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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Carbamazepine

PATIENT INFORMATION ON CARBAMAZEPINE

Carbamazepine is classified as a mood stabilizer and anticonvulsant agent.

Uses

Carbamazepine is used primarily in the treatment of acute mania and in the long-term control prophylaxis of Manic Depressive Illness (Bipolar Disorder). 

It is also used in the treatment of seizure disorders as well as certain pain syndromes ( e. g., trigeminal neuralgia).

Though not approved for these indications, carbamazepine has also been found to be useful in the treatment of withdrawal reactions from alcohol or sedative/hypnotics, and in behavior disturbances, such as chronic aggression or impulsivity.

How does the doctor decide what dose (how many milligrams) to prescribe?

The dose of carbamazepine is different for every patient and is based on how much carbamazepine is in the blood, as well as the response to treatment. The doctor will measure the drug level in the blood on a regular basis during the first few months. The carbamazepine level that is usually found to be effective for most patients is between 17 and 50 micro mol/L (4-12 microgm/ml).

You may initially take your medication several times a day (2 or 3); after several weeks, the doctor may decide to prescribe the drug once daily.

On the morning of your blood test, take the morning dose of carbamazepine after the test to avoid inaccurate results.

How quickly will the drug start working?

Control of manic symptoms may require up to 14 days of treatment. Because carbamazepine takes time to work , do not decrease or increase the dose or stop the medication without discussing this with your doctor. Improvement in seizures, pain symptoms, as well as aggression/impulsivity also occur gradually.

How long should you take this medication?

Following the first episode of mania it is recommended that carbamazepine be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms; if none occur, the drug can gradually be stopped. For individuals who have had several episodes of mania or depression, carbamazepine should be continued indefinitely. Long-term treatment is generally recommended for recurring depression , seizure disorder and aggression/impulsivity.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medications are noticed. If a side effect continues, speak to your doctor about appropriate treatment. 

Common side effects that should be reported to your doctor at the next appointment include:

  • Drowsiness and lethargy, difficulty concentrating-This problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Dizziness-Get up from a lying or sitting position slowly; dangle your legs over the edge of the bed for a few minutes before getting up. Sit or lie down if dizziness persists or if you feel faint-then call the doctor.
  • Ataxia or unsteadiness-Discuss this with your doctor as this may require an adjustment in your dosage.
  • Blurred vision-This usually occurs at the start of treatment and tends to be temporary. Reading under a bright light or at a distance may help; a magnifying glass can be of temporary use. If the problem continues, advise your doctor.
  • Dry mouth-Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie-laden beverages. Drink water and brush your teeth regularly.
  • Nausea or heartburn-If this happens , take the medication with food . If vomiting or diarrhea occur and persist for more than 24 hours, call your doctor.
  • Muscle tremor-Speak to your doctor as this may require an adjustment in your dosage.
  • Changes in sex drive or sexual performance-Discuss this with your doctor.
  • Weight changes-Monitor your food intake; avoid foods with high fat content (e. g., cakes and pastry).

Rare side effects you should report to your doctor IMMEDIATELY include:

 

  • Soreness of the mouth, gums, or throat, mouth lesions
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptom
  • Easy bruising, bleeding, appearance of splotchy purplish darkening of the skin
  • Confusion or disorientation

 

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of carbamazepine in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because carbamazepine can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking this drug.

Precautions

  1. Do not increase or decrease your without consulting your doctor.
  2. Avoid drinking grapefruit juice while on carbamazepine as it can affect the level of carbamazepine in your body.
  3. If your are on liquid carbamazepine, do not mix it with any other liquid medication.
  4. This drug may impair the mental and physical abilities and reaction time required for driving a car or operating other machinery. Avoid these activities if you feel drowsy or slowed down.
  5. Do not stop your drug suddenly as this may result in withdrawal symptoms such as anxiety, irritability and emotional liability.
  6. Report any changes in mood or behavior to your physician.
  7. Tablets or capsules of carbamazepine should be swallowed whole; do not crush them.
  8. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse