CARBAMAZEPINE (Systemic)

Some commonly used brand names are:

In the U.S.—

• Atretol
• Carbatrol
• Epitol
• Equetro
• Tegretol
• Tegretol-XR

In Canada—

• Apo-Carbamazepine
• Novo-Carbamaz
• Nu-Carbamazepine
• Taro-Carbamazepine
• Taro-Carbamazepine CR
• Tegretol
• Tegretol Chewtabs
• Tegretol CR

Generic name product may be available in the U.S.

Category

• Anticonvulsant
• Antidiuretic
• Antimanic
• Antineuralgic, specific pain syndromes
• Antipsychotic

Description

Carbamazepine (kar-ba-MAZ-e-peen) is used to control some types of seizures in the treatment of epilepsy. It is also used to relieve pain due to trigeminal neuralgia (tic douloureux). It should not be used for other more common aches or pains. It can also be used in the treatment of bipolar disorder (manic-depressive illness).

Carbamazepine may also be used for other conditions as determined by your doctor.

This medicine is available only with your doctor's prescription, in the following dosage forms:

• Oral
• Oral suspension (U.S. and Canada)
• Tablets (U.S. and Canada)
• Chewable tablets (U.S. and Canada)
• Extended-release capsules (U.S.)
• Extended-release tablets (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For carbamazepine, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to carbamazepine or to any of the tricyclic antidepressants, such as amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, or trimipramine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Carbamazepine has not been studied in pregnant women. However, there have been reports of babies having low birth weight, small head size, skull and facial defects, underdeveloped fingernails, and delays in growth when their mothers had taken carbamazepine in high doses during pregnancy. In addition, birth defects have been reported in some babies when the mothers took other medicines for epilepsy during pregnancy. Also, studies in animals have shown that carbamazepine causes birth defects when given in large doses. Therefore, the use of carbamazepine during pregnancy should be discussed with your doctor.

Breast-feeding—Carbamazepine passes into the breast milk, and in some cases the baby may receive enough of it to cause unwanted effects. In animal studies, carbamazepine has affected the growth and appearance of the nursing babies. Be sure you have discussed the risks and benefits of the medicine with your doctor.

Children—Behavior changes are more likely to occur in children.

Older adults—Confusion; restlessness and nervousness; irregular, pounding, or unusually slow heartbeat; and chest pain may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of carbamazepine.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking carbamazepine, it is especially important that your health care professional know if you are taking any of the following:

• Anticoagulants (blood thinners)—The effects of anticoagulants may be decreased; monitoring of blood clotting time may be necessary during and after carbamazepine treatment

• Central nervous system (CNS) depressants (medicines that cause drowsiness) or
• Alcohol—May increase the risk of serious side effects

• Cimetidine (e.g., Tagamet)—Blood levels of carbamazepine may be increased, leading to an increase in serious side effects

• Clarithromycin (e.g., Biaxin)—Blood levels of carbamazepine may be increased, increasing the risk of unwanted effects

• Clomipramine (e.g., Anafranil)—Blood levels of clomipramine may be increased, increasing risk of unwanted effects

• Corticosteroids (cortisone-like medicine)—The effects of corticosteroids may be decreased

• Delavirdine (e.g., Rescriptor)—May cause delavirdine to not work

• Diltiazem (e.g., Cardizem) or
• Erythromycin (e.g., E-Mycin, Erythrocin, Ilosone) or
• Propoxyphene (e.g., Darvon) or
• Verapamil (e.g., Calan)—Blood levels of carbamazepine may be increased; these medicines should not be used with carbamazepine

• Estrogens (female hormones) or
• Oral contraceptives (birth control pills) containing estrogen or
• Quinidine—The effects of these medicines may be decreased; use of a nonhormonal method of birth control or an oral contraceptive containing only a progestin may be necessary

• Fluvoxamine (e.g., Luvox)—Blood levels of carbamazepine may be increased, increasing the risk of unwanted effects

• Isoniazid (e.g., INH)—The risk of serious side effects may be increased

• Itraconazole (e.g., Sporanox) or
• Ketoconazole (e.g., Nizoral)—The effects of these medicines may be decreased

• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])—Taking carbamazepine while you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitors may cause sudden high body temperature, extremely high blood pressure, and severe convulsions; at least 14 days should be allowed between stopping treatment with one medicine and starting treatment with the other

• Other anticonvulsants (seizure medicine)—The effects of these medicines may be decreased; in addition, if these medicines and carbamazepine are used together during pregnancy, the risk of birth defects may be increased

• Risperidone [e.g., Risperdal]—The effects of risperidone may be decreased

• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])—Central nervous syste m depressant effects of carbamazepine may be increased while the anticonvulsant effects of carbamazepine may be decreased; seizures may occur more frequently

Other medical problems—The presence of other medical problems may affect the use of carbamazepine. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse (or history of)—Drinking alcohol may decrease the effectiveness of carbamazepine

• Anemia or other blood problems or
• Behavioral problems or
• Glaucoma or
• Heart or blood vessel disease or
• Problems with urination—Carbamazepine may make the condition worse

• Diabetes mellitus (sugar diabetes)—Carbamazepine may cause increased urine glucose levels

• Kidney disease or
• Liver disease—Higher blood levels of carbamazepine may result, increasing the chance of side effects