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carbamazepine [2017/05/17 02:51] – Scott Larsoncarbamazepine [2025/04/18 20:40] (current) – external edit 127.0.0.1
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 ====== Carbamazepine ====== ====== Carbamazepine ======
 ===== Side Effects ===== ===== Side Effects =====
-==== Major Side Effects ==== +==== Gastrointestinal ====
-  * **More common:** +
-    * blurred or double vision +
-    * nystagmus +
-  *** Less common:**  +
-    * Actions that are out of control +
-    * behavioral changes (especially in children) +
-    * confusion, agitation, or hostility (especially in the elderly) +
-    * diarrhea (severe) +
-    * discouragement +
-    * drooling +
-    * fear +
-    * feeling of unreality +
-    * feeling sad or empty +
-    * headache (continuing) +
-    * increase in seizures +
-    * irritability +
-    * lack of appetite +
-    * loss of balance control +
-    * loss of interest or pleasure +
-    * muscle trembling, jerking, or stiffness +
-    * nausea and vomiting (severe) +
-    * other problems with muscle control or coordination +
-    * sense of detachment from self or body +
-    * shakiness and unsteady walk +
-    * shuffling walk +
-    * stiffness of the limb +
-    * sudden, wide mood swings +
-    * talking, feeling, and acting with excitement +
-    * thoughts or attempts of killing oneself +
-    * tiredness +
-    * trouble concentrating +
-    * trouble sleeping +
-    * twisting movements of the body +
-    * uncontrolled movements, especially of the face, neck, and back +
-    * unusual drowsiness  +
-  * **Rare** +
-    * Black, tarry stools +
-    * blood in the urine or stools +
-    * bone or joint pain +
-    * chest pain +
-    * cough or hoarseness +
-    * darkening of the urine +
-    * difficulty with speaking or slurred speech +
-    * fainting +
-    * frequent urination +
-    * irregular, pounding, or unusually slow heartbeat +
-    * lower back or side pain +
-    * mental depression with restlessness and nervousness or other mood or mental changes +
-    * muscle or stomach cramps +
-    * nosebleeds or other unusual bleeding or bruising +
-    * numbness, tingling, pain, or weakness in the hands and feet +
-    * pain, tenderness, swelling, or bluish color in the leg or foot +
-    * painful or difficult urination +
-    * pale stools +
-    * pinpoint red spots on the skin +
-    * rapid weight gain +
-    * rigidity +
-    * ringing, buzzing, or other unexplained sounds in the ears +
-    * skin rash, hives, or itching +
-    * sore throat, chills, and fever +
-    * sores, ulcers, or white spots on the lips or in the mouth +
-    * swelling of the face, hands, feet, or lower legs +
-    * swollen or painful glands +
-    * sudden decrease in the amount of urine +
-    * tightness in the chest +
-    * trembling +
-    * troubled breathing +
-    * uncontrolled body movements +
-    * unusual tiredness or weakness +
-    * visual hallucinations (seeing things that are not there) +
-    * yellow eyes or skin+
  
 +Very common (10% or more): Nausea (29%), vomiting (18%), constipation (10%)
 +Very rare (less than 0.01%): Colitis, glossitis, stomatitis, pancreatitis
 +Frequency not reported: Dryness of the mouth, with suppositories occasional rectal irritation may occur, diarrhea, oral ulceration
 +Postmarketing reports: Gastric distress, abdominal pain, anorexia
 +A single case of chemical pancreatitis has been reported in association with carbamazepine intoxication.
 +
 +==== Endocrine ====
 +
 +Carbamazepine increases the rate of T4 and T3 metabolism and may lead to hypothyroidism in patients with hypothyroidism who are being treated with T4. Carbamazepine may also cause a 20% to 40% decrease in serum total and free T4 concentrations and a smaller decrease in serum total and free T3 concentrations in patients who have no thyroid disease.
 +
 +Chronic administration of carbamazepine may increase total cholesterol and HDL cholesterol levels. Carbamazepine may also transiently increase serum triglyceride and LDL cholesterol levels. One study has suggested that demeclocycline may be useful in prophylaxis of carbamazepine-induced hyponatremia.
 +
 +Very rare (less than 0.01%): Increase in prolactin (with or without symptoms such as gynecomastia or galactorrhea), impaired male fertility and/or abnormal spermatogenesis, abnormal thyroid function tests (e.g., decreased L-thyroxine [FT4, T4, T3] and increased TSH)
 +Frequency not reported: Hyponatremia, pancreatitis, lower serum testosterone, lower free androgen indexes, increased cerebrospinal fluid thyrotropin-releasing hormone levels
 +
 +==== Hematologic ====
 +
 +Very common (10% or more): Leucopenia
 +Common (1% to 10%): Eosinophilia, thrombocytopenia, neutropenia
 +Rare (0.01% to 0.1%): Leukocytosis, lymphadenopathy, folic acid deficiency
 +Very rare (less than 0.01%): Agranulocytosis, aplastic anemia, pure red cell aplasia, megaloblastic anemia, acute intermittent porphyria, reticulocytosis, hemolytic anemia
 +Frequency not reported: Aplastic anemia, pancytopenia, bone marrow depression, leukopenia, thrombophlebitis, thromboembolism, adenopathy
 +
 +Thrombocytopenia is the most common hematologic effect of carbamazepine and may be either mild and transient or severe. Significant decreases in white blood cell counts may occur although the values may still be within the normal range. Often counts will return to baseline during continued therapy, and therefore, discontinuation of carbamazepine may not be necessary. Dose reductions may also result in normalization of white blood cell counts. Aplastic anemia has been reported (although many of the reported cases had confounding exposures to other medications). The manufacturer reports an incidence of 2 per 1,000,000 patients for aplastic anemia and 6 per 1,000,000 patients for agranulocytosis. Cases of reticulocytosis have been reported rarely in association with carbamazepine therapy as well. In addition, cases of hemolytic anemia and erythroid arrest have been reported.
 +
 +Both humoral and nonimmune mechanisms have been implicated in the etiology of carbamazepine-induced bone marrow suppression.
 +
 +==== Cardiovascular ====
 +
 +Rare (0.01% to 0.1%): Disturbances of cardiac conduction
 +Very rare (less than 0.01%): Bradycardia, arrhythmias, AV-block with syncope, collapse, congestive heart failure, hypertension or hypotension, aggravation of coronary artery disease, thrombophlebitis, thromboembolism
 +
 +Most of the cases of cardiovascular effects reported have occurred in patients receiving carbamazepine for trigeminal neuralgia. The reported effects included congestive heart failure, edema, hypotension, syncope and arrhythmias. In general, the doses were titrated quickly because of severe pain. Many of the doses were higher than those used to treat epilepsy. Many of the reported cardiovascular effects resolved after discontinuation of carbamazepine.
 +
 +Increased sympathetic activity in the setting of seizure-induced hypoxia could predispose a patient to sudden unexpected death in epilepsy (SUDEP).
 +
 +==== Nervous system ====
 +
 +Very common (10% or more): Dizziness (44%), somnolence (32%), ataxia (15%) Common (1% to 10%): Headache, tremor, vertigo
 +Uncommon (0.1% to 1%): Abnormal involuntary movements (tremor, asterixis, dystonia, tics)
 +Rare (less than 0.1%): Choreoathetotic disorders, orofacial dyskinesia, oculomotor disturbances, speech disorders (e.g., dysarthria or slurred speech), peripheral neuritis, paresthesia, paretic symptoms, neuroleptic malignant syndrome
 +Frequency not reported: Drowsiness, fatigue, fever and chills[Ref]
 +
 +Rigidity and oculogyric crises have been reported. Euphoria has also been reported and has led to abuse of carbamazepine in some patients. Impairment of psychomotor function has been noted in association with use of the liquid suspension of carbamazepine. Additionally, impaired cognition, exacerbations of focal seizures and asterixis have been reported in association with carbamazepine treatment. One case of a lingual-facial-buccal extrapyramidal reaction has also been described.
 +
 +One study has suggested that gradual withdrawal of carbamazepine over ten days results in significantly fewer generalized tonic-clonic seizures compared to rapid withdrawal over four days.
 +
 +One study has suggested that the epoxide metabolite of carbamazepine may be responsible for the occasional occurrence of seizure exacerbations in patients receiving carbamazepine.
 +
 +==== Hypersensitivity ====
 +
 +Rare (0.01% to 0.1%): A delayed multi-organ hypersensitivity disorder (of serum sickness type) with fever, skin rashes, vasculitis, lymphadenopathy, disorders mimicking lymphoma, arthralgia, leucopenia, eosinophilia, hepato-splenomegaly and abnormal liver function tests, occurring in various combinations, other organs may also be affected (e.g., lungs, kidneys, pancreas, myocardium, colon)
 +Very rare (less than 0.01%): Aseptic meningitis (with myoclonus and peripheral eosinophilia), anaphylactic reaction, angioedema
 +Frequency not reported: Multiorgan hypersensitivity reactions occurring days, weeks, or months after initiating treatment
 +
 +Rash and pruritus often resolve after discontinuation of carbamazepine therapy. Both cases of lupus-like syndrome resolved after discontinuation of carbamazepine. Stevens-Johnson syndrome, erythema multiforme, and a mononucleosis-like syndrome have also been reported.
 +
 +==== Hepatic ====
 +
 +Very common (10% or more): Elevated gamma-GT (due to hepatic enzyme induction) usually not clinically relevant
 +Common (1% to 10%): Elevated alkaline phosphatase
 +Uncommon (0.1% to 1%): Elevated transaminases
 +Rare (0.01% to 0.1%): Cholestatic and hepatocellular jaundice, hepatitis of cholestatic, parenchymal (hepatocellular), or mixed type
 +Very rare (less than 0.01%): Granulomatous hepatitis, hepatic failure
 +Frequency not reported: Liver function test abnormalities, variegate porphyria, porphyria cutanea tarda
 +
 +Alterations in liver function tests may progress to hepatotoxicity including cholangitis, granuloma formation, fever and hepatocellular necrosis. Discontinuation of carbamazepine often results in improvement in laboratory abnormalities and liver injury.
 +
 +==== Renal ====
 +
 +Very rare (less than 0.01%): Interstitial nephritis, renal failure, renal dysfunction (including albuminuria, hematuria, oliguria, and elevated BUN/azotemia)
 +
 +==== Respiratory ====
 +
 +Very rare (less than 0.01%): Pulmonary hypersensitivity (characterized by fever, dyspnea, pneumonitis or pneumonia), pulmonary embolism
 +
 +==== Dermatologic ====
 +
 +Very common (10% or more): Allergic skin reactions, urticaria
 +Common (1% to 10%): Pruritus, rash, paresthesia
 +Uncommon (0.1% to 1%): Exfoliative dermatitis, erythroderma
 +Rare (0.01% to 0.1%): Systemic lupus erythematosus-like syndrome
 +Very rare (less than 0.01%): Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), photosensitivity, erythema multiforme, erythema nodosum, alterations in skin pigmentation, purpura, acne, sweating, alopecia, hirsutism, unusual bruising, pruritic and erythematous rashes, diaphoresis, onychomycosis, dermatitis
 +Frequency not reported: Psoriasiform eruption
 +
 +Dangerous, sometimes fatal skin reactions (Stevens Johnson syndrome and toxic epidermal necrolysis), that can be caused by carbamazepine therapy are significantly more common in patients with the human leukocyte antigen (HLA) allele, HLA-B 1502. This allele occurs almost exclusively in patients with ancestry across broad areas of Asia, including South Asian Indians. Patients with ancestry from areas in which HLA-B 1502 is present should be screened for the HLA-B 1502 allele before starting treatment with carbamazepine. If these individuals test positive, carbamazepine should not be started unless the expected benefit clearly outweighs the increased risk of serious skin reactions. Patients who have been taking carbamazepine for more than a few months without developing skin reactions are at low risk of these events ever developing from carbamazepine. This is true for patients of any ethnicity or genotype, including patients who test positive for HLA-B 1502.
 +
 +==== Ocular ====
 +
 +Common (1% to 10%): Diplopia, accommodation disorders (blurred vision)
 +Very rare (less than 0.01%): Lens opacities, conjunctivitis
 +Postmarketing reports: Diplopia, oculomotor disturbances, nystagmus, photosensitivity, visual hallucinations, scattered punctate cortical lens opacities, overall impairment of the chromatic and achromatic systems, increased intraocular pressure
 +
 +==== Oncologic ====
 +
 +Frequency not reported: Disorders mimicking lymphoma
 +
 +==== Immunologic ====
 +
 +Frequency not reported: Antibody deficiency
 +Postmarketing reports: Aseptic meningitis (with myoclonus and peripheral eosinophilia
 +
 +==== Psychiatric ====
 +
 +Common (1% to 10%): Abnormal thinking
 +Rare (0.01% to 0.1%): Hallucinations (visual or acoustic), depression, loss of appetite, restlessness, aggressive behavior, agitation, confusion, talkativeness
 +Very rare (less than 0.01%): Activation of psychosis, rebound mania following discontinuation of therapy
 +
 +==== Genitourinary ====
 +
 +Very rare (less than 0.01%): Sexual disturbances/impotence, abnormal spermatogenesis (with decreased sperm count and/or motility)
 +Frequency not reported: Urinary frequency, acute urinary retention, oliguria with elevated blood pressure, azotemia, albuminuria, glycosuria, elevated BUN, microscopic deposits in the urine
 +
 +==== Metabolic ====
 +
 +Common (1% to 10%): Hyponatremia, fluid retention, edema, weight gain, reduced plasma osmolarity due to an antidiuretic hormone (ADH)-like effect (leading in rare cases to water intoxication accompanied by lethargy)
 +Very rare (less than 0.01%): Disturbances of bone metabolism (decrease in plasma calcium and 25-OH-cholecalciferol) leading to osteomalacia, elevated cholesterol (including HDL cholesterol), elevated triglycerides
 +
 +==== Musculoskeletal ====
 +
 +Rare (0.01% to 0.1%): Muscle weakness
 +Very rare (less than 0.01%): Arthralgia
 +Postmarketing reports: Leg cramps[Ref]
 +
 +==== Other ====
 +
 +Very rare (less than 0.01%): Taste disturbances, tinnitus, hyperacusis, hypoacusis, changes in pitch perception[Ref]
 +
 +===== Pregnancy Warnings =====
 +  * US FDA pregnancy category D
 +    * Associated with congenital malformations 
 +      * Spina bifida, Craniofacial defects, cardiovascular malformations, hypospadias
 +    * Developmental Delay
 +
 +===== Breastfeeding Warnings =====
 +  * Excreted in human milk 25% to 60% of plasma levels 
 +  * Infants can have therapeutic drug concentrations
 +
 +
 +====== References ======
 +[[https://www.drugs.com/pro/carbamazepine.html|Drugs.com]]
 +  
 + {{tag>drugs}}