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(kar ba maz' e peen)Carbamazepine 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. 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.
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, and nutritional supplements you are taking or plan to take. 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); dalfopristin 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 US), 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 US); 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 breast-feed 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.
- 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 (about 1 in 500 people) who took anticonvulsants such as carbamazepine to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as one week after they started taking the medication. There is a risk that you may experience changes in your mental health if you take an anticonvulsant medication such as carbamazepine, but there may also be a risk that you will experience changes in your mental health if your condition is not treated. You and your doctor will decide whether the risks of taking an anticonvulsant medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. 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.
- memory problems
- dry mouth
- back pain
- loss of contact with reality
- chest pain
- yellowing of the skin or eyes
- vision problems