Carbamazepine (By mouth)

Introduction

Carbamazepine (kar-ba-MAZ-e-peen)

Treats different types of seizures. Also used to treat nerve pain and bipolar disorder, also known as manic-depressive illness.

Brand Name(s)

Carbatrol, Tegretol, Epitol, Equetro, Tegretol-XR, Tegretol XR

There may be other brand names for this medicine.

When This Medicine Should Not Be Used

You should not use this medicine if you have had an allergic reaction to carbamazepine or to certain medicines for depression (such as amitriptyline, desipramine, imipramine, nortriptyline, or protriptyline). You should not use this medicine if you have ever had bone marrow depression (low blood counts). Do not use this medicine if you are using nefazodone (Serzone®) or have used an MAO inhibitor (MAOI) such as selegiline (Eldepryl®), isocarboxazid (Marplan®), phenylzine (Nardil®), or tranylcypromine (Parnate®) within the past 14 days. Do not use this medicine if you are pregnant.

How to Use This Medicine

Long Acting Capsule, Liquid, Tablet, Chewable Tablet, Long Acting Tablet

• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• It is best to take this medicine with food or milk.
• Swallow the extended-release tablet or extended-release capsule whole. Do not crush, break, or chew it. Do not use an extended-release tablet that is cracked or chipped.
• If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as pudding, yogurt, or applesauce. Stir this mixture well and swallow it without chewing.
• The chewable tablet must be chewed before you swallow it.
• Tegretol® tablets works differently than Tegretol® oral suspension, even at the same dose (number of milligrams). Do not switch from the tablets to the oral suspension unless your doctor tells you to.
• Tegretol® may be used alone or together with other seizure medicines. Ask your doctor first before taking any other seizure medicine together with Tegretol®.
• Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup.
• This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.

If a dose is missed:

• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

How to Store and Dispose of This Medicine

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• There are many other drugs that can interact with carbamazepine. Make sure your doctor knows about all other medicines you are using. Some medicines that can interact include heart medicines, blood pressure medicines, seizure medicines, antidepressants, pain medicines, cancer medicines, steroids, and medicines to treat infections, including HIV or AIDS medicines. Also tell your doctor if you are using cimetidine (Tagamet®), cisplatin (Platinol®), doxorubicin (Adriamycin®), felbamate (Felbatol®), haloperidol (Haldol®), levothyroxine (Levoxyl®), methsuximide (Celontin®), niacinamide or nicotinamide (Vitamin B3), phenobarbital, phenytoin (Dilantin®), praziquantel (Biltricide®), primidone (Mysoline®), rifampin (Rifadin®, Rimactane®), risperidone (Risperdal®), theophylline (Theo-Dur®), ziprasidone (Geodon®), or a blood thinner (such as warfarin, Coumadin®).
• Tell your doctor if you are using acetazolamide (Diamox®), clarithromycin (Biaxin®), danazol (Danocrine®), delavirdine (Rescriptor®), diltiazem (Cardizem®), erythromycin (Ery-Tab®), fluoxetine (Prozac®), fluvoxamine (Luvox®), isoniazid (Nydrazid®), lithium (Eskalith®), loratadine (Claritin®), pancuronium (Pavulon®), propoxyphene (Darvon®), quinine (Qualaquin®), quinupristin/dalfopristin (Synercid®), troleandomycin (Tao®), valproate (Depakote®), verapamil (Calan®, Isoptin®, Verelan®), or zileuton (Zyflo®). Tell your doctor if you are also using a diuretic or "water pill" (such as furosemide, hydrochlorothiazide [HCTZ], or Lasix®), medicine for fungal infection (such as clotrimazole, fluconazole, ketoconazole, itraconazole, Diflucan®, Nizoral®, or Sporanox®), medicine for HIV/AIDS (such as indinavir, nelfinavir, ritonavir, saquinavir, Crixivan®, Fortovase®, Invirase®, or Viracept®), or medicine for malaria (such as chloroquine, mefloquine, Aralen®, or Lariam®).
• Birth control pills, implants, or shots will not work while you are using this medicine. To keep from getting pregnant, use another form of birth control such as condoms, diaphragms, contraceptive foams or jellies.
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.
• Tell your doctor if you are using any medicines that make you sleepy. These include sleeping pills, cold and allergy medicine, narcotic pain relievers, and sedatives.
• Do not drink alcohol while you are using this medicine.

Warnings While Using This Medicine

• Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away. Your doctor may want you to join a pregnancy registry for patients taking this medicine.
• Make sure your doctor knows if you are breastfeeding, or if you have kidney disease, liver disease, blood disease, glaucoma, heart block, heart disease, heart rhythm problems, or if you have ever had a mental illness or an inherited disease such as porphyria. Tell your doctor if you have had an allergic reaction to any other medicines (especially seizure medicines).
• Tell your doctor if you have Asian relatives, such as Filipino, Chinese, Japanese, Korean, or Taiwanese. You may need to be tested for a risk factor (called HLA-B*1502) for severe skin reactions.
• Tegretol® suspension contains sorbitol and should not be given in patients with a rare inherited problem called fructose intolerance.
• Serious skin reactions can occur with this medicine. Stop using this medicine and check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin; red skin lesions; severe acne or skin rash; sores or ulcers on the skin; or fever or chills while you are using this medicine.
• Check with your doctor right away if fever, sore throat, rash, ulcers in the mouth, easy bruising, or small red or purple spots on the skin occur. These could be symptoms of a serious blood problem.
• This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these unwanted effects, tell your doctor right away.
• Check with your doctor right away if you or your child have pain or tenderness in the upper stomach; pale stools; dark urine; loss of appetite; nausea; unusual tiredness or weakness; or yellow eyes or skin. These could be symptoms of a serious liver problem.
• This medicine may cause serious allergic reactions affecting multiple body organs (e.g., liver or kidney). Check with your doctor right away if you or your child have the following symptoms: fever, dark urine, headache, rash, stomach pain, unusual tiredness, or yellow eyes or skin.
• Do not stop using this medicine suddenly without asking your doctor. You may need to slowly decrease your dose before stopping it completely.
• Your doctor will need to check your blood or urine at regular visits while you are using this medicine. Be sure to keep all appointments. Your doctor may want to have certain tests done to see if you or your child are receiving the right amount of medicine or if certain side effects may be occurring without you knowing it.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.
• This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert.

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, or red skin rash.
• Change in how much or how often you urinate.
• Chest pain.
• Dark-colored urine or pale stools.
• Fast, slow, or pounding heartbeat.
• Fever, chills, cough, sore throat, or sores in your mouth.
• Lightheadedness or fainting.
• Nausea, vomiting, loss of appetite, or pain in your upper stomach.
• Problems with balance, walking, or speech.
• Shortness of breath, cold sweat, and bluish-colored skin.
• Swelling in your hands, ankles, or feet.
• Unusual bleeding, bruising, or weakness.
• Unusual thoughts or behavior or hurting yourself or others.
• Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

• Anxiety, confusion, depression, restlessness, or agitation.
• Diarrhea, constipation, heartburn, or upset stomach.
• Dizziness, drowsiness, or unsteady on your feet.
• Dry mouth.
• Headache or back pain.
• Mild skin rash or itching skin.
• Problems with memory.
• Sleepiness or unusual drowsiness.
• Vision changes.

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088