Patients should undergo routine monitoring of hematologic function, and any serious indication of bone marrow depression warrants discontinuation of the drug. Early symptoms of toxicity can include fever, pharyngitis, oral ulceration, or unusual bruising or bleeding. Leukopenia, thrombocytopenia, leukocytosis, eosinophilia, agranulocytosis, pancytopenia, or aplastic anemia have been reported with carbamazepine. CNS effects of carbamazepine include dizziness, drowsiness, fatigue, ataxia, blurred vision, diplopia, and hallucinations. Sedation may be seen for the first few days of therapy or following a dosage increase.
Tolerance usually develops.
Confusion and agitation are more likely to occur in geriatric patients, and dose adjustments may be necessary. Those requiring mental alertness should be warned of the possible effects of carbamazepine therapy. To minimize adverse reactions, carbamazepine should be instigated at the lowest possible dosage. These reactions can occur more frequently with the oral suspension due to more rapid absorption. To minimize adverse GI effects, the drug may be taken with food and at equally spaced intervals.