- Tablet: 200 mg, 400 mg
- Chewable tablet: 100 mg
- Liquid suspension 100 mg/5 mL
- Extended release tablet: 100 mg, 200 mg, 400 mg
- Extended release capsule: 100 mg, 200 mg, 300 mg
Generic name: carbamazepine (kar ba MAZ e peen)
Medication class: anticonvulsant, mood stabilizer
All FDA Black Box Warnings are at the end of this fact sheet. Please review before taking this medication.
What is Carbamazepine and what does it treat?
Carbamazepine is a medication that treats bipolar disorder (also known as manic depression). It is approved for the treatment of epilepsy or seizure disorders as well as acute mania and mixed episodes associated with bipolar disorder. Bipolar disorder involves episodes of mania and/or depression.
Symptoms of depression include:
- Depressed mood – feeling sad, empty, or tearful
- Feeling worthless, guilty, hopeless, or helpless
- Loss of interest or pleasure in normal activities
- Sleep and eat more or less than usual (for most people it is less)
- Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
- Psychomotor agitation ('nervous energy')
- Psychomotor retardation (feeling like you are moving in slow motion)
Symptoms of mania include:
- Feeling irritable or 'high'
- Having increased self esteem
- Feeling like you don’t need to sleep
- Feeling the need to continue to talk
- Feeling like your thoughts are too quick (racing thoughts)
- Feeling distracted
- Getting involved in activities that are risky or could have bad consequences (e.g. excessive spending)
What is the most important information I should know about Carbamazepine?
Bipolar disorder requires long-term treatment. Do not stop taking carbamazepine, even when you feel better.
Only your healthcare provider can determine the length of carbamazepine treatment that is right for you.
Missing doses of carbamazepine may increase your risk for a relapse in your mood symptoms.
Do not stop taking carbamazepine or change your dose without talking to with your healthcare provider first.
For carbamazepine to work properly, it should be taken every day as ordered by your healthcare provider.
Periodically, your healthcare provider may ask you to provide a blood sample to make sure the appropriate level of medication is in your body and to assess for side effects, such as changes in blood cell counts.
Are there specific concerns about Carbamazepine and pregnancy?
If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.
Carbamazepine has been associated with and increased risk of defects of the head and face, fingernails, and developmental delay. There may be precautions to decrease the risk of these effects. Discontinuing mood stabilizer medications during pregnancy has been associated with a significant increase in symptom relapse.
The American Academy of Pediatrics committee on medications in breastfeeding lists carbamazepine as compatible with breast-feeding.
What should I discuss with my healthcare provider before taking Carbamazepine?
- Symptoms of your condition that bother you the most
- If you have thoughts of suicide or harming yourself
- Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
- If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
- Any other psychiatric or medical problems you have
- All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
- Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
- If you are pregnant, plan to become pregnant, or are breast-feeding
- If you drink alcohol or use illegal drugs
How should I take Carbamazepine?
Carbamazepine is usually taken 2-4 times per day with or without food.
The dose usually ranges from 200-1600 mg/day. Only your healthcare provider can determine the correct dose for you.
Carbamazepine suspension: Measure with a dosing spoon or oral syringe, which you can get from your pharmacy.
Extended-release capsules: Swallow whole or sprinkle onto food, such as applesauce or pudding and eat immediately. Do not chew the sprinkle capsule or contents.
Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member a friend to remind you or check in with you to be sure you are taking your medication.
What happens if I miss a dose of Carbamazepine?
If you miss a dose of carbamazepine, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your dose or take more than what is prescribed.
What should I avoid while taking Carbamazepine?
Avoid drinking alcohol or using illegal drugs while you are taking carbamazepine. They may decrease the benefits (e.g. worsen your symptoms) and increase adverse effects effects (e.g., sedation) of the medication.
What happens if I overdose with Carbamazepine?
If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.
A specific treatment to reverse the effects of carbamazepine does not exist.
What are possible side effects of Carbamazepine?
Common Side Effects
- Upset stomach, dry mouth, and constipation, feeling dizzy or drowsy
Rare Side Effects
Carbamazepine can cause a decrease in the body’s sodium level, especially at higher doses. Some signs of low sodium include nausea, drowsiness, and confusion.
Serious Side Effects
Studies have found that individuals who take anticonvulsant medications including carbamazepine have suicidal thoughts or behaviors up to 2 times more often than individuals who take placebo (inactive medication). These thoughts or behaviors occurred in approximately 1 in 550 patients taking the anticonvulsant class of medications.
Mild rash occurs in about 10-15% in those who take carbamazepine. In rare cases (1%) a severe, spreading rash with blistering of the skin in patches over the entire body along with fever, headache and cough can occur (Stevens-Johnson Syndrome). Although this is rare with carbamazepine, discontinuation of this medication is necessary.
Carbamazepine may lower blood counts. Your doctor will occasionally order blood work to monitor for this side effect.
Contact your healthcare provider immediately if you develop a skin reaction, fever, swelling, or shortness of breath.
Are there any risks for taking Carbamazepine for long periods of time?
To date, there are no known problems associated with long term use of carbamazepine. It is a safe and effective medication when used as directed.
What other medications may interact with Carbamazepine?
Carbamazepine may decrease the effectiveness of several other medications by increasing their breakdown and elimination from the body. The effectiveness of carbamazepine may be reduced by other medications as well. People who are taking carbamazepine should consult their doctor before taking or discontinuing the following:
- Oral contraceptives (birth control pills)
- Antipsychotics: Latuda® (lurasidone), Abilify® (aripiprazole), Geodon® (ziprasidone), Clozaril® (clozapine)
- Anticonvulsants: Dilantin® (phenytoin), Depakote® (valproic acid), Luminal® (phenobarbital), Lamictal® (lamotrigine), Sabril® (vigabatrin)
- Calcium Channel Blockers: Norvasc® (amlodipine); Calan®, Covera-HS®, Isoptin SR® (verapamil); Cardizem®, Tiazac®(diltiazem), Plendil® (felodipine), Procardia®, Adalat® (nifedipine)
- Benzodiazepines: Xanax® (alprazolam), Halcion® (triazolam), Valium® (diazepam)
- Antibiotics: Biaxin® (clarithromycin), Ery-Tab® (erythromycin), Ketek® (telithromycin)
- Cholesterol lowering agents: Lipitor®(atorvastatin), Mevacor® (lovastatin), Zocor® (simvastatin)
- HIV Medications: Crixivan® (indinavir), Norvir® (ritonavir); Fortovase®, Invirase®, (saquinavir), Kaletra® (lopinovir/ritonavir), Rescriptor® (delavirdine)
- Anticoagulants (blood thinners: e.g., warfarin, aspirin, clopidogrel)
- Tricyclic antidepressants: Elavil® (amitriptyline); Asendin® (amoxapine); Anafranil® (clomipramine); Norpramin®, Pertofrane®(desipramine); Sinequan® (doxepin); Tofranil® (imipramine); Pamelor®, Aventyl® (nortriptyline); Vivactil® (protriptyline); Surmontil® (trimipramine)
- Other: Adenocard® (adenosine), Buspar® (buspirone), Camptosar® (irinotecan), Desyrel® (trazodone), Viagra® (sildenafil), Tagamet® (Cimetidine), corticosteroids, Luvox® (fluvoxamine)
- Monoamine oxidase (MAO) inhibitors: Marplan® (isocarboxazid), Nardil® (phenelzine), Eldepryl® (selegiline), Parnate®(tranylcypromine)
How long does it take for Carbamazepine to work?
It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking carbamazepine. It will probably take several weeks to see big enough changes in your symptoms to decide if carbamazepine is the right medication for you.
Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder. Your doctor can best discuss the duration of treatment you need based on your symptoms and illness.
Summary of FDA Black Box Warnings
Decreased Blood Cell Counts
Carbamazepine may lower your blood counts (e.g. white blood cell which fight off infection). Your doctor will occasionally order blood work to monitor for changes in your blood counts. Notify your doctor if you experience fever, sore throat, infections and easy bruising.
Screen for the genotype HAL-B 1502 allele in Asian patients
Patients with a positive result are more likely to have serious side effects and should not take carbamazepine.
the College of Psychiatric and Neurologic Pharmacists