Carbamazepine (patient information)

# IMPORTANT WARNING
Carbamazepine 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.
Keep all 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.

# Why this medication is 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 this medication should be used
Carbamazepine comes 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.
Swallow the 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 them.
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.

# Special precautions
Before taking carbamazepine:
- 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),buproprion (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); delviradine (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 effects.
- 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 breastfeed while you are taking carbamazepine.
- 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.

# Special dietary instructions
Talk to your doctor about drinking grapefruit juice while taking this medicine.

# What to do if you 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.

# Side effects

## Minor side effects
Carbamazepine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- drowsiness
- dizziness
- unsteadiness
- upset stomach
- vomiting
- headache
- anxiety
- memory problems
- diarrhea
- constipation
- heartburn
- dry mouth
- back pain

## Severe side effects
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:
- rash
- confusion
- loss of contact with reality
- depression
- thinking about killing yourself or planning or trying to do so
- chest pain
- yellowing of the skin or eyes
- vision problems
Carbamazepine may 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  or by phone .

# Storage conditions needed for this medication
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 may include:
- unconsciousness
- seizures
- restlessness
- muscle twitching
- abnormal movements
- shaking of a part of your bodythat you cannot control
- drowsiness
- dizziness
- blurred vision
- irregular or slowed breathing
- rapid or pounding heartbeat
- upset stomach
- vomiting
- difficulty urinating

# Other information
Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking carbamazepine.
Carbamazepine can 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.
The extended-release 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.

# Brand names
- Carbatrol
- Epitol
- Equetro
- Tegretol
- Tegretol-XR