Carbamazepine, Oral

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KEY POINTS

• This medicine is taken by mouth to prevent or control seizures, relieve some types of nerve pain, or treat some symptoms of bipolar disorder. Take it exactly as directed.
• Keep all appointments for tests to see how this medicine affects you.
• This medicine may increase suicidal thoughts or actions in some people.
• This medicine may cause a serious (and sometimes fatal) skin condition, anemia, or other unwanted side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• This medicine can interact with many products. Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Carry some form of ID stating that you are taking this medicine.

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What are other names for this medicine?

Type of medicine: antiseizure; analgesic

Generic and brand names: carbamazepine, oral; Carbatrol; Epitol; Equetro; Tegretol; Tegretol Suspension; Tegretol XR

What is this medicine used for?

This medicine is taken by mouth to:

• Prevent or control certain types of seizures (epilepsy)
• Relieve certain types of nerve pain
• Treat acute manic or mixed episodes that happen with bipolar disorder (Equetro)

This medicine may be used to treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• An allergic reaction to any medicine
• A blood disorder or bone marrow problem
• Glaucoma
• Heart problems
• Hepatic porphyria or other liver disease
• Kidney problems
• Mental health problems such as depression or thoughts of suicide

Do not take this medicine if you have taken any of these medicines in the past 2 weeks:

• Anti-HIV medicines such as delavirdine (Rescriptor), efavirenz (Atripla, Sustiva), etravirine (Intelence), nevirapine (Viramune), or rilpivirine (Complera, Edurant)
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate)
• Nefazodone (an antidepressant)

If you are of Asian ancestry, you may be at high risk of a serious skin reaction. Your provider may give you a blood test to find out if you carry the HLA-A*3101 or HLA-B*1502 gene. If the test is positive, you are at high risk for severe reaction. Talk with your provider about this.

Females of childbearing age: This medicine is not usually given to pregnant women because it can harm the baby. Tell your healthcare provider if you are pregnant or breast-feeding. Do not become pregnant while you are taking this medicine. This medicine may make hormonal birth control less effective. Talk with your healthcare provider about effective birth control methods. If you become pregnant, stop taking this medicine and contact your healthcare provider right away. Do not breast-feed while taking this medicine.

How do I take it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you get a refill.

This medicine is not an ordinary pain reliever and should not be used for any other type of pain. Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider directs for the condition for which it was prescribed. Do not take more than prescribed. Taking too much may increase the risk of side effects. Take this medicine regularly to control seizures. Do not stop taking it without your healthcare provider's approval. You may have to gradually reduce your dosage. Seizures may get worse if you suddenly stop taking this medicine.

Check with your healthcare provider before using this medicine in children. Some brands should not be used in children under a certain age.

This medicine comes in several forms, such as regular tablets, extended-release tablets or capsules, chewable tablets, and liquid.

Do not break, crush, or chew the extended-release tablets or capsules. Swallow them whole. If you have trouble swallowing, the extended-release capsule may be opened and the medicine beads sprinkled on soft food such as applesauce. Swallow the mixture without chewing. Ask your pharmacist if you have any questions.

Take the regular tablets, chewable tablets, extended release tablets, and liquid with food. You may take the extended release capsules (Carbatrol, Equetro) with or without food.

If you are taking the liquid form of this medicine, shake the bottle well before taking the medicine. Use the measuring spoon, cup, dropper, or oral syringe that comes with the medicine, or ask your pharmacist for one. Do not use a kitchen spoon because the dose may not be correct. Do not take this medicine at the same time that you take other liquid medicines.

Talk with your provider before changing the amount of fiber in your diet. Fiber can affect the way your body absorbs this medicine.

What if I miss a dose?

If you miss a dose, take it as soon as you remember, unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: slow or shallow breathing, fast or irregular heartbeat, nausea, vomiting, urinating less or not at all, muscle twitches, restlessness, tremors, slurred speech, trouble with balance or walking, lightheadedness, fainting, seizures, coma.

What should I watch out for?

Rarely, this medicine may cause a form of anemia. You may need to have blood tests regularly to see how this medicine affects you. Keep all appointments for tests. Contact your healthcare provider if you develop any of these symptoms:

• Unusual bruising or bleeding
• Fever
• Sore throat or swollen glands
• Red or purple spots on your body

Antiseizure medicines may increase suicidal thoughts or actions in some people. Call your healthcare provider right away if you have new or worsening depression, any unusual changes in mood or behavior, or new or increased thoughts of suicide.

This medicine may cause a rash. Rarely, the rash can develop into a serious (and sometimes fatal) skin condition. Warning signs that a rash is serious are:

• A swollen face
• Flaky, painful, blistering, or peeling skin
• Purple blotches
• Raised lumps
• Sores on the lips or inside the mouth
• Wheezing or trouble breathing

See your healthcare provider right away if you get a rash while taking this medicine.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

This medicine increases the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicines unless your healthcare provider approves.

This medicine may make your skin more sensitive to the sun, which may lead to painful sunburns. While you are taking this medicine, avoid long exposure to the sun. Wear protective clothing, a hat, and sunscreen lotion when you need to be outdoors. Do not use a sunlamp. If you get a severe sunburn, contact your healthcare provider right away.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (Report these to your healthcare provider right away.): Severe nausea or vomiting; confusion; memory problems; unusual mood or behavior changes; new or worsening depression; thoughts of suicide; vision problems; ringing in your ears; uncontrollable eye or muscle twitches; slurred speech; increased seizures; slow, irregular, or pounding heartbeat; chest pain; trembling; sudden decrease in urination; severe dizziness or fainting; dark urine; mouth sores; sore throat; swollen glands; unexplained fever; unusual bruising or bleeding; unusual tiredness or weakness; unexplained muscle pain; yellowing of your skin or eyes; unexplained loss of appetite; severe skin redness, blisters, or peeling skin; swelling of the feet or legs.

Other: Slight drowsiness or dizziness, clumsiness, mild nausea or vomiting, dry mouth, constipation.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• Acetaminophen and medicines that contain acetaminophen
• Acetazolamide (Diamox)
• Albendazole (Albenza)
• Antianxiety medicines such as alprazolam (Xanax), buspirone, clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), and midazolam (Versed)
• Antibiotics such as azithromycin (Zithromax, Zmax), bedaquiline (Sirturo), ciprofloxacin (Cipro), clarithromycin (Biaxin), dalfopristin/quinupristin (Synercid), dapsone, doxycycline (Doryx, Monodox, Vibramycin), erythromycin (E.E.S., Ery-Tab, Erythrocin), isoniazid, linezolid (Zyvox), rifampin (Rifadin), and sulfamethoxazole/trimethoprim (Bactrim, Septra)
• Antidepressants such as amitriptyline, amoxapine, citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), fluoxetine (Prozac), fluvoxamine (Luvox), imipramine (Tofranil), mirtazapine (Remeron), nefazodone, nortriptyline (Pamelor), sertraline (Zoloft), trazodone, and trimipramine (Surmontil)
• Antifungal medicines such as fluconazole (Diflucan), isavuconazonium (Cresemba), itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), and voriconazole (Vfend)
• Antihistamines such as azelastine (Astelin, Astepro), chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril), and loratadine (Alavert, Claritin)
• Antipsychotic medicines such as aripiprazole (Abilify), cariprazine (Vraylar), clozapine (Clozaril, FazaClo), haloperidol (Haldol), lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), thiothixene (Navane), trifluoperazine, and ziprasidone (Geodon)
• Antiseizure medicines such as clobazam (Onfi), eslicarbazepine (Aptiom), ethosuximide (Zarontin), felbamate (Felbatol), fosphenytoin (Cerebyx), lamotrigine (Lamictal), Levetiracetam (Keppra), methsuximide (Celontin), oxcarbazepine (Trileptal), phenobarbital, phenytoin (Dilantin, Phenytek), primidone (Mysoline), rufinamide (Banzel), tiagabine (Gabitril), topiramate (Qudexy, Topamax, Trokendi), valproic acid (Depacon, Depakene, Depakote), and zonisamide (Zonegran)
• Antiviral medicines such as daclatasvir (Daklinza), elbasvir/grazoprevir (Zepatier), ledipasvir/sofosbuvir (Harvoni), ombitasvir/paritaprevir/ritonavir (Technivie), ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira)
• Apremilast (Otezla)
• Aprepitant (Emend)
• Avanafil (Stendra)
• Bosentan (Tracleer)
• Bupropion (Aplenzin, Forfivo, Wellbutrin, Buproban, Zyban)
• Calcium channel blockers such as amlodipine (Norvasc), amlodipine/atorvastatin (Caduet), diltiazem (Cardizem, Cartia, Tiazac), felodipine, nifedipine (Adalat CC, Procardia), and verapamil (Calan, Covera, Verelan)
• Cancer medicines such as abiraterone (Zytiga), axitinib (Inlyta), bortezomib (Velcade), bosutinib (Bosulif), cabozantinib (Cometriq), ceritinib (Zykadia), cisplatin, cobimetinib (Cotellic), crizotinib (Xalkori), dabrafenib (Tafinlar), doxorubicin (Doxil), enzalutamide (Xtandi), ibrutinib (Imbruvica), imatinib (Gleevec), irinotecan (Camptosar), lapatinib (Tykerb), mitotane (Lysodren), nilotinib (Tasigna), nilutamide (Nilandron), olaparib (Lynparza), pazopanib (Votrient), pomalidomide (Pomalyst), ponatinib (Iclusig), procarbazine (Matulane), regorafenib (Stivarga), romidepsin (Istodax), sorafenib (Nexavar), temsirolimus (Torisel), toremifene (Fareston), vandetanib (Caprelsa), and vincristine (Marqibo)
• Cholesterol-lowering medicines such as atorvastatin (Lipitor), lovastatin (Altoprev), and simvastatin (Zocor)
• Corticosteroids such as betamethasone, dexamethasone, prednisolone (Omnipred, Orapred, Prelone), and prednisone (Prednisone Intensol)
• Cystic fibrosis medicines such as ivacaftor (Kalydeco) and lumacaftor/ivacaftor (Orkambi)
• Danazol
• Diabetes medicines such as chlorpropamide, glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (Glynase), linagliptin (Tradjenta), nateglinide (Starlix), pioglitazone (Actos), repaglinide (Prandin), rosiglitazone (Avandia), and sitagliptin (Januvia)
• Diuretics (water pills) such as chlorothiazide (Diuril), chlorthalidone, furosemide (Lasix), hydrochlorothiazide (Microzide), and torsemide (Demadex)
• Doxepin (Silenor)
• Everolimus (Afinitor, Zortress)
• Heart medicines such as betaxolol, dronedarone (Multaq), losartan (Cozaar), mexiletine, and ranolazine (Ranexa)
• HIV medicines such as atazanavir (Reyataz), darunavir (Prezista), delavirdine (Rescriptor), efavirenz (Sustiva), elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild), etravirine (Intelence), maraviroc (Selzentry), nelfinavir (Viracept), nevirapine (Viramune), rilpivirine (Edurant), ritonavir (Norvir), and saquinavir (Invirase)
• Hormonal birth control implants, IUDs, patches, pills, shots, and vaginal rings (Talk to your healthcare provider if you need birth control.)
• Immunosuppressants such as cyclosporine (Gengraf, Neoral, Sandimmune), sirolimus (Rapamune), and tacrolimus (Astagraf, Prograf, Protopic)
• Levothyroxine (Levo-T, Levothroid, Levoxyl, Synthroid, Unithroid)
• Lithium (Lithobid)
• Malaria medicines such as artemether/lumefantrine (Coartem), chloroquine, mefloquine, primaquine, and quinine
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines to block or prevent stomach acid such as cimetidine (Tagamet), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (AcipHex)
• Medicines to treat breathing or lung problems such as zafirlukast (Accolate) and zileuton (Zyflo)
• Medicines to treat low sodium levels such as conivaptan (Vaprisol) and tolvaptan (Samsca)
• Medicines to treat or prevent blood clots such as apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto), and warfarin (Coumadin)
• Mifepristone (Korlym, Mifeprex)
• Muscle relaxants such as baclofen (Gablofen, Lioresal), carisoprodol (Soma), cyclobenzaprine (Amrix), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• Natural remedies such as gotu kola, kava, St. John's wort, and valerian
• Nausea medicines such as aprepitant (Emend), fosaprepitant (Emend), prochlorperazine (Compro), promethazine, and rolapitant (Varubi)
• Niacin
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as celecoxib (Celebrex), diclofenac (Cambia, Voltaren, Zipsor), hydrocodone/ibuprofen (Vicoprofen), ibuprofen (Advil, Motrin), indomethacin (Indocin), ketoprofen, ketorolac, meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Anaprox, Naprelan), oxaprozin (Daypro), piroxicam (Feldene), and sulindac (Clinoril)
• Pain medicines such as buprenorphine (Buprenex, Butrans), codeine, fentanyl (Abstral, Actiq, Duragesic, Fentora, Sublimaze), hydrocodone (Hysingla, Zohydro), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), pentazocine (Talwin), tapentadol (Nucynta), and tramadol (ConZip, Ultram)
• Praziquantel (Biltricide)
• Propranolol (Hemangeol, Inderal, InnoPran)
• Rasagiline (Azilect)
• Riluzole (Rilutek)
• Roflumilast (Daliresp)
• Ropinirole (Requip)
• Sleeping pills such as butabarbital (Butisol), flurazepam, temazepam (Restoril), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien, Edluar, Intermezzo)
• Stimulants such as armodafinil (Nuvigil) and modafinil (Provigil)
• Tadalafil (Adcirca, Cialis)
• Theophylline
• Tofacitinib (Xeljanz)
• Tretinoin (Atralin, Renova, Retin-A)

Ask your healthcare provider or pharmacist if you need to avoid products that contain grapefruit, Seville oranges, and tangelos while you are taking this medicine. These fruits and juices can affect the way this medicine works and may increase your risk of serious side effects.

Do not drink alcohol while taking this medicine unless your healthcare provider approves.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

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This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.