Carbamazepine.doc

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Carbamazepine

Carbamazepine is a drug that is licensed to treat several conditions,

including bipolar disorder, epilepsy, and trigeminal neuralgia.

The prescription medication is available in a number of forms,

including tablets, chewable tablets, extended-release tablets,

extended-release capsules, and suspension (liquid). Depending on

the product, carbamazepine is usually taken two to four times

daily. As with any drug, there are possible side effects with

carbamazepine, such as dizziness, drowsiness, and nausea.

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

• Carbamazepine Warnings and Precautions

• Carbamazepine Overdose

• Carbamazepine and Pregnancy• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

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What Is Carbamazepine?

Carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®) is a prescription medication

used to treat the following conditions: 

• Bipolar disorder -- carbamazepine is approved to treat manic or mixed

episodes (which include characteristics of both mania and depression)

associated with bipolar disorder, also known as manic depression.

• Epilepsy -- carbamazepine is approved to treat various types of seizures,

though it is usually not effective at treating absence seizures (petit mal

seizures).

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• Trigeminal neuralgia -- carbamazepine is approved to treat pain associated

with trigeminal neuralgia (also known as tic douloureux), a nerve condition

that causes episodes of facial pain (typically cheek or jaw pain).

 Not all forms of carbamazepine are approved for each of the above uses. Equetro is

approved to treat bipolar disorder only, while Carbatrol, Epitol, Tegretol, and generic

carbamazepine are approved to treat epilepsy and trigeminal neuralgia (but not bipolar 

disorder).

How Does Carbamazepine Work?

Epilepsy is a brain disorder that causes recurring, brief changes in how the brain's

electrical system works. These changes in brain activity can lead to a seizure (see Epilepsy Symptoms ). It is not known exactly how carbamazepine works to prevent

 partial seizures in people with epilepsy. It may work by blocking sodium channels in

the brain. By blocking sodium channels, carbamazepine may decrease the activity of 

nerve cells, preventing them from firing abnormally. Carbamazepine may also prevent

the abnormal brain signals from spreading to other parts of the brain.

It is thought that carbamazepine works to treat trigeminal neuralgia by blocking the

nerve signals that cause pain and other unpleasant sensations.

It is not known exactly how Equetro works for  bipolar disorder treatment. Equetro

affects several different brain chemicals -- though it is not known if this is howEquetro works to treat bipolar disorder .

When and How to Take Carbamazepine

Some general considerations for when and how to take carbamazepine include:

• Carbamazepine comes in several different forms, including tablets, chewable

tablets, extended-release tablets, extended-release capsules, and suspension

(liquid). It is taken by mouth, usually two to four times daily, depending onthe particular product.

• Carbamazepine can be taken with or without food. If carbamazepine upsets

your stomach, try taking it with food.

• Carbamazepine suspension -- make sure to shake the suspension thoroughly

 just before each dose. Do not mix the suspension with food or other liquids(including other medications).

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• Extended-release carbamazepine tablets (Tegretol XR ®) -- do not crush, chew,

or break this long-acting form of carbamazepine. Inspect each tablet to make

sure it is not chipped or damaged. Make sure each tablet has a tiny hole (this is

how the medication is released from the tablet). You may notice thecarbamazepine shell in your stool; this is normal and should not cause any

 problems.

• Extended-release carbamazepine capsules (Carbatrol, Equetro) -- do not crush

or chew the capsules, as this could cause too much medication to be released

too quickly. If necessary, the capsules can be opened and the contents

sprinkled over a spoonful of applesauce or other soft food. The food and

medication should immediately be swallowed whole (without chewing).

• Carbamazepine should be taken at the same times each day to maintain even

levels of the drug in your blood.

• For the medication to work properly, it must be taken as prescribed.

Carbamazepine will not work if you stop taking it.

• Do not stop taking carbamazepine without first discussing it with your 

healthcare provider (see Carbamazepine Withdrawal  ).

Dosing Information for Carbamazepine

The dose of carbamazepine that your healthcare provider recommends will vary

depending on a number of factors, including:

• The particular carbamazepine product

• Your age and weight

• The medical condition being treated

• Other medications you may be taking

• Other medical conditions you may have.

As always, do not adjust your carbamazepine dose unless your healthcare provider 

specifically instructs you to do so.

 (Click Carbamazepine Dosage for more information.)

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Side Effects of Carbamazepine

As with any medicine, side effects are possible with carbamazepine. However, not

everyone who takes the drug will experience side effects. In fact, most people tolerate

it quite well. If side effects do occur, in most cases they are minor and either require

no treatment or can easily be treated by you or your healthcare provider. Serious side

effects are less common.

Common side effects of carbamazepine include but are not limited to:

• Dizziness

• Drowsiness

• Unsteadiness

•

 Nausea• Vomiting.

Drug Interactions With Carbamazepine

Carbamazepine can potentially interact with several other medicines (see

Carbamazepine Drug Interactions ).

Carbamazepine: What Should I Tell My Healthcare

Provider?

You should talk with your healthcare provider prior to taking carbamazepine if you

have:

• Anemia or other blood disorders

• Absence seizures (petit mal seizures)

• Acute intermittent porphyria

• Glaucoma

• Heart disease

• An irregular heart rhythm (arrhythmia)• Thyroid problems

• Liver disease, including liver failure, cirrhosis, or hepatitis

• Kidney disease, including kidney failure (renal failure)

• Any allergies, including allergies to food, dyes, or preservatives.

Also let your healthcare provider know if you are:

• Pregnant or thinking of becoming pregnant (see Carbamazepine and 

 Pregnancy ) 

• Breastfeeding (see Carbamazepine and Breastfeeding  ).

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Make sure to tell your healthcare provider about all of the medicines you take,

including prescription and non-prescription medicines, vitamins, and herbal

supplements.

What If I Take an Overdose of Carbamazepine?

People who take too much carbamazepine may have overdose symptoms that could

include:

• Irregular breathing or difficulty breathing

• A rapid heart rate (tachycardia)

• Low blood pressure (hypotension) or high blood pressure (hypertension)

• Shock 

• Loss of consciousness• Coma

• Seizures

• Restlessness

• Twitching or shakiness

• Unusual body movements or postures

• Coordination problems

• Drowsiness

• Dizziness

•  Nausea or vomiting.

If you happen to overdose on carbamazepine, seek medical attention immediately (see

Carbamazepine Overdose ).

How Should Carbamazepine Be Stored?

Carbamazepine should be stored at room temperature, away from moisture and heat.

Store carbamazepine in an airtight container.

 Keep carbamazepine and all other medications out of the reach of children.

What Should I Do If I Miss a Dose of 

Carbamazepine?

If you do not take your carbamazepine as scheduled, take your missed dose as soon as

you remember. If it is almost time for your next dose, skip the missed dose and

continue with your regular schedule. Do not take a double dose of carbamazepine.

Make sure to let your healthcare provider know if you miss any carbamazepine doses,

especially if your carbamazepine blood levels are being monitored.

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Carbamazepine Side Effects

A few common side effects of carbamazepine include drowsiness,

unsteadiness, and vomiting. Some of the less common side effects

include hair loss, a dry mouth, and blurred vision. While side

effects of this medication are usually minor, certain

carbamazepine side effects are more serious and may need

immediate medical attention. Notify your healthcare provider

immediately if you experience serious side effects, such as

unusual bleeding or bruising, hallucinations, or an irregularheart rhythm.

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

• Carbamazepine Warnings and Precautions

• Carbamazepine Overdose

• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

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An Introduction to Carbamazepine Side Effects

As with any medicine, side effects are possible with carbamazepine (Carbatrol®,

Epitol®, Equetro®, Tegretol®). However, not everyone who takes the medication will

experience side effects. In fact, most people tolerate carbamazepine quite well. If side

effects do occur, in most cases they are minor and either require no treatment or are

easily treated by you or your healthcare provider.

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(This article covers many, but not all, of the possible side effects with carbamazepine.

Your healthcare provider can discuss a more complete list of carbamazepine side

effects with you.)

Serious Side Effects of Carbamazepine

Some side effects of carbamazepine, while occurring infrequently, are potentially

serious and should be reported immediately to your healthcare provider. These

include but are not limited to:

• Anemia or other blood disorders

• Unusual bruising or bleeding

• Worsening of seizures 

• Hallucinations

• Depression• Increased infections or infections that do not go away

• Water retention, swelling, or difficulty breathing, which can be signs of 

congestive heart failure (CHF)

• High blood pressure (hypertension) or low blood pressure (hypotension)

• An irregular heart rhythm (arrhythmia)

• Yellowing of the whites of the eyes or skin (jaundice), which may be a sign of 

liver damage, including liver failure or hepatitis

• Difficulty passing urine or a sudden, unexplained decrease in urine production

(which can be a sign of kidney damage)

• Low sodium levels in the blood (hyponatremia), which may cause symptoms

that include:

o Loss of appetite

o  Nausea or vomiting

o Irritability

o Excessive tiredness

o Confusion

o Hallucinations

o Muscle weaknesso Muscle spasms or cramps

• Signs of an allergic reaction, including an unexplained rash, hives, itching, and

unexplained swelling

• Suicidal thinking or behavior (see Seizure Medications and Suicide ).

Common Side Effects of Carbamazepine

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Carbamazepine has been studied thoroughly in clinical trials. In these studies, the side

effects that occurred in a group of people taking the drug were documented and then

compared to the side effects that occurred in another group of people taking a placebo

(a "sugar pill" that does not contain any active ingredients). As a result, it was

 possible to see what side effects occurred, how often they appeared, and how they

compared to the group not taking the medicine.

In these studies, some of the most common carbamazepine side effects included:

• Unsteadiness

•  Nausea

• Dizziness

• Drowsiness

• Vomiting.

Less Common Carbamazepine Side Effects

Less common side effects of carbamazepine are also possible. Because these side

effects are so uncommon, it can be difficult to tell whether they are actually caused by

carbamazepine or by factors unrelated to the medication.

These less common side effects include but are not limited to:

• Hair loss (see Carbamazepine and Hair Loss ) 

• Sweating• Sensitivity to the sun

• Changes in skin color 

• Body or facial hair growth

• Frequent urination

• Impotence, also known as erectile dysfunction or  ED 

• Coordination problems

• Headaches

• Blurred vision

• Underactive thyroid (hypothyroidism)

•

Double vision• Ringing in the ears (tinnitus)

• Diarrhea or constipation 

• Dry mouth (see Carbamazepine and Dry Mouth ) 

• Leg cramps.

Carbamazepine has also been reported to interfere with some pregnancy tests.

Final Thoughts on Carbamazepine Side Effects

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It is possible that you may experience some or none of the carbamazepine side effects

listed in this article. Unfortunately, there is no way for your healthcare provider to

know beforehand if you will have side effects from a medicine that you have never 

tried. Therefore, make sure to let your healthcare provider know if you develop any

side effects while taking carbamazepine. Also let your healthcare provider know if 

you develop something that "just does not seem right." While it may not be a sideeffect of carbamazepine, your healthcare provider will be able to diagnose and treat

the problem.

Carbamazepine Uses

Carbamazepine is used for treating various types of epileptic seizures,

pain associated with trigeminal neuralgia (a painful nerve

disorder), and manic or mixed episodes associated with bipolar

disorder. The medication is approved for treating epilepsy in

children, but it is not approved for treating bipolar disorder or

trigeminal neuralgia in children. Off-label carbamazepine uses

can include the treatment of dementia, alcohol withdrawal, and

hiccups.

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

• Carbamazepine Warnings and Precautions

• Carbamazepine Overdose• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

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What Is Carbamazepine Used For? -- An Overview

Carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®) is a prescription medicationused to treat the following conditions:

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• Bipolar disorder -- carbamazepine is approved to treat manic or mixed

episodes (which include characteristics of both mania and depression)

associated with bipolar disorder, also known as manic depression.

• Epilepsy -- carbamazepine is approved to treat various types of seizures,

though it is usually not effective at treating absence seizures (petit mal

seizures).

• Trigeminal neuralgia -- carbamazepine is approved to treat pain associated

with trigeminal neuralgia (also known as tic douloureux), a nerve condition

that causes episodes of facial pain (typically cheek or jaw pain).

 Not all forms of carbamazepine are approved for each of the above uses. Equetro is

approved to treat bipolar disorder only, while Carbatrol, Epitol, Tegretol, and generic

carbamazepine are approved to treat epilepsy and trigeminal neuralgia (but not bipolar 

disorder).

Carbamazepine Uses (Cont.)

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage• Carbamazepine Drug Interactions

• Carbamazepine Warnings and Precautions

• Carbamazepine Overdose

• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

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Carbamazepine and Bipolar Disorder

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Bipolar disorder , also known as manic depression, is a serious brain disease that

causes extreme shifts in mood, energy, and functioning. Currently, it is thought that

 bipolar disorder may be at least partially genetic (see Bipolar Causes ). Bipolar 

disorder is different from the normal ups and downs that everyone goes through -- the

symptoms of bipolar disorder are more severe. Episodes of mania and depression 

typically recur throughout the affected person's lifespan. 

Between episodes, most people with bipolar disorder are free of symptoms (see

 Bipolar Disorder Symptoms ). Effective bipolar disorder treatment usually involves a

combination of psychotherapy (see Bipolar Psychosocial Treatments ) and  bipolar 

medications.

One brand of carbamazepine (Equetro) is approved to treat manic or mixed episodes

associated with bipolar disorder. Mixed episodes have characteristics of both mania

and depression. Equetro has not been adequately studied for the long-term treatment

of bipolar disorder.

Carbamazepine and Epilepsy

Epilepsy is a brain condition that occurs when there are sudden, brief changes in how

the brain's electrical system works. These changes in brain activity can lead to a

seizure (see Epilepsy Symptoms ). Depending on which part of the brain is affected, a

seizure may affect the person's consciousness, body movements, emotions, or senses

(taste, touch, smell, vision, or hearing).

Some people may only have a single seizure during their lives, and one seizure doesnot mean that a person has epilepsy (see Seizures and Epilepsy ). In fact, the term

epilepsy refers to a number of different kinds of unprovoked, recurring seizures that

happen for a number of different reasons.

In over half of all cases, the cause of epilepsy is not known. There are over 30

different types of seizures a person with epilepsy may experience. These seizures are

generally classified into two main categories, partial seizures (also known as focal

seizures) and generalized seizures.

Epilepsy treatments may include medications (see Epilepsy Medication ), surgery (see

 Epilepsy Surgery ), diet changes (see Epilepsy Diet  ), and biofeedback. Carbamazepineis approved to treat various types of seizures, including:

• Partial seizures, including simplex partial or complex partial seizures

• Generalized seizures, including generalized tonic-clonic seizures (grand-mal

seizures)

• Mixed seizures.

Carbamazepine is generally not considered effective at treating absence seizures (alsoknown as petit mal seizures).

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Carbamazepine Uses (Cont.)

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

•

Carbamazepine Warnings and Precautions• Carbamazepine Overdose

• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

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Carbamazepine and Trigeminal Neuralgia

Trigeminal neuralgia, also called tic douloureux, is a condition affecting the

trigeminal nerve (the fifth cranial nerve), one of the largest nerves in the head. The

trigeminal nerve is responsible for sending impulses of touch, pain, pressure, and

temperature to the brain from the face, jaw, gums, forehead, and around the eyes.

Trigeminal neuralgia symptoms are characterized by a sudden, severe, electric shock-

like or stabbing pain, typically felt on one side of the jaw or cheek. The attacks of 

 pain, which generally last for several seconds and may be repeated one after the other,

may be triggered by:

• Talking

•

Brushing the teeth• Touching the face

• Chewing

• Swallowing.

The exact causes of trigeminal neuralgia are not known. However, certain factors

(such as physical nerve damage and stress) can trigger the beginning of the painful

trigeminal neuralgia attacks.

Treatment for trigeminal neuralgia includes medication or surgery. Carbamazepine isone of the medications commonly used to treat trigeminal neuralgia.

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How Does Carbamazepine Work?

Epilepsy is a brain disorder that causes recurring, brief changes in how the brain's

electrical system works. These changes in brain activity can lead to a seizure (see

 Epilepsy Symptoms ). It is not known exactly how carbamazepine works to prevent

 partial seizures in people with epilepsy. It may work by blocking sodium channels in

the brain. By blocking sodium channels, carbamazepine may decrease the activity of 

nerve cells, preventing them from firing abnormally. Carbamazepine may also prevent

the abnormal brain signals from spreading to other parts of the brain.

It is thought that carbamazepine works to treat trigeminal neuralgia by blocking the

nerve signals that cause pain and other unpleasant sensations.

It is not known how exactly carbamazepine works for  bipolar disorder treatment.Carbamazepine affects several different brain chemicals, though it is not known if this

is how carbamazepine works to treat  bipolar disorde

Carbamazepine Uses (Cont.)

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

•

Carbamazepine Warnings and Precautions• Carbamazepine Overdose

• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

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Carbamazepine Uses in Children

Carbamazepine is approved for epilepsy treatment in children. It is not approved for 

treating bipolar disorder or trigeminal neuralgia in children. Talk with your healthcare

 provider about the benefits and risks of using carbamazepine in children.

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Off-Label Carbamazepine Uses

On occasion, your healthcare provider may recommend carbamazepine for treating

something other than the conditions discussed above. At this time, off-label 

carbamazepine uses can include the treatment of:

• Agitation

• Alcohol withdrawal (to prevent seizures)

• Dementia

• Hiccups

• Migraine headaches (used on a daily basis to prevent migraines)

• Other types of nerve pain, such as diabetic neuropathy.

Carbamazepine Dosage

In order for carbamazepine to work properly, you must take it as

prescribed. The carbamazepine dosage your healthcare provider

recommends will be based on a number of factors, such as your

age and weight, the condition being treated, the particularcarbamazepine product being used, and other medications you

are taking. Carbamazepine is available in several forms,

including tablets, chewable tablets, extended-release tablets,

extended-release capsules, and a liquid.

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

• Carbamazepine Warnings and Precautions

• Carbamazepine Overdose

• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding• Carbamazepine Withdrawal

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An Introduction to Carbamazepine Dosage

The dose of carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®) that your 

healthcare provider recommends will vary depending on a number of factors,

including:

• Your age and weight

• The condition being treated

• The particular carbamazepine product

• Other medications you may be taking

• Other medical conditions you may have.

As always, do not adjust your carbamazepine dose unless your healthcare provider 

specifically instructs you to do so.

(Click on the following links for dosing information for your particular 

carbamazepine product:

• Carbatrol Dosage

•  Epitol Dosage

•  Equetro Dosage

• Tegretol Dosage , which also applies to generic carbamazepine tablets and  suspension.) 

General Carbamazepine Dosage Information

Some considerations for people taking carbamazepine include:

• Carbamazepine comes in several different forms, including tablets, chewable

tablets, extended-release tablets, extended-release capsules, and suspension(liquid). It is taken by mouth, usually two to four times daily, depending on

the particular product.

• Carbamazepine can be taken with or without food. If carbamazepine upsets

your stomach, try taking it with food.

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• Carbamazepine suspension -- make sure to shake the suspension thoroughly

 just before each dose. Do not mix the suspension with food or other liquids

(including other medications).

• Extended-release carbamazepine tablets (Tegretol XR ®) -- do not crush, chew,

or break this long-acting form of carbamazepine. Inspect each tablet, to make

sure it is not chipped or damaged. Make sure each tablet has a tiny hole (this is

how the medication is released from the tablet). You may notice the

carbamazepine shell in your stool; this is normal and should not cause any

 problems.

• Extended-release carbamazepine capsules (Carbatrol, Equetro) -- do not crush

or chew the capsules, as this could cause too much medication to be released

too quickly. If necessary, the capsules can be opened and the contents

sprinkled over a spoonful of applesauce or other soft food. The food and

medication should immediately be swallowed whole (without chewing).

• Carbamazepine should be taken at the same times each day to maintain even

levels of the drug in your blood.

• For the medication to work properly, it must be taken as prescribed.

Carbamazepine will not work if you stop taking it.

• If you are unsure about anything related to your dosage or carbamazepine

dosing in general, talk with your healthcare provider, nurse, or pharmacist. Do

not stop taking the drug without first discussing it with your healthcare

 provider (see Carbamazepine Withdrawal  ). 

Carbamazepine Drug Interactions

Drug interactions can potentially occur when carbamazepine is taken

with certain other drugs, such as antidepressants, some

antibiotics, and other seizure medications. Some of these potential

carbamazepine drug interactions can alter the level of 

carbamazepine in your blood, increasing your risk of side effectsor making the medication less effective. In some cases, your

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healthcare provider may need to monitor you closely and adjust

your carbamazepine dosage.

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

•

Carbamazepine Warnings and Precautions• Carbamazepine Overdose

• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

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An Overview of Carbamazepine Drug Interactions

Carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®) can potentially interact

with many other medications, including several other  seizure medications. Some of 

these medicines that may lead to carbamazepine interactions include:

• Alcohol

• Antidepressants

• Certain antibiotics or antifungals, including:

o Clarithromycin (Biaxin®)o Erythromycin (Ery-Tab®)

o Fluconazole (Diflucan®)

o Isoniazid (Nydrazid®)

o Itraconazole (Sporanox®)

o Ketoconazole (Nizoral®)

o Telithromycin (Ketek ®)

• Certain antipsychotic medications, including:

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o Clozapine (Clozaril®, FazaClo®)

o Haloperidol (Haldol®)

o Risperidone (Risperdal®)

o Ziprasidone (Geodon®)

• Certain calcium channel blockers, including:

o Amlodipine ( Norvasc®)

o Diltiazem (Cardizem®, Cartia XT®, Dilacor XR ®, Dilt-CD®, Diltia

XT®, Dilt-XR ®, Taztia XT®, Tiazac®)

o Felodipine (Plendil®)

o Isradipine (Dynacirc®, Dynacirc CR ®)

o  Nicardipine (Cardene®)

o  Nifedipine (Adalat CC®, Afeditab CR ®, Nifediac CC®,  Nifedical XL®,

Procardia®)

o  Nimodipine (Nimotop®)

o Verapamil (Calan®, Isoptin SR ®, Verelan®)

• Cisplatin (Platinol®

)• Cimetidine (Tagamet®)

• Cyclosporine (Gengraf ®, Neoral®, Sandimmune®)

• Danazol (Danocrine®)

• Doxorubicin (Adriamycin®, Doxil®)

• Doxycycline (Periostat®, Vibramycin®)

• Grapefruit juice

• Hormone contraceptives (such as  birth control pills, implants, patches, and

rings)

• Lithium (Eskalith®, Lithobid®)

• Monoamine oxidase inhibitors (MAOIs), including:

o Isocarboxazid (Marplan®)

o Phenelzine ( Nardil®)

o Rasagiline (Azilect®)

o Selegiline (Eldepryl®, Emsam®, Zelapar ®)

o Tranylcypromine (Parnate®)

•  Niacin (Niacor ®, Niaspan®)

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•  Nefazodone (Serzone®)

• Other seizure medications

• Propoxyphene (Darvon®, Darvocet®)

• Protease inhibitors, such as:

o Amprenavir (Agenerase®)

o Atazanavir (Reyataz®)

o Fosamprenavir (Lexiva®)

o Indinavir (Crixivan®)

o  Nelfinavir (Viracept®)

o Ritonavir ( Norvir ®)

o Saquinavir (Invirase®)

• Rifampin (Rifadin®)

• Theophylline (Elixophyllin®, TheoCap®, Theocron®, Theo-24®, Uniphyl®).

Carbamazepine Drug Interactions

(Cont.)

Carbamazepine Medication Information

• Carbamazepine

• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

• Carbamazepine Warnings and Precautions

• Carbamazepine Overdose

• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

Scroll up Scroll down

Carbamazepine Interactions Explained

The following sections explain in detail the potentially negative interactions that can

occur when carbamazepine is combined with any of the drugs listed above.

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Alcohol

Generally, you should not drink alcohol if you are taking carbamazepine. Doing so

may increase your risk of side effects.

AntidepressantsSome antidepressants can raise the level of carbamazepine in your blood, increasing

your risk of carbamazepine side effects. Also, carbamazepine can decrease the level

of some antidepressants in your blood, perhaps making them less effective. Talk with

your healthcare provider before combining an antidepressant with carbamazepine.

Certain Antibiotics or Antifungals

Some antibiotics and antifungal medications can raise the level of carbamazepine in

your blood, increasing your risk of side effects. Additionally, carbamazepine can

make some antifungal medications less effective. Talk with your healthcare provider 

 before using these medications together.

 Certain Antipsychotic Medications

Carbamazepine can decrease the levels of some antipsychotic medications in your 

 blood, making them less effective. If you are taking these drugs together, your 

healthcare provider may need to increase your antipsychotic medication dose.

Calcium Channel Blockers

Some calcium channel blockers can raise the level of carbamazepine in your blood,

increasing your risk of carbamazepine side effects. Also, carbamazepine can decrease

the levels of some calcium channel blockers in your blood, perhaps making them less

effective. Talk with your healthcare provider before combining a calcium channel

 blocker with carbamazepine.

Cisplatin (Platinol)

Cisplatin can decrease the level of carbamazepine in your blood, perhaps making it

less effective. If you are taking these drugs together, your healthcare provider may

need to monitor the level of carbamazepine in your blood and adjust your 

carbamazepine dosage as necessary.

Cimetidine (Tagamet)

Cimetidine can raise the level of  carbamazepine in your blood, increasing your risk of 

side effects. In general, you should not take these medications together, as there aremany other cimetidine alternatives that do not interact with carbamazepine.

Cyclosporine (Gengraf, Neoral, Sandimmune)

Carbamazepine can decrease the level of cyclosporine in your blood, perhaps making

it less effective. If you are taking these drugs together, your healthcare provider may

need to increase your cyclosporine dosage.

Danazol (Danocrine)

Danazol can raise the level of carbamazepine in your blood, increasing your risk of 

side effects. If you are taking these drugs together, your healthcare provider may need

to monitor the level of carbamazepine in your blood and adjust your carbamazepinedosage as necessary.

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Doxorubicin (Adriamycin, Doxil)

Doxorubicin can decrease the level of carbamazepine in your blood, perhaps making

it less effective. If you are taking these drugs together, your healthcare provider may

need to monitor the level of carbamazepine in your blood and adjust your 

carbamazepine dosage as necessary. 

Doxycycline (Periostat, Vibramycin)

Carbamazepine can decrease the level of  doxycycline in your blood, perhaps making

it less effective. If you are taking these drugs together, your healthcare provider may

need to increase your doxycycline dosage.

Grapefruit Juice

Grapefruit juice can raise the level of carbamazepine in your blood, increasing your 

risk of side effects. In general, you should not drink grapefruit juice if you are taking

carbamazepine. If your healthcare provider decides that you may drink grapefruit

 juice, you should do so consistently and in moderation.

Hormone Contraceptives

Carbamazepine may make hormone contraceptives (including  birth control pills,

implants, patches, and rings) less effective, increasing your chances of pregnancy.

Talk with your healthcare provider about non-hormonal forms of contraception (such

as condoms).

Lithium (Eskalith, Lithobid)

Combining lithium with carbamazepine can increase your risk of side effects. Talk 

with your healthcare provider before taking these medications together.

Monoamine Oxidase Inhibitors (MAOIs)

In general, you should not take monoamine oxidase inhibitors (MAOIs) and

carbamazepine together. Before you can take carbamazepine, you need to stop taking

an MAOI for at least 14 days.

Nefazodone (Serzone)

Carbamazepine and nefazodone should not be taken together. Carbamazepine can

significantly decrease the level of nefazodone in your blood, possibly making

nefazodone ineffective.

 Niacin (Niacor, Niaspan)

 Niacin products (including non-prescription niacin) can raise the level of 

carbamazepine in your blood, increasing your risk of side effects. Be aware that many

B-complex vitamins contain niacin. Talk with your healthcare provider before taking

niacin and carbamazepine together.

Other Seizure Medications

Some other seizure medications may increase or decrease the level of carbamazepine

in your blood. Also, carbamazepine can increase or decrease the levels of other 

seizure medications in your blood. Your healthcare provider should monitor you

closely if you take carbamazepine in combination with other seizure medications. 

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Propoxyphene (Darvon, Darvocet)

Propoxyphene can raise the level of carbamazepine in your blood, increasing your 

risk of side effects. Talk with your healthcare provider before taking these

medications together.

Protease InhibitorsProtease inhibitors can raise the level of carbamazepine in your blood, increasing your 

risk of side effects. If you are taking these drugs together, your healthcare provider 

may need to lower your carbamazepine dose.

Rifampin (Rifadin)

Rifampin may decrease the level of carbamazepine in your blood, perhaps making it

less effective. If you are taking these drugs together, your healthcare provider may

need to increase your carbamazepine dose.

Theophylline (Elixophyllin, TheoCap, Theocron, Theo-24, Uniphyl)

Taking theophylline with carbamazepine can decrease the levels of both medicationsin your blood, making them less effective. Talk with your healthcare provider before

taking these medications together.

Final Thoughts on Carbamazepine Drug Interactions

It is possible that not all carbamazepine drug interactions were discussed in this

article. Therefore, you should talk with your pharmacist or healthcare provider about

any specific drug interactions with carbamazepine that may apply to you.

Carbamazepine Warnings and

Precautions

Some carbamazepine warnings and precautions to be aware of include

potential drug interactions, the safety of taking carbamazepine

while nursing or pregnant, and people who should not take

carbamazepine at all. Among the conditions that you should tell

your healthcare provider about prior to taking the drug are heartdisease, thyroid problems, and glaucoma. Among the people who

should not take carbamazepine are those who have had bone

marrow depression and those who are allergic to tricyclic

antidepressants.

Carbamazepine Medication Information

• Carbamazepine

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• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions• Carbamazepine Warnings and Precautions

• Carbamazepine Overdose

• Carbamazepine and Pregnancy

• Carbamazepine and Breastfeeding

• Carbamazepine Withdrawal

Scroll up Scroll down

Carbamazepine: What Should I Tell My HealthcareProvider?

You should talk with your healthcare provider prior to taking carbamazepine 

(Carbatrol®, Epitol®, Equetro®, Tegretol®) if you have:

• Heart disease

• An irregular heart rhythm (arrhythmia)

• Thyroid problems

• Anemia or other blood disorders

• Absence seizures (petit mal seizures)• Acute intermittent porphyria

• Glaucoma

• Liver disease, including liver failure, cirrhosis, or hepatitis

• Kidney disease, including kidney failure (renal failure)

• Any allergies, including allergies to food, dyes, or preservatives.

Also let your healthcare provider know if you are:

• Pregnant or thinking of becoming pregnant

• Breastfeeding.

You should also make sure to tell your healthcare provider about all of the medicines

you take, including prescription and non-prescription medicines, vitamins, and herbal

supplements.

Specific Carbamazepine Warnings and Precautions

Some warnings and precautions to be aware of prior to taking carbamazepine include:

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• Carbamazepine can cause very serious cases of anemia or other low blood

counts, which may put you at risk of bleeding or serious infections. These

 problems, while very rare, can be fatal. Your healthcare provider should test

your blood counts (using a blood test) before you start taking carbamazepine

and periodically thereafter.

• As with all seizure medications, carbamazepine should not be stopped

suddenly (see Carbamazepine Withdrawal  ).

• Carbamazepine can increase the pressure within the eye, which can be

especially dangerous for people with glaucoma. 

• Be sure to tell your healthcare provider if you have acute intermittent

 porphyria, since carbamazepine can make this condition worse.

• Sometimes, carbamazepine can make seizures worse in people with absence

seizures (petit mal seizures). Due to this problem (and because carbamazepine

is not generally effective at treating absence seizures), carbamazepine isusually not recommended for treating people with absence seizures.

• Tell your healthcare provider if you have heart, liver, or kidney disease, as

carbamazepine may not be the best choice for you. Your body may not handle

carbamazepine the way it should, or you may be at an increased risk of certain

carbamazepine side effects. 

• Carbamazepine can cause very serious, and even life-threatening, skin

reactions. Let your healthcare provider know right away if you develop an

unexplained rash.

• Carbamazepine can make agitation, confusion, or psychosis worse. Tell your 

healthcare provider if you experience any unusual behavior or thought changes

during treatment with carbamazepine.

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• Make sure to see how carbamazepine affects you before driving or operating

any machinery, as carbamazepine can cause drowsiness and dizziness. In

general, you should avoid alcohol while taking carbamazepine, due to the risk 

of increased drowsiness.

• Carbamazepine can cause low levels of sodium in the blood (hyponatremia),

which can be serious. Let your healthcare provider know if you have possible

signs of hyponatremia, such as:

o Nausea

o A general ill feeling

o Headaches

o Lethargy

o Confusion

o Decreased consciousnesso Worsening of seizures.

• Your healthcare provider should check your liver and kidney function (using a

 blood test) before you start taking carbamazepine and periodically thereafter.

Your healthcare provider should also check your eyes regularly, as

carbamazepine can cause eye problems.

• Carbamazepine can cause a decrease in thyroid function (hypothyroidism).

• Carbamazepine has been reported to interfere with some pregnancy tests.

• Carbamazepine can potentially interact with certain other medications (see

Carbamazepine Drug Interactions ).

• Carbamazepine is considered a pregnancy Category D medication. This means

that it is probably not safe for many pregnant women. Talk with your 

healthcare provider about the risks and benefits of taking the drug during

 pregnancy (see Carbamazepine and Pregnancy ).

• Carbamazepine passes through breast milk. Therefore, if you are breastfeeding

or plan to start breastfeeding, discuss this with your healthcare provider prior 

to taking the drug (see Carbamazepine and Breastfeeding  ).

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• Early evidence suggests that seizure medications, including carbamazepine,

may increase the risk of suicidal thoughts or behaviors (see Seizure

 Medications and Suicide for more information).

Who Should Not Take Carbamazepine?

You should not take carbamazepine if you:

• Are allergic to carbamazepine or any of the inactive components used to make

carbamazepine. Your healthcare provider or pharmacist has a list of the

inactive ingredients.

• Are taking nefazodone (Serzone®), as carbamazepine may make nefazodone

ineffective.

• Have had bone marrow depression in the past. Bone marrow depression is a

 blood disorder in which the bone marrow does not function properly to

 produce blood cells. You may have had bone marrow depression if you have

ever had a low blood count on a laboratory test.

• Are allergic to tricyclic antidepressants, such as:

o Amitriptyline (Elavil®)

o Amoxapine (Asendin®)

o Clomipramine (Anafranil®)

o Desipramine ( Norpramin®)

o

Doxepin (Sinequan

®

)o Imipramine (Tofranil®, Tofranil PM®)

o Maprotiline (Ludiomil®)

o  Nortriptyline (Pamelor ®)

o Protriptyline (Vivactil®)

o Trimipramine (Surmontil®).

• Have taken a monoamine oxidase inhibitor (MAOI) within the past two

weeks. Some examples of MAOIs include:

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o Isocarboxazid (Marplan®)

o Phenelzine ( Nardil®)

o Rasagiline (Azilect®)

o Selegiline (Eldepryl®, Emsam®, Zelapar ®)

o Tranylcypromine (Parnate®).

Final Thoughts on Carbamazepine Warnings and

Precautions

There are a number of situations in which carbamazepine should not be taken, as well

as several precautions and warnings people should be aware of before taking the

medication. However, it is possible that not all of the warnings or precautions were

discussed in this article. Therefore, you should talk with your healthcare provider 

about the specific carbamazepine warnings and precautions that may apply to you.

Carbamazepine and Pregnancy

In previous studies that looked at carbamazepine and pregnancy,

carbamazepine raised the risk of birth defects, such as head and

facial deformities, spina bifida, and heart defects. Therefore, the

FDA has classified carbamazepine as a pregnancy Category D

drug, which means that it may not be safe for use duringpregnancy. However, if the benefits to the pregnant woman

outweigh possible the risks to the child, a healthcare provider

may still prescribe carbamazepine.

Carbamazepine Medication Information

• Carbamazepine• Carbamazepine Side Effects

• Carbamazepine and Hair Loss

• Carbamazepine and Dry Mouth

• Carbamazepine Uses

• Carbamazepine Dosage

• Carbamazepine Drug Interactions

• Carbamazepine Warnings and Precautions

• Carbamazepine Overdose

• Carbamazepine and Pregnancy

•

Carbamazepine and Breastfeeding• Carbamazepine Withdrawal

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Final Thoughts on Carbamazepine and Pregnancy

If you are pregnant or thinking of becoming pregnant while taking carbamazepine, let

your healthcare provider know. He or she will consider the benefits and risks of using

the medication during pregnancy before making a recommendation for your particular 

situation.

Phenobarbital

Main Use Active Ingredient Manufacturer  Epilepsy Phenobarbital. Non-proprietary

How does it work?

Phenobarbital (previously known as phenobarbitone in the UK) belongs

to a group of medicines called barbiturates. It is used to treat epilepsy

and works by stabilising electrical activity in the brain.

The brain and nerves are made up of many nerve cells that communicate

with each other through electrical signals. These signals must be

carefully regulated for the brain and nerves to function properly. When

abnormally rapid and repetitive electrical signals are released in the brain, the brain becomes over-stimulated and normal function is

disturbed. This can result in fits or seizures.

Phenobarbital prevents epileptic fits by preventing the excessive

electrical activity in the brain. It is thought to achieve this by affecting

certain neurotransmitters in the brain.

 Neurotransmitters are chemicals that are stored in nerve cells and are

involved in transmitting messages between the nerve cells. GABA is a

neurotransmitter that acts as a natural 'nerve-calming' agent. It helps keep

the nerve activity in the brain in balance. Glutamate is a neurotransmitter 

that acts as a natural 'nerve-exciting' agent. It is released when electrical

signals build up in nerve cells and subsequently excites more nerve cells.

It is thought to play a key role in causing epileptic seizures.

Phenobarbital increases the activity of GABA and decreases the activity

of glutamate in the brain. These actions help stabilise the electrical

activity in the brain and prevent epileptic fits.

Phenobarbital is available as tablets, elixir and injection. The injection is

used to control repeated fitting, when consciousness is not regained

 between seizures. This condition is called status epilepticus.

What is it used for?

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• Epilepsy.

Warning!

• This medication may cause drowsiness. If affected do not driveor operate machinery. Avoid alcoholic drink.

• You should not suddenly stop taking this medicine unless your 

doctor tells you otherwise, as suddenly stopping treatment is

likely to make your seizures return. It may also result in

withdrawal symptoms such as difficulty sleeping (insomnia),

anxiety, tremor, dizziness, nausea and delirium.

• Phenobarbital decreases the blood levels of hormonal

contraceptives that contain oestrogen and/or progesterone. This

can make these types of contraceptive ineffective, or cause

 breakthrough bleeding. Women taking phenobarbital who needcontraception should be prescribed hormonal contraceptives that

contain a total of at least 50 micrograms of ethinylestradiol

(oestrogen), or use non-hormonal methods of contraception, such

as condoms. It is important for women who could get pregnant to

discuss contraception and pregnancy with their doctor before

starting treatment with this medicine.

• This medicine may rarely cause problems with your blood cells.

You should consult your doctor immediately if you experience

any of the following symptoms, as these may signs of problems

with your blood cells: unexplained bruising or bleeding, purple

spots, sore throat, mouth ulcers, high temperature (fever), feeling

tired or general illness. Your doctor may want you to have a

 blood test to check your blood cells.

Use with caution in

• Elderly people.

• Children.

• Slow, shallow breathing (respiratory depression).

•

History of  asthma.• Decreased kidney function.

• Decreased liver function.

• Diabetes mellitus.

• Anaemia.

• History of drug or alcohol abuse.

• People who are hyperactive.

• People who are suffering from senility or dementia.

• People who are run down, weak or debilitated.

• People suffering from severe chronic pain.

 Not to be used in

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• Allergy to barbiturate medicines.

• Dangerously slow, shallow breathing (severe respiratory

depression).

• Hereditary blood disorders called porphyrias.• Severe kidney disease.

• Severe liver disease.

This medicine should not be used if you are allergic to one or any of its

ingredients. Please inform your doctor or pharmacist if you have

 previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this

medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeedingCertain medicines should not be used during pregnancy or breastfeeding.

However, other medicines may be safely used in pregnancy or 

 breastfeeding providing the benefits to the mother outweigh the risks to

the unborn baby. Always inform your doctor if you are pregnant or 

 planning a pregnancy, before using any medicine.

• It is vital that women with epilepsy receive specialist advice

 before getting pregnant, so they are well informed of potential

risks and benefits of continuing antiepileptic treatment. Pregnant

women taking antiepileptic medicine have a higher risk of 

carrying a baby with developmental problems andmalformations. However, if a woman with epilepsy stops

treatment because she is pregnant, there is a risk of seizures that

can harm both mother and baby. This risk may be higher than

that from continuing the medication. It is important that all the

risks and benefits of treatment are weighed up. Seek medical

advice from your doctor.

• Women who decide to try for a baby while taking phenobarbital

should start taking folic acid daily as soon as contraception is

stopped, as this may reduce the risk of neural tube defects such as

spina bifida in the baby. Ask your doctor for advice on the dose

to take - it may be recommended that you take 5mg daily.

• This medicine passes into breast milk and may cause drowsiness

in a nursing infant. The manufacturer recommends that women

taking this medicine should avoid breastfeeding their infants and

 bottlefeed instead. Seek medical advice from your doctor.

Label warnings

• This medication may cause drowsiness. If affected do not drive

or operate machinery. Avoid alcoholic drink.

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• Do not stop taking this medication except on your doctor's

advice.

Side effects

Medicines and their possible side effects can affect individual people in

different ways. The following are some of the side effects that are knownto be associated with this medicine. Just because a side effect is stated

here does not mean that all people using this medicine will experience

that or any side effect.

• Drowsiness.

• Irritability.

• Disturbances in behaviour.

• Unusual excitement.

• Hyperactivity, particularly in children and elderly people.

• Difficulty thinking.

• Memory problems.

• Seeing or hearing things that are not really there (hallucinations).

• Depression.

• Slow, shallow breathing (respiratory depression).

• Low blood pressure (hypotension).

• Shaky movements and unsteady walk (ataxia).

• Rapid involuntary movements of the eyes (nystagmus).

• Disturbances in the normal numbers of blood cells in the blood.

• Inflammation of the liver (hepatitis).

• Softening of the bones (osteomalacia).• Allergic skin reactions.

The side effects listed above may not include all of the side effects

reported by the drug's manufacturer.

For more information about any other possible risks associated with this

medicine, please read the information provided with the medicine or 

consult your doctor or pharmacist.

How can this medicine affect other medicines?

Phenobarbital can interact with many medicines and the dose of  phenobarbital or the interacting medicine may need to be altered as a

result. It is important to tell your doctor what medicines you are taking,

including herbal medicines and non-prescription medicines, before you

start phenobarbital. Likewise, once you are taking phenobarbital it is

important to check with your doctor or pharmacist before you stop taking

any existing medicines, or start taking any new medicines, including

herbal medicines and those bought without a prescription.

There may be an increased risk of drowsiness if phenobarbital is taken in

combination with any of the following, which can also cause drowsiness:

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• alcohol

•  benzodiazepines, eg diazepam, temazepam

• sedating antihistamines, eg chlorphenamine, promethazine,

hydroxyzine• sleeping tablets, eg zopiclone

• strong opioid painkillers, eg morphine, codeine (these may also

increase the risk of breathing difficulties).

Phenobarbital may may increase the breakdown of the following

medicines by the liver. As this could decrease the level of these

medicines in the blood and may make them less effective, your doctor 

may need to prescribe a larger than normal dose of these:

• abacavir 

• aprepitant

• aripiprazole

•  bupropion

• calcium channel blockers, eg felodipine, nifedipine, nimodipine,

verapamil

• carbamazepine

• chloramphenicol

• chlorpromazine

• ciclosporin

•

clonazepam• clozapine

• corticosteroids such as dexamethasone, methylprednisolone,

 prednisolone

• disopyramide

• doxycycline

• efavirenz (this may also affect the blood level of phenobarbital)

• eplerenone

• ethosuximide

• etoposide

• fentanyl

• gestrinone• griseofulvin

• haloperidol

• imatinib

• itraconazole

• ketoconazole

• lamotrigine

• lidocaine

• methadone

• metoprolol

•

metronidazole• mianserin

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• mirtazapine

• montelukast

• oestrogens and progestogens such as those in the contraceptive

 pill (Phenobarbital can make these types of contraceptive

ineffective, or cause breakthrough bleeding. Women taking

 phenobarbital who need a contraceptive should be prescribedhormonal contraceptives that contain a total of at least 50

micrograms of oestrogen, or use non-hormonal methods of 

contraception, such as condoms. Discuss this with your doctor.)

• oestrogens and progestogens in HRT (hormone replacement

therapy)

•  paroxetine

•  pethidine

•  phenytoin

•  posaconazole

•  propafenone

•  propranolol

•  protease inhibitors for HIV infection

• quetiapine

• quinidine

• rifampicin

• sirolimus

• tacrolimus

• telithromycin

• theophylline

• thyroxine

• tiagabine• timolol

• topiramate

• toremifene

• tricyclic antidepressants, eg amitriptyline

• vitamin D

• voriconazole (should not be used in combination with

 phenobarbital)

• warfarin and other coumarin anticoagulants

• zonisamide.

The following medicines may reduce the breakdown of phenobarbital by

the liver. As this could increase the level of phenobarbital in your blood

and may increase the risk of side effects, your doctor may need to

decrease your phenobarbital dose if you are prescribed any of these:

• felbamate

•  phenytoin

• sodium valproate.

The following medicines may increase the breakdown of phenobarbital by the liver. As this could decrease the level of phenobarbital in your 

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 blood and may make it less effective, your doctor may need to increase

your phenobarbital dose if you are prescribed any of these:

• folic acid

•  pyridoxine (large doses)• rifampicin

• the herbal remedy St John's wort (Hypericum perforatum) - this

should not be taken by people who are taking phenobarbital.

There may be an increased risk of bone softening due to lack of vitamin

D (osteomalacia) if acetazolamide is used in combination with

 phenobarbital.

Last updated 22.01.2008

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FOCUS

Anxiety

Irritation, a racing heart beatand tremor are just some of 

the symptoms. Discover the

different types and

treatments.

Epilepsy

Seizures can start at any age,

 but are most likely in the

elderly and children.

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Phenobarbital

Generic name:

 Brand names: Phenobarbital 

Why is Phenobarbital prescribed?

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Phenobarbital, a barbiturate, is used as a sleep aid and in the treatment of certain typesof epilepsy, including generalized or grand mal seizures and partial seizures.

Most important fact about Phenobarbital

Phenobarbital can be habit-forming. You may become tolerant (needing more and

more of the drug to achieve the same effect) and physically and psychologically

dependent with continued use. Never increase the amount of phenobarbital you take

without checking with your doctor.

How should you take Phenobarbital?

Take Phenobarbital exactly as prescribed.

If you are taking phenobarbital for seizures, do not discontinue it abruptly.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one

you missed and go back to your regular schedule. Never take 2 doses at once.

--Storage instructions...

Store at room temperature in a tightly closed container.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, notify your 

doctor as soon as possible. Only your doctor can determine whether it is safe for you

to continue taking phenobarbital.

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 Narcotic pain relievers such as Percocet

Oral contraceptives

Other epilepsy drugs such as Dilantin, Depakene, and Depakote

Other sedatives such as Nembutal and Seconal

Steroids such as Medrol and Deltasone

Tranquilizers such as Xanax and Valium

Special information if you are pregnant or

breastfeeding

Barbiturates such as phenobarbital may cause damage to the developing baby during

 pregnancy. Withdrawal symptoms may occur in an infant whose mother took 

 barbiturates during the last 3 months of pregnancy. If you are pregnant or plan to

 become pregnant, inform your doctor immediately.

Phenobarbital appears in breast milk and could affect a nursing infant. If  phenobarbital is essential to your health, your doctor may advise you to stop

 breastfeeding until your treatment is finished.

Recommended dosage

ADULTS

Sedation

The usual initial dose of phenobarbital is a single dose of 30 to 120 milligrams. Your doctor may repeat this dose at intervals, depending on how you respond to

Phenobarbital.

You should not take more than 400 milligrams during a 24-hour period.

 Daytime Sedation

The usual dose is 30 to 120 milligrams a day, divided into 2 to 3 doses.

To Induce Sleep

The usual dose is 100 to 200 milligrams.

 Anticonvulsant Use

Phenobarbital dosage must be individualized on the basis of specific laboratory tests.

Your doctor will determine the exact dose best for you. The usual dose is 60 to 200

milligrams daily.

CHILDREN

 Anticonvulsant Use

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The phenobarbital dosage must be individualized on the basis of specific laboratory

tests. Your doctor will determine the exact dose best for your child.

The usual dose is 3 to 6 milligrams per 2.2 pounds of body weight per day.

DOSAGE ADJUSTMENT

People who are elderly or weak may be prescribed a lower dose. People who have

liver or kidney disease may also require a lower dose of phenobarbital.

Overdosage

Barbiturate overdose can be fatal. If you suspect an overdose, seek medical treatment

immediately.

•

Symptoms of phenobarbital overdose may include:Congestive heart failure, diminished breathing, extremely low body

temperature, fluid in lungs, involuntary eyeball movements, irregular 

heartbeat, kidney failure, lack of muscle coordination, low blood pressure,

 poor reflexes, skin reddening or bloody blisters, slowdown of the central

nervous system