CARBAMAZEPINE (e.g. ‘Tegretol’)
Car – bam – ay – ze – peen
Why have I been prescribed carbamazepine?
Carbamazepine is used to help treat mood swings, as happens in bipolar affective disorder or manic depression. People
with bipolar affective disorder have mood swings that are much more severe than the small changes in mood that
everybody experiences. With bipolar affective disorder, mood may be elevated or depressed (up or down).
When the mood is extremely elevated this is called hypomania or mania. People with hypomania feel very energetic and
elated but can be irritable and frustrated. They may talk very quickly, sleep very little and be full of ideas and plans. They
can be described as being “high”. Treatment is usually needed because when people are “high” they may make poor
judgements and can quickly become exhausted. Periods of depression will also occur in bipolar disorder. Symptoms
include feelings of sadness, tiredness and poor sleep. Antidepressants may be required to help lessen these obviously
unpleasant symptoms. Carbamazepine helps stabilise the mood. It reduces the highs and the lows.
What exactly is carbamazepine?
Carbamazepine is known as a mood stabiliser but it can also be used to treat other disorders. Many people with epilepsy
take it to stop them having fits. Carbamazepine may also help depression when taken with other antidepressants.
Your pharmacy stocks different brands of carbamazepine tablets. If your doctor prescribes the "Retard" tablet, make sure
you get this one every time from your pharmacist. A common brand or trade name of carbamazepine is Tegretol’.
Why do I need to have some blood tests?
The first blood test is to check that it's safe for you to take carbamazepine. Your blood must be healthy. After a few days,
you may need another blood test. This will tell your doctor if you are taking the right dose of carbamazepine. If he or she is
satisfied, you will only need a blood test every three to six months.
Is carbamazepine safe to take?
It is usually safe to have carbamazepine regularly as prescribed by your doctor, but it doesn’t suit everyone. Let your doctor
know if any of the following apply to you, as extra care may be needed:
a) if you have glaucoma, porphyria, or suffer from heart, liver or kidney trouble;
b) if you are taking any other medication. This includes the contraceptive “Pill" and medicine from your pharmacist, such
as cimetidine (‘Tagamet’), theophylline or St. John’s wort;
c) if you are pregnant, breast feeding, or wish to become pregnant.
What is the usual dose of Carbamazepine?
The usual starting dose is 200mg twice a day. This is usually slowly increased to between 300mg and 500mg twice a day.
How should I take carbamazepine?
Look at the label on your medicine; it should have all the necessary instructions on it. Follow this advice carefully. If you
have any questions, speak to your pharmacist, doctor or nurse. Most medicines are now dispensed with an information
leaflet for you to read.
What should I do if I miss a dose?
Never change your dose without checking with your doctor. If you forget a dose, take it as soon as you remember, as long
as it is within a few hours of the usual time.
What will happen to me when I start taking carbamazepine?
For most people with bipolar affective disorder highs and lows occur quite rarely. Carbamazepine should make these highs
and lows less extreme or less frequent. So, it may take months or years to see the effects of carbamazepine. The best way
to know whether carbamazepine is working for you is to compare your highs and low before and whilst taking it.
Unfortunately, you might get some side effects before your mood gets any better. Most side effects should go away after a
few weeks. Sometimes, the level of carbamazepine in your body gets too high which can be dangerous. You need to be
able to spot the side effects that can mean a high level of carbamazepine. Look at the table over the page. It tells you what
to do if you get any side effects. Not everyone will get the side effects shown. There are many other possible side effects.
Ask your pharmacist, doctor or nurse if you are worried about anything else that you think might be a side effect.
Side effect What is it? What should I do if it happens to me?
COMMON
DIPLOPIA Seeing double. Don't drive or use machinery. You won't need new glasses but
see your doctor if you are worried.
DIZZINESS Feeling light-headed and faint. Don't stand up too quickly. Try and lie down when you feel it
coming on. Don't drive.
DROWSINESS Feeling sleepy or sluggish. It can last for a
few hours after taking your dose.
Don't drive or use machinery. Ask your doctor if you can take
your carbamazepine at a different time of the day.
LESS COMMON
NAUSEA and
VOMITING
Feeling sick or being sick. Taking each dose with or after food may help. If it is bad,
contact your doctor. The slow-release tablets may help.
UNCOMMON
ATAXIA Being very unsteady on your feet. Your carbamazepine level may be too high. Contact your
doctor now.
HEADACHE When your head is painful and pounding. It should be safe to take aspirin or paracetamol. Don't take any
co-proxamol ("Distalgesic").
RARE
BLOOD, HEPATIC
and SKIN
DISORDERS
Red rash, fever, sore throat, mouth ulcers,
bruising or bleeding
Stop taking the carbamazepine and contact your doctor now.
CONFUSION Your mind is all mixed up. Your carbamazepine level may be too high. Contact your
doctor now.
CONSTIPATION Feeling "bunged up" inside. You can't pass a
motion or stool.
Eat more fibre e.g. bran, fruit and vegetables. Do more walking.
Make sure you drink plenty of fluid. A mild laxative from a
pharmacy might help.
DIARRHOEA The “runs”, or loose stools This should wear off fairly quickly. If it becomes a problem,
contact your pharmacist or doctor.
RASH A mild red rash seen anywhere on the skin. If mild, discuss with your doctor when you next meet. If it
worsens, contact your doctor now.
SIADH Low sodium levels in the blood. Not much
urine is passed.
This can be dangerous. See your doctor soon.
What about alcohol?
It is officially recommended that people taking carbamazepine should not drink alcohol. This is because both carbamazepine and
alcohol can cause drowsiness. If the two are taken at the same time, severe drowsiness can result. This can lead to falls or accidents.
As well as this, drinking alcohol often makes your mood unstable. Excessive drinking is especially likely to do this. Once people are
used to taking medication, they can sometimes drink alcohol in small amounts without any harm. Avoid alcohol altogether for the first
one or two months. After this, if you want a drink, try a glass of your normal drink and see how you feel. If this doesn’t make you feel
drowsy, then it is probably OK to drink small amounts. It pays to be very cautious because alcohol affects people in different ways,
especially when they are taking medication.
Don’t stop taking your medication because you fancy a drink at the weekend. If you do drink alcohol, drink only small amounts. Never
drink any alcohol and drive while on carbamazepine. Discuss any concerns you may have with your pharmacist, doctor or nurse.
When I feel better, can I stop taking it?
No. If you stop taking carbamazepine, your original symptoms may return. You should decide with your doctor when you can come off
it. Most people need to be on carbamazepine for quite a long time, sometimes years. This is not thought to be harmful. Carbamazepine
is not addictive.
Remember, leaflets like this can only describe some of the effects of medication. You may find other
books or leaflets also useful. If you have access to the internet you may find a lot of information
there as well, but be careful, as internet based information is not always accurate.
2001 United Kingdom Psychiatric Pharmacy Group www.ukppg.org.uk
This leaflet is to help you understand about your medicine. It is not an official manufacturer's Patient Information Leaflet. For more
information call the UKPPG National Telephone Helpline, 11am to 5pm, Monday to Friday on 020 7919 2999 or visit
www.nmhct.nhs.uk/pharmacy
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