Carbamazepine

Parent or patient Information Leaflet

Dr. C. P. Ravi Kumar

Consultant Paediatric Neurologist
MRCPCH, CCT in Paediatrics (U.K.)
Fellow in Paediatric Epilepsy &
Neurology (London)

Carbamazepine is a medicine used in epilepsy to control several different seizures or convulsions (fits): focal seizures or partial seizures, occasionally for

generalized tonic-clonic seizures. In addition, it is used for some non-epileptic conditions such as Trigeminal Neuralgia.

Carbamazepine is the older brother of Oxcarbazepine and Eslicarbazepine. The biggest side effect of this family of drugs is severe skin reaction (Stevens Johnson Syndrome), more information below.

Why is carbamazepine important for my child’s treatment?

It is important that your child takes Carbamazepine regularly so that they do not suffer from Seizures or have fewer seizures.

Do not stop giving Carbamazepine all of a sudden, as it may result into your child may having more seizures.

What is Carbamazepine available as?

Carbamazepine is available in the preparation of Liquid medicine, Tablets, Modified-release tablets (releases medication slowly into blood after it has been consumed) in the market.

Brand names:

Tablets: Zeptol, Zen

Syrup: Tegrital

Delayed release: Zeptol CR

“Generic vs Branded”

When should Carbamazepine meant to be given?

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.

What if I miss a dose?

Tablets & liquids: The child can be given the missed dose, if you remember to give it within a lapse of 6 hours. If you fail to give the missed dose within 6 hours, then might as well leave it. It is advisable to wait until the time of next routine dose.

Modified release preparations: If you miss a dose, you can give it any time within the next 8 hours. After this time, wait until the next routine dose.

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.

How much of the drug should be given?

Your doctor will work out the accurate amount of carbamazepine (the dose) for your child and write the dosage in your prescription.

When you first start giving carbamazepine to your child, you are supposed to give them a small amount and then increase the dose little by little over a course of few days or weeks. This helps your child’s body to get use to the medicine. Your doctor will clarify what steps to take.

It is mandatory to follow the instructions given by your doctor about the dosage of medication.

Ultimately, when your child is free of seizures or convulsions (fits) and has no obvious side effects, you will know that the dosage is just correct.

How should I give the medicine to my child? “Giving Medicine”

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.

Could this medication have any side effects on my child? “Side Effects”

Although medicines are given to make children feel better, sometimes, they may cause some unwanted side effects.

Side-effects that you must do something about…

Excessively sleepy (drowsy), double vision, drunken gait (ataxia) MAY occur after initiating the medicine, it usually settles in a few days, if no improvement is noted after two weeks, discuss with your doctor.

At a high dose, a fine tremor, or slight shaking of the hands is rarely seen, which usually subsides if the dose is reduced.

Occasionally, Carbamazepine causes a reduction in the blood platelets, which help the blood to clot after cuts. Rarely but at some occasions, the child may have unexplained bruising or bleeding episodes, in which case the doctor will arrange a blood test for the same.

Liver disease: If the child complains of feeling sick every few hours, experiences stomach pains, is extremely tired or sleepy, gets jaundice i.e. the skin or eyes look yellow or experiences more episodes of seizures than normal, please bring them to the doctor’s office or the hospital immediately .

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 behavior, do not hesitate and immediately contact your doctor.

Despite this long list of side effects, Carbamazepine is a very effective anti-epileptic (anticonvulsant) medicine and has very little effect on the child’s level of alertness, behavior and learning abilities.

CAN WE AVOID SERIOUS SIDE EFFECT DESCRIBED ABOVE?

A genetic test for HLA – B 1502 may be done. If present, this gene increases the chances of the above reaction (Stevens Johnson Syndrome), so the use of this medication may be avoided.

Can other common medicines be given at the same time as Carbamazepine?

• Medications like ibuprofen, paracetamol, antibiotics or any of the other over the counter medicines can be given when necessary, except the ones your doctor has prohibited you from.
• Consult with your doctor before giving any other medicines to your child. This includes herbal or complementary medicines..
• Some other medicines used to treat epilepsy may affect how well Carbamazepine works or may cause side effects

Where should I keep the medication?

• Keep the medicine in a cupboard, secured away from heat and direct sunlight. It is not a must to keep the medicine in the refrigerator though.
• Make sure the medicine is out of your child’s reach.
• Store the medication in the same box it was packed in.

For more information please to the manufacturer’s information leaflet.

References :

1. IAP Drug Formulary Web Update 2020(3) Edition 58, https://www.iapdrugformulary.com/Home
2. Consumer Medicines Information (CMI), https://www.tga.gov.au/consumer-medicines-information-cmi
3. British National Formulary for Children (BNFC)
4. Food and Drug Administration, USA https://www.fda.gov

Disclaimer:

Medical information is simplified to make it easy for a layman to understand, hence it cannot be comprehensive, it cannot address individual needs. No website content can replace expertise of a doctor; hence this information should NEVER be taken as a replacement for medical consultation. It is possible the information may not be accurate and may even mislead in some cases. It is hence advised to seek medical consultation without delay for any queries.