Carbamazepine suspension and tablets should be taken with meals to lessen the chance of stomach upset (nausea and vomiting). Carbamazepine extended-release capsules do not need to be taken with meals unless they upset your stomach. The contents of these extended-release capsules may be sprinkled over a teaspoonful of applesauce or other similar food; the capsule or its contents should not be crushed or chewed.

It is very important that you take this medicine exactly as directed by your doctor to obtain the best results and lessen the chance of serious side effects. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

If you are taking this medicine for pain relief:

• Carbamazepine is not an ordinary pain reliever. It should be used only when a doctor prescribes it for certain kinds of pain. Do not take carbamazepine for any other aches or pains.

If you are taking this medicine for epilepsy:

• Do not suddenly stop taking this medicine without first checking with your doctor. To keep your seizures under control, it is usually best to gradually reduce the amount of carbamazepine you are taking before stopping completely.

Dosing

The dose of carbamazepine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of carbamazepine. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets or teaspoonfuls of suspension that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking carbamazepine.

• For oral dosage form (suspension):
  • For epilepsy:
    • Adults and teenagers At first, 100 milligrams (mg) taken up to four times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1200 mg a day.
    • Children 6 to 12 years of age At first, 50 mg taken four times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1000 mg a day.
    • Children up to 6 years of age Dose is based on body weight and will be determined by your doctor.
  • For trigeminal neuralgia:
    • Adults and teenagers At first, 50 mg four times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1200 mg a day.
    • Children Use and dose must be determined by your doctor.
• For oral dosage form (tablets and chewable tablets):
  • For epilepsy:
    • Adults and teenagers At first, 200 mg taken two times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1200 mg a day.
    • Children 6 to 12 years of age At first, 100 mg taken two times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1000 mg a day.
    • Children up to 6 years of age Dose is based on body weight and will be determined by your doctor.
  • For trigeminal neuralgia:
    • Adults and teenagers At first, 100 mg taken two times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1200 mg a day.
    • Children Use and dose must be determined by your doctor.
• For oral extended-release capsule dosage form:
  • For epilepsy:
    • Adults and teenagers At first, 200 mg taken one or two times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1200 mg a day.
    • Children up to 12 years of age Dose is based on body weight and will be determined by your doctor. However, the dose is usually not more than 1000 mg a day.
  • For trigeminal neuralgia:
    • Adults and teenagers At first, 200 mg a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1200 mg a day.
    • Children Use and dose must be determined by your doctor.
• For oral extended-release tablet dosage form:
  • For epilepsy:
    • Adults and teenagers At first, 100 to 200 mg taken one or two times a day with meals. Your doctor may increase your dose if needed. However, the dose is usually not more than 1200 mg a day.
    • Children 6 to 12 years of age At first, 100 to 200 mg taken in smaller doses during the day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1000 mg a day.
    • Children up to 6 years of age Use and dose must be determined by your doctor.
  • For trigeminal neuralgia:
    • Adults and teenagers At first, 100 mg taken two times a day. Your doctor may increase your dose if needed. However, the dose is usually not more than 1200 mg a day.
    • Children Use and dose must be determined by your doctor.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. However, if you miss more than one dose a day, check with your doctor.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store the tablet forms of carbamazepine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and become less effective.
• Keep the liquid form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For carbamazepine, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to carbamazepine or to any of the tricyclic antidepressants, such as amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, or trimipramine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Carbamazepine has not been studied in pregnant women. However, there have been reports of babies having low birth weight, small head size, skull and facial defects, underdeveloped fingernails, and delays in growth when their mothers had taken carbamazepine in high doses during pregnancy. In addition, birth defects have been reported in some babies when the mothers took other medicines for epilepsy during pregnancy. Also, studies in animals have shown that carbamazepine causes birth defects when given in large doses. Therefore, the use of carbamazepine during pregnancy should be discussed with your doctor.

Breast-feeding Carbamazepine passes into the breast milk, and in some cases the baby may receive enough of it to cause unwanted effects. In animal studies, carbamazepine has affected the growth and appearance of the nursing babies.

Children Behavior changes are more likely to occur in children.

Older adults Confusion; restlessness and nervousness; irregular, pounding, or unusually slow heartbeat; and chest pain may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of carbamazepine.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking carbamazepine, it is especially important that your health care professional know if you are taking any of the following:

• Anticoagulants (blood thinners) The effects of anticoagulants may be decreased; monitoring of blood clotting time may be necessary during and after carbamazepine treatment

• Cimetidine (e.g., Tagamet) Blood levels of carbamazepine may be increased, leading to an increase in serious side effects

• Clarithromycin (e.g., Biaxin) Blood levels of carbamazepine may be increased, increasing the risk of unwanted effects

• Corticosteroids (cortisone-like medicine) The effects of corticosteroids may be decreased

• Diltiazem (e.g., Cardizem) or
• Erythromycin (e.g., E-Mycin, Erythrocin, Ilosone) or
• Propoxyphene (e.g., Darvon) or
• Verapamil (e.g., Calan) Blood levels of carbamazepine may be increased; these medicines should not be used with carbamazepine

• Estrogens (female hormones) or
• Oral contraceptives (birth control pills) containing estrogen or
• Quinidine The effects of these medicines may be decreased; use of a nonhormonal method of birth control or an oral contraceptive containing only a progestin may be necessary

• Fluvoxamine (e.g., Luvox) Blood levels of carbamazepine may be increased, increasing the risk of unwanted effects

• Isoniazid (e.g., INH) The risk of serious side effects may be increased

• Itraconazole (e.g., Sporanox) or
• Ketoconazole (e.g., Nizoral) The effects of these medicines may be decreased

• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) Taking carbamazepine while you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitors may cause sudden high body temperature, extremely high blood pressure, and severe convulsions; at least 14 days should be allowed between stopping treatment with one medicine and starting treatment with the other

• Other anticonvulsants (seizure medicine) The effects of these medicines may be decreased; in addition, if these medicines and carbamazepine are used together during pregnancy, the risk of birth defects may be increased

• Risperidone [e.g., Risperdal] The effects of risperidone may be decreased

• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]) Central nervous system depressant effects of carbamazepine may be increased while the anticonvulsant effects of carbamazepine may be decreased; seizures may occur more frequently

• Alcohol abuse (or history of) Drinking alcohol may decrease the effectiveness of carbamazepine

• Anemia or other blood problems or
• Behavioral problems or
• Glaucoma or
• Heart or blood vessel disease or
• Problems with urination Carbamazepine may make the condition worse

• Diabetes mellitus (sugar diabetes) Carbamazepine may cause increased urine glucose levels

• Kidney disease or
• Liver disease Higher blood levels of carbamazepine may result, increasing the chance of side effects