
lamotrigine (Lamictal), methsuximide (Celontin),
oxcarbazepine (Trileptal), phenobarbital (Luminal,
Solfoton), phensuximide (Milontin) (not available in
the United States), phenytoin (Dilantin), primidone
(Mysoline), tiagabine (Gabitril),topiramate (Topamax),
and valproic acid (Depakene, Depakote); methadone (Dolophine);
nefazodone; niacinamide (nicotinamide, Vitamin B3);
propoxyphene (Darvon); praziquantel (Biltricide);
quinine; rifampin (Rifadin, Rimactane); sedatives;
sleeping pills; terfenadine (Seldane) (not available
in the United States); theophylline (Theobid, Theo-Dur);
tramadol (Ultram); tranquilizers; troleandomycin
(TAO); verapamil (Calan, Covera, Isoptin, Verelan);
and zileuton (Zyflo). Many other medications may
also interact with carbamazepine, so be sure to tell
your doctor about all the medications you are
taking, even those that do not appear on this list.
Your doctor may need to change the doses of your
medications or monitor you carefully for side
- if you are taking any other
liquid medications, do not take them at the same
time as carbamazepine liquid.
- tell your doctor what herbal
products you are taking, especially St. John's Wort.
- tell your doctor if you have or
have ever had glaucoma; psychosis; or heart, kidney,
thyroid, or liver disease.
- you should know that
carbamazepine may decrease the effectiveness of
hormonal contraceptives (birth control pills,
patches, rings, injections, implants, or
intrauterine devices). Use another form of birth
control while taking carbamazepine. Tell your doctor
if you have unexpected vaginal bleeding or think you
may be pregnant while you are taking carbamazepine.
- tell your doctor if you are
pregnant or plan to become pregnant. Carbamazepine
may harm the fetus. If you become pregnant while
taking carbamazepine, call your doctor immediately.
- do not breast-feed while you are
- if you are having surgery,
including dental surgery, tell the doctor or dentist
that you are taking carbamazepine.
- you should know that
carbamazepine may make you drowsy. Do not drive a
car or operate machinery until you know how this
medication affects you.
- remember that alcohol can add to
the drowsiness caused by this medication.
- you should know that your mental
health may change in unexpected ways, and you may
become suicidal (thinking about harming or killing
yourself or planning or trying to do so) while you
are taking carbamazepine for the treatment of
epilepsy, mental illness, or other conditions. A
small number of adults and children 5 years of age
and older who took antiepileptics such as
carbamazepine during clinical studies were found to
be twice as likely to become suicidal than people
who did not take the medication. This increased risk
of suicidal behavior was seen as early as one week
after starting the medication. You, your family, or
your caregiver should call your doctor right away if
you experience any of the following symptoms:
anxiety, agitation, hostility, mania (frenzied,
abnormally excited mood), talking or thinking about
wanting to hurt yourself or end your life,
withdrawing from friends and family, new or
worsening depression, preoccupation with death and
dying, or giving away prized possessions. Be sure
that your family or caregiver knows which symptoms
may be serious so they can call the doctor if you
are unable to seek treatment on your own.
What special dietary instructions
should I follow?
Talk to your doctor
about drinking grapefruit juice while taking this
What should I do if I forget a dose?
Take the missed dose
as soon as you remember it. However, if it is almost
time for the next dose, skip the missed dose and
continue your regular dosing schedule. Do not take a
double dose to make up for a missed one.
What side effects can this medication
cause side effects. Tell your doctor if any of these
symptoms are severe or do not go away:
- upset stomach
- memory problems
- dry mouth
- back pain
Some side effects can
be serious. The following symptoms are uncommon, but if
you experience any of them or those listed in the
IMPORTANT WARNING section, call your doctor immediately:
- loss of contact with reality
- thinking about killing yourself
or planning or trying to do so
- chest pain
- yellowing of the skin or eyes
- vision problems
cause other side effects. Call your doctor if you have
any unusual problems while taking this medication.
If you experience a
serious side effect, you or your doctor may send a
report to the Food and Drug Administration's (FDA)
MedWatch Adverse Event Reporting program online [at
http://www.fda.gov/MedWatch/index.html] or by phone
What storage conditions are needed
for this medicine?
Keep this medication
in the container it came in, tightly closed, and out of
reach of children. Store it at room temperature, away
from excess heat and moisture (not in the bathroom).
Throw away any medication that is outdated or no longer
needed. Talk to your pharmacist about the proper
disposal of your medication.
In case of emergency/overdose
In case of overdose,
call your local poison control center at 1-800-222-1222.
If the victim has collapsed or is not breathing, call
local emergency services at 911.
Symptoms of overdose
- muscle twitching
- abnormal movements
- shaking of a part of your body
that you cannot control
- blurred vision
- irregular or slowed breathing
- rapid or pounding heartbeat
- upset stomach
- difficulty urinating
What other information should I know?
Before having any
laboratory test, tell your doctor and the laboratory
personnel that you are taking carbamazepine.
interfere with the results of home pregnancy tests.Talk
to your doctor if you think you might be pregnant while
you are taking carbamazepine. Do not try to test for
pregnancy at home.
tablet does not dissolve in the stomach after
swallowing. It slowly releases the medicine as it passes
through your digestive system. You may notice the tablet
coating in the stool.
Do not let anyone
else take your medication. Ask your pharmacist any
questions you have about refilling your prescription.
It is important for
you to keep a written list of all of the prescription
and nonprescription (over-the-counter) medicines you are
taking, as well as any products such as vitamins,
minerals, or other dietary supplements. You should bring
this list with you each time you visit a doctor or if
you are admitted to a hospital. It is also important
information to carry with you in case of emergencies.
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 doctor will usually order a test to
see if you have the genetic risk factor before
prescribing carbamazepine. If you do have this
risk factor, your doctor will probably prescribe
another medication that is less likely to cause
SJS or TEN. If you do not have this genetic risk
factor, your doctor may prescribe carbamazepine,
but there is still a slight risk that you will
develop SJS or TEN. Call your doctor immediately
if you develop a rash, blisters, or a fever
during your treatment with carbamazepine.
Stevens-Johnson syndrome or toxic epidermal
necrolysis usually occurs during the first few
months of treatment with carbamazepine. If you
have taken carbamazepine for several months or
longer, you probably will not need to be tested,
even if you are Asian.
may decrease the number of blood cells 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
doctor if you have ever had a decreased number
of blood cells, especially if it was caused by
another medication. If you experience any of the
following symptoms, call your doctor
immediately: sore throat, fever, chills, or
other signs of infection; unusual bleeding or
bruising; tiny purple dots or spots on the skin;
mouth sores; or rash.
appointments with your doctor and the
laboratory. Your doctor will order certain lab
tests before and during your treatment to check
your body's response to carbamazepine.
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