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.

Carbamazepine is typically used for the treatment of seizure disorders and neuropathic pain. It may be used off-label as a second line treatment for bipolar disorder and as an adjunct, never alone, with an antipsychotic in some cases of schizophrenia when treatment with a conventional antipsychotic alone has failed.

In the United States, the FDA-approved indications are epilepsy (including partial seizures, generalized tonic-clonic seizures and mixed seizures), trigeminal neuralgia, and manic and mixed episodes of bipolar I disorder.Although data are still lacking, carbamazepine appears to be as effective and safe as lithium for the treatment of bipolar disorder, both in the acute and maintenance phase.

If adverse reactions are of such severity that the drug must be discontinued, the physician must be aware that abrupt discontinuation of any anticonvulsant drug in a responsive epileptic patient may lead to seizures or even status epilepticus with its life-threatening hazards.

The most severe adverse reactions have been observed in the hemopoietic system and skin (see BOXED WARNING), the liver, and the cardiovascular system.

The most frequently observed adverse reactions, particularly during the initial phases of therapy, are dizziness, drowsiness, unsteadiness, nausea, and vomiting. To minimize the possibility of such reactions, therapy should be initiated at the low dosage recommended.

The following additional adverse reactions have been reported:

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

Interactions

Carbamazepine has a potential for drug interactions; caution should be used in combining other medicines with it, including other antiepileptics and mood stabilizers.Lower levels of carbamazepine are seen when administrated with phenobarbital, phenytoin (Dilantin), or primidone (Mysoline), which can result in breakthrough seizure activity. Carbamazepine, as a CYP450 inducer, may increase clearance of many drugs, decreasing their concentration in the blood to subtherapeutic levels and reducing their desired effects.Drugs that are more rapidly metabolized with carbamazepine include warfarin (Coumadin), lamotrigine (Lamictal), phenytoin (Dilantin), theophylline, and valproic acid (Depakote, Depakote ER, Depakene, Depacon).Drugs that decrease the metabolism of carbamazepine or otherwise increase its levels include erythromycin, cimetidine (Tagamet), propoxyphene (Darvon), and calcium channel blockers. Carbamazepine also increases the metabolism of the hormones in birth control pills and can reduce their effectiveness, potentially leading to unexpected pregnancies. As a drug that induces cytochrome P450 enzymes, it accelerates elimination of many benzodiazepines and decreases their action.

Valproic acid and valnoctamide both inhibit microsomal epoxide hydrolase (mEH), the enzyme responsible for the breakdown of carbamazepine-10,11 epoxide into inactive metabolites. By inhibiting mEH, valproic acid and valnoctamide cause a buildup of the active metabolite, prolonging the effects of carbamazepine and delaying its excretion.

Grapefruit juice raises the bioavailability of carbamazepine by inhibiting CYP3A4 enzymes in the gut wall and in the liver.

In case of overdose If the victim has collapsed or is not breathing,
Symptoms of overdose may include:

unconsciousness

seizures

restlessness

muscle twitching

abnormal movements

shaking of a part of your body that you cannot control

unsteadiness

drowsiness

dizziness

blurred vision

irregular or slowed breathing

rapid or pounding heartbeat

nausea

vomiting

difficulty urinating