CARBAMAZEPINE:
Carbamazepine is a medication prescribed for managing various types of seizures and convulsions in individuals with epilepsy.
What is Carbamazepine used for?
- Focal onset seizures and generalized onset seizures
- Bipolar disorder, hypo mania and mild to moderate manic or mixed episodes and bipolar major depression
- Neuropathic pain
What is Carbamazepine available?
- Tablets
- Extended-release capsule
- Syrup
How does Carbamazepine act (mechanism of action)?
It works by blocking sodium channels and reduces abnormal electrical activity in the brain and thereby reduces the frequency of seizures.
How much time does Carbamazepine take to act?
Carbamazepine typically starts to take effect within 4 to 8 hours after an oral dose. This can vary depending on the form of carbamazepine (e.g., immediate-release vs. extended-release formulations), the dose, and individual factors such as metabolism.
For extended-release formulations, the peak concentration may occur a little later, sometimes closer to 12 hours after administration, because of the slower release of the drug into the bloodstream.
However, it may take 2 to 4 weeks to experience the full therapeutic effects, especially for conditions like epilepsy, bipolar disorder, or neuropathic pain.
Why is Carbamazepine important for you/your child’s treatment?
It is important that you/your child takes Carbamazepine regularly so that you/your child doesn’t have Seizures or have fewer seizures episodes and other diseases.
Carbamazepine controls seizures but doesn’t cure epilepsy and works only while you keep taking it. So do not stop giving carbamazepine suddenly, as it may result in having more seizures
What is the ideal time to take Carbamazepine?
Twice a day; morning and evening. Ideally, 10-12 hours apart.
For example, anytime between 7 to 8 am and right after 12 hours between 7 to 8 pm. You can adjust the time slot according to your schedule.
However, there are some exceptions when your doctor may advise to give it thrice a day. Please follow your doctor’s instructions in such case.
It should ideally be given at the same time every day to establish a routine as it minimizes the chances of missing a dose.
When should Carbamazepine be taken?
Carbamazepine can be taken either before food or after food but taking it after food is often recommended as it can help reduce the likelihood of stomach upset, which some people may experience when taking the medication on an empty stomach.
How should I give the Carbamazepine?
Tablets: A whole tablet must be swallowed with a glass of water, juice or milk. You may give it by crushing and mixing it in water/ juice or small serving of yogurt / Curd.
Liquid or syrup: Use an oral syringe or a medicine spoon to measure the adequate amount. You can easily get these from any pharmacy nearby.
Do not use a kitchen teaspoon as it will not give the accurate amount of the drug.
Immediate-release and extended-release tablets: Swallow the whole tablet; do not split, chew, or crush them.
What if I miss a dose?
If you miss the dose, it can be taken as soon as you remember within the lapse of 6 hours. Do not take the missed dose if it is close to the next one; just take the next dose as normal. If you miss two or more doses, discuss with your doctor.
NEVER GIVE A DOUBLE DOSE OF CARBAMAZEPINE
If your child vomits out the content within 30 minutes of taking the medicine dosage then you can give the dose again; but if your child vomits after 30 minutes of taking the dose, then just leave it be and do not give it again.
Could this medication have any side effects on my child?
Every medication has both positive and potential negative effects. Fortunately, adverse effects are not common for everyone, but it’s essential to be aware of them. Understanding possible side effects allows us to act quickly and effectively if they occur, ensuring that we can address any concerns promptly while continuing to benefit from the intended effects of medications.
Even though it may be rare, few people sometimes may have serious side effects when taking a drug. Consult your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
Side effects of Carbamazepine:
Very Common (More than 10%):
- Stomach problems like nausea or vomiting.
- Feeling dizzy, sleepy, or uncoordinated.
Common (1% to 10%):
- Heart: Increased blood pressure.
- Skin: Itching or rashes.
- Stomach: Constipation or a dry mouth.
- Nervous system: Trouble concentrating, feeling weak, tingling sensations, slurred speech, trembling, muscle jerks, dizziness, or having harmful thoughts.
- Eyes: Blurry vision.
Other RARE, but SERIOUS side-effect you need to know about
If your child develops a rash, ulcers in the mouth or genital area then medication should be stopped immediately. Seek doctor’s opinion or rush to hospital emergency department
Sometimes your child may experience other side-effects that are not listed above. If you notice any abnormalities with your child’s body or behaviour, do not hesitate and immediately contact your doctor.
CAN WE AVOID SERIOUS SIDE EFFECT DESCRIBED ABOVE?
A genetic test for HLA-B1502 may be performed, as the presence of this gene increases the likelihood of these severe reactions. If the gene is detected, the use of Carbamazepine may be avoided to reduce the risk. However, absence of this gene doesn’t rule out serious side effect.
Can other common medicines be taken during the course of Carbamazepine?
When taking Carbamazepine, it is crucial to be cautious with other medications such as Antidepressants, Antihypertensives, Antibiotics, Oral Contraceptives, Warfarin and other Anti-seizure Medications (e.g., Phenytoin, Valproate) due to potential interactions.
Carbamazepine is known to affect the liver enzymes that metabolize many drugs, which can alter the effectiveness of other medications or increase their side effects. It is recommended to consult your doctor before taking any over-the-counter medications to ensure safety when using them alongside Carbamazepine.
What foods to avoid while taking Carbamazepine?
When taking Carbamazepine, certain foods and beverages should be avoided or consumed with caution due to their potential interactions with the medication. These interactions can affect how well Carbamazepine works, increase side effects, or cause other health issues. Here’s a list of foods to be cautious with:
- Grapefruit: Grapefruit can interfere with the liver enzymes that metabolize Carbamazepine. Avoid grapefruit and its juice while taking Carbamazepine.
- Alcohol: Alcohol can enhance the sedative effects of Carbamazepine, leading to increased drowsiness, dizziness. Limit or avoid alcohol. Avoid driving and machineries
- High-Fat Meals: High-fat meals can slow the absorption of Carbamazepine. Avoid.
- Caffeine: excessive caffeine can increase the risk of side effects like nervousness, insomnia, or heart palpitations.
General Tips:
- Hydrate well: Staying well-hydrated can help your kidneys process the drug and reduce potential side effects like dizziness or dehydration.
- Balanced diet: A healthy, balanced diet is always recommended, but it is important to avoid making drastic changes while on Carbamazepine.
If you’re unsure about specific foods or have concerns, it’s best to consult your doctor to tailor dietary recommendations to your individual needs.
PREGNANCY:
Carbamazepine is not considered completely safe during pregnancy due to potential risks to the developing foetus, but it may still be prescribed if the benefits outweigh the risks, particularly for women who require the medication for controlling seizures or bipolar disorder.
LACTATION:
Carbamazepine is generally considered safe to use during lactation, it is excreted into breast milk in low concentrations, and the amount an infant would be exposed to is typically not enough to cause significant adverse effects
Is there any risk if I conceive while taking Carbamazepine?
If you are planning to conceive, it’s important to consult your doctor. Carbamazepine is associated with risks during pregnancy, but it may still be necessary for managing certain conditions. Your doctor can help determine if it’s safe for you to continue taking it or if alternatives should be considered.
Can I stop taking Carbamazepine?
Withdrawal from Carbamazepine is not commonly associated with severe effects, but stopping it abruptly can lead to potential issues, particularly if it was being used for conditions like glaucoma, epilepsy, or altitude sickness.
Where should you store Carbamazepine?
Carbamazepine should be stored in a cool, dry place at room temperature, typically between 20°C to 25°C (68°F to 77°F).
It should be kept in its original container, tightly closed, and away from moisture, heat, and direct light.
Keep the medication out of the reach of children and avoid storing it in the bathroom, as the humidity can affect its effectiveness.
For complete information please see the manufacturer’s information leaflet.
Monitoring parameters of Carbamazepine
- CBC with platelets count
- Ophthalmic examination
- HLA-B*1502 and HLA-A*3101 genotype screening, prior to therapy initiation
- Observe patient for excessive sedation.
- Monitor serum carbamazepine concentrations.
How to cope up with side effects of carbamazepine?
Coping with the side effects of carbamazepine can vary depending on the specific symptoms you experience. Here are some general strategies to manage the common side effects:
- Nausea and Vomiting: Try taking the medication after food to reduce stomach upset.
- Constipation: Eat a high-fibre diet (fruits, vegetables, whole grains), drink plenty of water, and stay active to help with bowel movements.
- Dry Mouth: Suck on sugar-free candies or drink plenty of water throughout the day. Avoid alcohol-based mouthwashes as they can make dry mouth worse.
- Dizziness/Drowsiness: If you feel light headed or tired, try standing up slowly and taking breaks throughout the day. Avoid driving or operating heavy machinery until you know how carbamazepine affects you.
- Lack of Coordination: Take extra care when walking or performing tasks that require balance. Talk to your doctor if these issues become severe.
- High Blood Pressure (Hypertension): Monitor your blood pressure regularly. If it increases, inform your doctor, who may adjust your medication or recommend lifestyle changes (e.g., reducing salt intake, exercising, or managing stress).
- Skin Reactions (Itching, Rash): Consult doctor immediately if you develop a rash, as this can be a sign of a more serious allergic reaction. Avoid scratching, as it can irritate the skin further.
- Suicidal Thoughts: If you experience any mood changes or thoughts of harming yourself, seek immediate help from your healthcare provider or a mental health professional.
- Blurred Vision: If you experience blurred vision, make sure to have regular eye exams. If it becomes problematic, speak to your doctor, as they may need to adjust the dosage.
General Tips:
- Always keep your doctor updated about any side effects you’re experiencing. They may adjust your dose or suggest alternative treatments.
Carbamazepine is a vital medication for controlling seizures, mood disorders, and nerve pain. While it doesn’t cure these conditions, it helps manage symptoms effectively when taken as prescribed. It’s important to monitor for side effects, follow dietary advice, and avoid missing doses for the best results. Always consult your doctor if you have concerns or notice unusual symptoms.
Let us know if this information was useful!
Author:
1. Dr. Ramya. R, Pharm D, Clinical pharmacologist, Aster Hospitals, Bengaluru
2. Dr Praveen Kumar, B. Pharm, Pharm D(PB), Head Clinical Pharmacologist, Aster Hospitals, Bengaluru
3. Dr C P Ravi Kumar, Consultant Paediatric Neurologist, Aster CMI Hospital.