Side effect of carbamazepine

Contents

Tegretol

SIDE EFFECTS

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 lowest dosage recommended.

The following additional adverse reactions have been reported:

Hemopoietic System

Aplastic anemia, agranulocytosis, pancytopenia, bone marrow depression, thrombocytopenia, leukopenia, leukocytosis, eosinophilia, acute intermittent porphyria, variegate porphyria, porphyria cutanea tarda.

Skin

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) (see BOXED WARNING), Acute Generalized Exanthematous Pustulosis (AGEP), pruritic and erythematous rashes, urticaria, photosensitivity reactions, alterations in skin pigmentation, exfoliative dermatitis, erythema multiforme and nodosum, purpura, aggravation of disseminated lupus erythematosus, alopecia, diaphoresis, onychomadesis and hirsutism. In certain cases, discontinuation of therapy may be necessary.

Cardiovascular System

Congestive heart failure, edema, aggravation of hypertension, hypotension, syncope and collapse, aggravation of coronary artery disease, arrhythmias and AV block, thrombophlebitis, thromboembolism (e.g., pulmonary embolism), and adenopathy or lymphadenopathy.

Some of these cardiovascular complications have resulted in fatalities. Myocardial infarction has been associated with other tricyclic compounds.

Liver

Abnormalities in liver function tests, cholestatic and hepatocellular jaundice, hepatitis, very rare cases of hepatic failure.

Pancreatic

Pancreatitis.

Respiratory System

Pulmonary hypersensitivity characterized by fever, dyspnea, pneumonitis, or pneumonia.

Genitourinary System

Urinary frequency, acute urinary retention, oliguria with elevated blood pressure, azotemia, renal failure, and impotence. Albuminuria, glycosuria, elevated BUN, and microscopic deposits in the urine have also been reported. There have been rare reports of impaired male fertility and/or abnormal spermatogenesis.

Testicular atrophy occurred in rats receiving Tegretol orally from 4 to 52 weeks at dosage levels of 50 to 400 mg/kg/day. Additionally, rats receiving Tegretol in the diet for 2 years at dosage levels of 25, 75, and 250 mg/kg/day had a dose-related incidence of testicular atrophy and aspermatogenesis. In dogs, it produced a brownish discoloration, presumably a metabolite, in the urinary bladder at dosage levels of 50 mg/kg and higher. Relevance of these findings to humans is unknown.

Nervous System

Dizziness, drowsiness, disturbances of coordination, confusion, headache, fatigue, blurred vision, visual hallucinations, transient diplopia, oculomotor disturbances, nystagmus, speech disturbances, abnormal involuntary movements, peripheral neuritis and paresthesias, depression with agitation, talkativeness, tinnitus, hyperacusis, neuroleptic malignant syndrome.

There have been reports of associated paralysis and other symptoms of cerebral arterial insufficiency, but the exact relationship of these reactions to the drug has not been established.

Isolated cases of neuroleptic malignant syndrome have been reported both with and without concomitant use of psychotropic drugs.

Digestive System

Nausea, vomiting, gastric distress and abdominal pain, diarrhea, constipation, anorexia, and dryness of the mouth and pharynx, including glossitis and stomatitis.

Eyes

Scattered punctate cortical lens opacities, increased intraocular pressure (see WARNINGS, General) as well as conjunctivitis, have been reported. Although a direct causal relationship has not been established, many phenothiazines and related drugs have been shown to cause eye changes.

Musculoskeletal System

Aching joints and muscles, and leg cramps.

Metabolism

Fever and chills. Hyponatremia (see WARNINGS, General). Decreased levels of plasma calcium have been reported. Osteoporosis has been reported.

Isolated cases of a lupus erythematosus-like syndrome have been reported. There have been occasional reports of elevated levels of cholesterol, HDL cholesterol, and triglycerides in patients taking anticonvulsants.

A case of aseptic meningitis, accompanied by myoclonus and peripheral eosinophilia, has been reported in a patient taking carbamazepine in combination with other medications. The patient was successfully dechallenged, and the meningitis reappeared upon rechallenge with carbamazepine.

Drug Abuse And Dependence

No evidence of abuse potential has been associated with Tegretol, nor is there evidence of psychological or physical dependence in humans.

Read the entire FDA prescribing information for Tegretol (Carbamazepine)

What is Tegretol?

Tegretol is a medication known as an anticonvulsant that is used to treat the manic symptoms of bipolar disorder. It is also used to treat seizures and nerve pain.

When did the U.S. Food and Drug Administration (FDA) approve the medication?

Tegretol was first approved by the FDA in 1968.

Is there a generic version of Tegretol?

Yes, the generic version is known as carbamazepine and is sold in the U.S.

Are there any major differences between Tegretol and other medications used to treat bipolar disorder?

Tegretol belongs to the class of medications known as anticonvulsants. Anticonvulsants are sometimes taken to treat or prevent the manic episodes associated with bipolar disorder. Tegretol may be prescribed alone or in combination with other medications to treat symptoms.

What warning information do I need to know about Tegretol?

Tegretol may cause a life-threatening allergic reaction known as Stevens-Johnson Syndrome or toxic epidermal necrolysis. This can cause damage to your internal organs or skin. The risk factor is genetic, with people of Asian ancestry being at higher risk. Talk to your doctor about getting genetic testing to evaluate the risk of taking Tegretol. Tegretol can also decrease the number of blood cells in the body, so talk to your doctor if you already have a low number or are taking other medications that increase this risk.

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Can children take Tegretol?

Children over the age of 6 can be prescribed Tegretol for seizures. Talk to your doctor about the risks and benefits and potential side effects to monitor.

Are there potential interaction issues for people taking Tegretol and any other drugs?

There are hundreds of drugs which are known to interact with Tegretol in major, moderate, or mild ways, so let your doctor know what other medications you are taking before you begin taking the medication. Some of these might include medication for mental illness such as depression or anxiety, antifungals, seizure medications, HIV protease inhibitors, malaria medications, sleeping medications, and any vitamins or over the counter prescriptions you might be taking. Tegretol may also decrease the effectiveness of hormonal contraceptives.

Are there any other medical conditions that would make someone ineligible for Tegretol therapy?

Talk to your doctor about other medical conditions before you take Tegretol, such as glaucoma, heart disease, kidney disease, thyroid or liver disease, or a history of psychosis. Also tell your doctor if you have a history of low blood cell count.

What is the typical dose that would be prescribed to someone taking Tegretol?

Dosage will vary depending on the age of the patient and the condition being treated.

What do I do if I miss a dose?

Take the dose of Tegretol when you remember, but skip the missed dose if it is almost time for your next dose. You should never take extra doses of the medication to make up for missed doses.

What side effects can Tegretol cause?

Common side effects can include:
• nausea
• dry mouth
• constipation
• dizziness
• drowsiness
• mild rash

It also is recommended that you wait to drive or operate machinery until you know how the medication affects you and to avoid alcohol and illegal drugs while on the medication, as they can worsen adverse effects. Report major side effects to your doctor immediately, which can include swelling, shortness of breath, skin reaction, and fever. Report side effects to the FDA at 1-800-FDA-1088 or online.

What are the potential psychological side effects of taking Tegretol?

Anticonvulsant medications sometimes cause suicidal thoughts and behaviors in a small percentage of people who take the medication. Seek medical help if you experience these thoughts or other changes in your behavior or mood.

What are the potential long-term effects of taking Tegretol?

Tegretol can cause lower blood counts and lower sodium levels. Your doctor may want to monitor these periodically while you’re taking the medication.

Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Tegretol?

Tegretol can cause birth defects and fetal harm when taken during pregnancy. The drug can be transferred via breast milk and potentially harm a baby. Therefore, talk to your doctor if you are pregnant, planning to become pregnant, or are nursing before you take Tegretol.

Can symptoms occur if Tegretol is discontinued?

It’s important not to discontinue use of the drug before talking with your doctor. Withdrawal symptoms of Tegretol can include sleep problems, increased anxiety, numbness in limbs, joint pain, shaking, and the return of manic or depressive symptoms.

What should I do if I overdose on Tegretol?

An overdose of Tegretol could be fatal, so seek immediate help or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include abnormal or uncontrollable movements, restlessness, seizures, loss of balance, dizziness, drowsiness, blurred vision, slower or irregular breathing, rapid heartbeat, nausea, vomiting, trouble urinating, and unconsciousness.

Is Tegretol habit-forming?

Tegretol has no habit-forming potential, but it is not recommended that you discontinue use of the drug before talking with your doctor, as withdrawal symptoms can occur.

How much does Tegretol cost?

According to goodrx.com, 60 tables of 200 mg generic carbamazepine cost approximately $65. 60 tablets of 200 mg Tegretol cost approximately $150.

Are there any disadvantages to Tegretol?

The biggest disadvantages of Tegretol are potential side effects which include severe allergic reaction and decreased blood cell count. Pregnant women are also typically advised not to take the medication due to the risk of birth defects.

DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other healthcare providers. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

Article Sources Last Updated: Nov 25, 2018

Tegretol 100mg Tablets

Warnings

Agranulocytosis and aplastic anaemia have been associated with Tegretol; however, due to the very low incidence of these conditions, meaningful risk estimates for Tegretol are difficult to obtain. The overall risk in the general untreated population has been estimated at 4.7 persons per million per year for agranulocytosis and 2.0 persons per million per year for aplastic anaemia.

Decreased platelet or white blood cell counts occur occasionally to frequently in association with the use of Tegretol. Nonetheless, complete pre-treatment blood counts, including platelets and possibly reticulocytes and serum iron, should be obtained as a baseline, and periodically thereafter.

Patients and their relatives should be made aware of early toxic signs and symptoms indicative of a potential haematological problem, as well as symptoms of dermatological or hepatic reactions. If reactions such as fever, sore throat, rash, ulcers in the mouth, easy bruising, petechial or purpuric haemorrhage appear, the patient should be advised to consult the physician immediately.

If the white blood cell or platelet count is definitely low or decreased during treatment, the patient and the complete blood count should be closely monitored (see Section 4.8 Undesirable Effects). However, treatment with Tegretol should be discontinued if the patient develops leucopenia which is severe, progressive or accompanied by clinical manifestations, e.g. fever or sore throat. Tegretol should also be discontinued if any evidence of significant bone marrow depression appears.

Liver function tests should also be performed before commencing treatment and periodically thereafter, particularly in patients with a history of liver disease and in elderly patients. The drug should be withdrawn immediately in cases of aggravated liver dysfunction or acute liver disease.

Some liver function tests in patients receiving carbamazepine may be found to be abnormal, particularly gamma glutamyl transferase. This is probably due to hepatic enzyme induction. Enzyme induction may also produce modest elevations in alkaline phosphatase. These enhancements of hepatic metabolising capacity are not an indication for the withdrawal of carbamazepine.

Severe hepatic reactions to carbamazepine occur very rarely. The development of signs and symptoms of liver dysfunction or active liver disease should be urgently evaluated and treatment with Tegretol suspended pending the outcome of the evaluation.

Suicidal ideation and behaviour have been reported in patients treated with anti-epileptic agents in several indications. A meta-analysis of randomised placebo-controlled trials of anti-epileptic drugs has also shown a small increased risk of suicidal ideation and behaviour. The mechanism of this risk is not known and the available data do not exclude the possibility of an increased risk for carbamazepine.

Therefore patients should be monitored for signs of suicidal ideation and behaviours and appropriate treatment should be considered. Patients (and caregivers of patients) should be advised to seek medical advice should signs of suicidal ideation or behaviour emerge.

Serious dermatological reactions, including toxic epidermal necrolysis (TEN: also known as Lyell’s syndrome) and Stevens Johnson syndrome (SJS) have been reported very rarely with Tegretol. Patients with serious dermatological reactions may require hospitalization, as these conditions may be life-threatening and may be fatal. Most of the SJS/TEN cases appear in the first few months of treatment with Tegretol. These reactions are estimated to occur in 1 to 6 per 10,000 new users in countries with mainly Caucasian populations. If signs and symptoms suggestive of severe skin reactions (e.g. SJS, Lyell’s syndrome/TEN) appear, Tegretol should be withdrawn at once and alternative therapy should be considered.

Cutaneous reactions

Serious and sometimes fatal cutaneous reactions including toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) have been reported during treatment with carbamazepine. These reactions are estimated to occur in 1-6 per 10 000 new users in countries with mainly Caucasian populations, but the risk in some Asian countries is estimated to be about 10 times higher.

There is growing evidence of the role of different HLA alleles in predisposing patients to immune-mediated adverse reactions (see section 4.2).

HLA-B*1502 allele – in Han Chinese, Thai and other Asian populations

HLA-B*1502 in individuals of Han Chinese and Thai origin has been shown to be strongly associated with the risk of developing Stevens-Johnson syndrome (SJS) when treated with carbamazepine. The prevalence of HLA-B*1502 carrier is about 10% in Han Chinese and Thai populations. Whenever possible, these individuals should be screened for this allele before starting treatment with carbamazepine (see section 4.2). If these individuals test positive, carbamazepine should not be started unless there is no other therapeutic option. Tested patients who are found to be negative for HLA-B*1502 have a low risk of SJS, although the reactions may still very rarely occur.

There are some data that suggest an increased risk of serious carbamazepine-associated TEN/SJS in other Asian populations. Because of the prevalence of this allele in other Asian populations (e.g. above 15% in the Philippines and Malaysia), testing genetically at risk populations for the presence of HLA-B*1502 may be considered.

The prevalence of the HLA-B*1502 allele is negligible in e.g. European descent, African, Hispanic populations sampled, and in Japanese and Koreans (< 1%).

HLA-A*3101 allele – European descent and Japanese populations

There are some data that suggest HLA-A*3101 is associated with an increased risk of carbamazepine induced cutaneous adverse drug reactions including SJS, TEN, Drug rash with eosinophilia (DRESS), or less severe acute generalized exanthematous pustulosis (AGEP) and maculopapular rash (see section 4.8) in people of European descent and the Japanese.

The frequency of the HLA-A*3101 allele varies widely between ethnic populations. HLA-A*3101 allele has a prevalence of 2 to 5% in European populations and about 10% in Japanese population.

The presence of HLA-A*3101 allele may increase the risk for carbamazepine induced cutaneous reactions (mostly less severe) from 5.0% in general population to 26.0% among subjects of Northern European ancestry, whereas its absence may reduce the risk from 5.0% to 3.8%.

There are insufficient data supporting a recommendation for HLA-A*3101 screening before starting carbamazepine treatment.

If patients of European descent or Japanese origin are known to be positive for HLA-A*3101 allele, the use of carbamazepine may be considered if the benefits are thought to exceed risks.

Other dermatologic reactions

Mild skin reactions e.g. isolated macular or maculopapular exanthema, can also occur and are mostly transient and not hazardous. They usually disappear within a few days or weeks, either during the continued course of treatment or following a decrease in dosage. However, since it may be difficult to differentiate the early signs of more serious skin reactions from mild transient reactions, the patient should be kept under close surveillance with consideration given to immediately withdrawing the drug should the reaction worsen with continued use.

The HLA-B*1502 allele has not been found to predict risk of less severe adverse cutaneous reactions from carbamazepine, such as anticonvulsant hypersensitivity syndrome or non-serious rash (maculopapular eruption).

Hypersensitivity

Tegretol may trigger hypersensitivity reactions, including Drug Rash with Eosinophilia and Systemic Symptoms (DRESS), reactivation of HHV6 associated with DRESS, a delayed multi-organ hypersensitivity disorder with fever, rash, vasculitis, lymphadenopathy, pseudo lymphoma, arthralgia, leukopenia, eosinophilia, hepato-splenomegaly, abnormal liver function tests and vanishing bile duct syndrome (destruction and disappearance of the intrahepatic bile ducts), that may occur in various combinations. Other organs may also be affected (e.g. lungs, kidneys, pancreas, myocardium, colon) see section 4.8 Undesirable Effects.

In general, if signs and symptoms suggestive of hypersensitivity reactions occur, Tegretol should be withdrawn immediately.

Patients who have exhibited hypersensitivity reactions to carbamazepine should be informed that 25-30 % of these patients may experience hypersensitivity reactions with oxacarbazepine (Trileptal).

Cross-hypersensitivity can occur between carbamazepine and aromatic antiepileptic drugs (e.g. phenytoin, primidone and phenobarbital).

Tegretol should be used with caution in patients with mixed seizures which include absences, either typical or atypical. In all these conditions, Tegretol may exacerbate seizures. In case of exacerbation of seizures, Tegretol should be discontinued.

An increase in seizure frequency may occur during switchover from an oral formulation to suppositories.

Dose reduction and withdrawal effects

Abrupt withdrawal of Tegretol may precipitate seizures, therefore carbamazepine withdrawal should be gradual. If treatment with Tegretol has to be withdrawn abruptly in a patient with epilepsy, the changeover to another anti-epileptic drug should if necessary be effected under the cover of a suitable drugs.

Endocrinological effects

Breakthrough bleeding has been reported in women taking Tegretol while using hormonal contraceptives. The reliability of hormonal contraceptives may be adversely affected by Tegretol and women of child-bearing potential should be advised to consider using alternative forms of birth control while taking Tegretol.

Patients taking Tegretol and requiring hormonal contraception should receive a preparation containing not less than 50µg oestrogen or use of some alternative non-hormonal method of contraception should be considered.

Monitoring of plasma levels

Although correlations between dosages and plasma levels of carbamazepine, and between plasma levels and clinical efficacy or tolerability are rather tenuous, monitoring of the plasma levels may be useful in the following conditions: dramatic increase in seizure frequency/verification of patient compliance; during pregnancy; when treating children or adolescents; in suspected absorption disorders; in suspected toxicity when more than one drug is being used (see 4.5 Interaction with other medicinal products and other forms of interaction).

Precautions

Tegretol should be prescribed only after a critical benefit-risk appraisal and under close monitoring in patients with a history of cardiac, hepatic or renal damage, adverse haematological reactions to other drugs, or interrupted courses of therapy with Tegretol.

Baseline and periodic complete urinalysis and BUN determinations are recommended.

Hyponatremia

Hyponatremia is known to occur with carbamazepine. In patients with pre-existing renal conditions associated with low sodium or in patients treated concomitantly with sodium-lowering medicinal products (e.g. diuretics, medicinal products associated with inappropriate ADH secretion), serum sodium levels should be measured prior to initiating carbamazepine therapy. Thereafter, serum sodium levels should be measured after approximately two weeks and then at monthly intervals for the first three months during therapy, or according to clinical need. These risk factors may apply especially to elderly patients. If hyponatraemia is observed, water restriction is an important counter-measurement if clinically indicated.

Hypothyroidism

Carbamazepine may reduce serum concentrations of thyroid hormones through enzyme induction requiring an increase in dose of thyroid replacement therapy in patients with hypothyroidism. Hence thyroid function monitoring is suggested to adjust the dosage of thyroid replacement therapy.

Anticholinergic effects

Tegretol has shown mild anticholinergic activity; patients with increased intraocular pressure and urinary retention should therefore be closely observed during therapy (see section 4.8).

Psychiatric effects

The possibility of activation of a latent psychosis and, in elderly patients, of confusion or agitation should be borne in mind.

Interactions

Co-administration of inhibitors of CYP3A4 or inhibitors of epoxide hydrolase with carbamazepine can induce adverse reactions (increase of carbamazepine or carbamazepine-10,11 epoxide plasma concentrations, respectively). The dosage of Tegretol should be adjusted accordingly and/or the plasma levels monitored.

Co-administration of CYP3A4 inducers with carbamazepine may decrease carbamazepine plasma concentrations and its therapeutic effect, while discontinuation of a CYP3A4 inducer may increase carbamazepine plasma concentrations. The dosage of Tegretol may have to be adjusted.

Carbamazepine is a potent inducer of CYP3A4 and other phase I and phase II enzyme systems in the liver, and may therefore reduce plasma concentrations of co-medications mainly metabolized by CYP3A4 by induction of their metabolism. See section 4.5 Interactions.

Female patients of child-bearing potential should be warned that the concurrent use of Tegretol with hormonal contraceptives may render this type of contraceptive ineffective (see sections 4.5 Interactions and 4.6 Fertility, pregnancy and lactation). Alternative non-hormonal forms of contraception are recommended when using Tegretol.

Falls

Tegretol treatment has been associated with ataxia, dizziness, somnolence, hypotension, confusional state, sedation (see section 4.8 Undesirable effects) which may lead to falls and, consequently fractures or other injuries. For patients with diseases, conditions, or medications that could exacerbate these effects, complete risk assessment of fall should be considered recurrently for patients on long-term Tegretol treatment.

Brand Names: Carbatrol, Epitol, Equetro, TEGretol, TEGretol XR

Generic Name: carbamazepine (oral)

  • What is carbamazepine?
  • What are the possible side effects of carbamazepine?
  • What is the most important information I should know about carbamazepine?
  • What should I discuss with my healthcare provider before taking carbamazepine?
  • How should I take carbamazepine?
  • What happens if I miss a dose?
  • What happens if I overdose?
  • What should I avoid while taking carbamazepine?
  • What other drugs will affect carbamazepine?
  • Where can I get more information?

What is carbamazepine?

Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain.

Carbamazepine is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. Carbamazepine is also used to treat bipolar disorder.

Carbamazepine may also be used for purposes not listed in this medication guide.

What are the possible side effects of carbamazepine?

Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include: skin rash, fever, swollen glands, flu-like symptoms, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes. Symptoms may occur several weeks after you start using carbamazepine.

Report any new or worsening symptoms to your doctor, such as: sudden mood or behavior changes, depression, anxiety, insomnia, or if you feel agitated, hostile, restless, irritable, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • a skin rash, no matter how mild;
  • loss of appetite, right-sided upper stomach pain, dark urine;
  • slow, fast, or pounding heartbeats;
  • anemia or other blood problems–fever, chills, sore throat, mouth sores, bleeding gums, nosebleeds, pale skin, easy bruising, unusual tiredness, feeling light-headed or short of breath; or
  • low levels of sodium in the body–headache, confusion, severe weakness, feeling unsteady, increased seizures.

Common side effects may include:

  • dizziness, loss of coordination, problems with walking;
  • nausea, vomiting; or
  • drowsiness.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about carbamazepine?

You should not take carbamazepine if you have a history of bone marrow suppression, or if you are allergic to carbamazepine or to certain antidepressant medications.

Tell your doctor about all your current medicines and any you start or stop using. Many drugs can interact, and some drugs should not be used together.

Carbamazepine may cause serious blood problems or a life-threatening skin rash or allergic reaction. Call your doctor if you have a fever, unusual weakness, bleeding, bruising, or a skin rash that causes blistering and peeling.

Some people have thoughts about suicide while taking seizure medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Do not stop taking carbamazepine without asking your doctor first, even if you feel fine.

Does Lamictal Cause Weight Gain?

If weight gain is a concern for you during your bipolar disorder treatment, discuss Lamictal with your doctor. Although Lamictal is less likely to cause weight gain, it can cause other side effects and interactions.

Below is more information you should consider if you take this drug or plan to take this drug.

More common side effects

The more common side effects of Lamictal in people treated for bipolar I disorder include:

  • nausea
  • sleeping trouble
  • sleepiness or extreme tiredness
  • back pain
  • rash
  • runny nose
  • stomach pain
  • dry mouth

Serious side effects

Serious skin rashes

These rashes may need treatment in a hospital. They can also be fatal. This side effect can happen at any time, but it’s more likely to happen within the first 8 weeks of treatment. Symptoms can include:

  • rash
  • blistering or peeling of your skin
  • hives
  • painful sores in your mouth or around your eyes

Reactions that can affect the function of your liver or blood cells

Symptoms of these reactions can include:

  • fever
  • frequent infections
  • severe muscle pain
  • swollen lymph glands
  • unusual bruising or bleeding
  • weakness or tiredness
  • yellowing of your skin or the whites of your eyes
  • swelling of your face, eyes, lips, or tongue

Suicidal thoughts or actions

Aseptic meningitis

This is inflammation of the protective membrane that covers your brain and spinal cord. Symptoms can include:

  • headache
  • fever
  • nausea
  • vomiting
  • stiff neck
  • rash
  • unusual sensitivity to light
  • muscle pains
  • chills
  • confusion
  • drowsiness

Interactions

If you take Lamictal with certain drugs, the interaction may cause side effects. Interactions may also cause one or more of the drugs to stop working normally.

Taking the anticonvulsant and mood-stabilizing drugs valproic acid or divalproex sodium (Depakene, Depakote) along with Lamictal can double the amount of Lamictal that stays in your body. This effect can greatly increase your chances of side effects from Lamictal.

On the other hand, taking the anticonvulsant and mood-stabilizing drugs carbamazepine (Tegretol), phenytoin (Dilantin), phenobarbital (Luminal), or primidone (Mysoline) along with Lamictal can decrease the levels of Lamictal in your body by about 40 percent.

Estrogen-containing birth control pills and the antibiotic rifampin (Rifadin) also can decrease Lamictal levels by about 50 percent. These effects can greatly reduce how well Lamictal works to treat your symptoms of bipolar disorder.

Other conditions

If you have moderate liver or kidney damage, your body may not process Lamictal as well as it should. Your doctor may suggest a lower starting dosage or a different drug.

Pregnancy and breastfeeding

It’s not known if Lamictal is safe to use during pregnancy. Tell your doctor if you’re pregnant or plan to become pregnant before taking this drug.

Lamictal also passes into breast milk and may cause side effects in your child if you breastfeed. Talk to your doctor about the best way to feed your child if you take Lamictal.

Carbamazepine, Oral Tablet

Carbamazepine oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with carbamazepine are listed below.

Heart drugs

Taking certain heart drugs with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • diltiazem
  • verapamil

Fungal infection drugs

Taking one of these drugs with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • ketoconazole
  • itraconazole
  • fluconazole
  • voriconazole

Altitude sickness drug

Taking acetazolamide with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Anti-allergy drug

Taking loratadine with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Antibiotics

Taking certain antibiotics with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • clarithromycin
  • erythromycin
  • ciprofloxacin

HIV drugs

Taking certain HIV medications with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • ritonavir
  • indinavir
  • nelfinavir
  • saquinavir

Tuberculosis drugs

Taking rifampin with carbamazepine will decrease the level of carbamazepine in your body. This means that it won’t work as well to treat your condition. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Taking isoniazid with carbamazepine may increase your risk of liver damage.

Anti-nausea drug

Taking aprepitant with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Mental health drugs

Taking certain mental health drugs with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • fluoxetine
  • fluvoxamine
  • trazodone
  • olanzapine
  • loxapine
  • quetiapine

Taking nefazodone with carbamazepine will decrease the level of nefazodone in your body. Taking these two drugs together is not recommended.

Taking aripiprazole with carbamazepine will decrease the levels of aripiprazole in your body. Your doctor may increase your dose of aripiprazole.

Anti-spasm drug

Taking dantrolene with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Bladder drug

Taking oxybutynin with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Blood thinners

Taking carbamazepine with certain drugs called anticoagulants can decrease the effects of these drugs. That means they won’t work as well to prevent blood clots. Examples of these drugs include:

  • rivaroxaban
  • apixaban
  • dabigatran
  • edoxaban

Taking ticlopidine with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Heartburn drugs

Taking certain heartburn drugs with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • cimetidine
  • omeprazole

Anti-seizure drugs

Taking certain anti-seizure drugs with carbamazepine will decrease the level of carbamazepine in your body. This means it won’t work as well to treat your condition. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • felbamate
  • methsuximide
  • phenytoin
  • fosphenytoin
  • phenobarbital
  • primidone

Taking other anti-seizure drugs with carbamazepine with one of these drugs may affect how your thyroid hormone works. These drugs include:

  • phenytoin
  • phenobarbital

Taking valproic acid with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Herbal products

Taking niacinamide with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Cancer drugs

Taking certain cancer drugs with carbamazepine will decrease the level of carbamazepine in your body. This means it won’t work as well to treat your condition. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • cisplatin
  • doxorubicin

Taking other cancer drugs with carbamazepine will change the level of the cancer drug in your body. Your doctor should avoid use of these drugs together. However, if they must be used together, you doctor may change the dosage of your cancer drug. Examples of these drugs include:

  • temsirolimus
  • lapatinib

Taking cyclophosphamide with carbamazepine will increase the level of the cancer drug in your body. Your doctor may change your dosage of the cancer drug if you take it with carbamazepine.

Pain drug

Taking ibuprofen with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Anti-rejection drug

Taking tacrolimus with carbamazepine will change the levels of tacrolimus in your body. Your doctor may monitor your blood levels of tacrolimus and change your dosage.

Bipolar disorder drug

Taking lithium with carbamazepine may increase your risk of side effects.

Hormonal birth control drugs

Taking carbamazepine with hormonal birth control, such as the birth control pill, may make the birth control less effective. You may need to use alternative or back-up methods of contraception.

Respiratory drugs

Taking certain respiratory drugs with carbamazepine will decrease the level of carbamazepine in your body. This means it won’t work as well to treat your condition. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • aminophylline
  • theophylline

Muscle relaxers

Taking one of these drugs with carbamazepine can decrease the effect of these medications. Your doctor may adjust your dosage of these drugs if you take them with carbamazepine. These drugs include:

  • pancuronium
  • vecuronium
  • rocuronium
  • cisatracurium

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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