Carbamazepine

​Carbamazepine may cause some unwanted side effects. Generally, the common side effects tend to occur at the beginning of treatment. Such side effects may include:

• Drowsiness, dizziness and headache
• Be careful when giving any over-the-counter medicines to your child. Medicines for allergy or cold symptoms can add on to the drowsiness. Be sure to supervise your child when he/she is involved in activities such as cycling or swimming
• Nausea, vomiting, abdominal pain (take carbamazepine with meals to reduce these problems), loss of appetite, increased thirst, diarrhea or constipation
• Unusual behavioral changes such as confusion and agitation
• Back pain, muscle pain and weakness

Inform your doctor if any of the above side effects lasts more than a few days or become severe and bothersome.

If your child experiences excessive drowsiness and vomiting, doubled vision and unstable movement, please consult your child’s neurologist as he/she may be too sensitive to carbamazepine, and the doctor may need to adjust his/her dose.

Rare but serious side effects may manifest as the following symptoms. Contact your doctor as soon as possible, if you notice any of the following:

• Prolonged fever, sore throat and mouth sores/ulcers
• Easy bruising, rapid deteriorating illness
• Yellowing of the skin or eyes
• Stevens-Johnson syndrome (SJS)

Stevens-Johnson syndrome (SJS) is a life-threatening skin reaction that is characterized by skin rash*, multiple mouth ulcers, blistering rash*, fever, itching and other symptoms.
SJS usually occurs within the first few months (monitor closely for the first 3 months) of treatment. Patients who have been taking carbamazepine for more than 3 months without developing skin reactions are at low risk of SJS.

*As SJS is rapidly progressing, caregivers should consult hospital healthcare professionals if patient shows first sign of rash.

It is important to note that certain groups of patients are at a higher risk of SJS after using carbamazepine. In accordance to the Health Science Authority (HSA) regulation, it is therefore compulsory for all patients who are first prescribed with carbamazepine to be tested for the specific gene. Kindly approach your neurologists or pharmacists for further information on this.

​Antibiotics such as erythromycin, clarithromycin, azithromycin should not be taken with carbamazepine.

Grapefruit or grapefruit products should also be avoided while taking carbamazepine.

• Carbamazepine is usually taken 2 to 3 times daily. The doctor may start your child on a low dose and then slowly increase the dose. Follow the instructions on the label carefully and take your medicine regularly. Ask your pharmacist or doctor if you are unsure.
• Do not take this medication more often than directed and do not stop unless instructed by your doctor. Stopping this medicine too rapidly can increase the risk of seizures or fits.
• Do not change brands or dosage forms without informing your doctor.
• Oral liquid form / Suspension:​
  Shake well before using. Use a medicine spoon or graduated syringe provided to measure your medicine. Do not use household spoons as they may not be accurate. It should be taken with or after food.
• Tablets:
  ​Swallow tablets whole with a glass of water. It should be taken with or after food.
• Extended-release tablets (e.g. Tegretol CR®):
  ​These tablets are specially designed to release the medicine slowly over a period. Swallow the tablets whole with a glass of water. The tablet could be cut into two and swallow one piece at a time if the whole tablet is too big to be swallowed. However, they should not be chewed or crushed. It should be taken with or after food.

• Take the dose as soon as you remember and then continue to take it as you normally would. However, if it is almost time for the next dose, skip the dose you missed and take your next dose at the usual time.
• Do not double or increase the dose.
• If your child has missed more than two doses or you are not sure of what to do, consult your doctor or pharmacist.
• Ensure that your child has at least 2 weeks supply of medication at all times. If your child has less than 2 weeks medication supplies, please ensure that you have made an appointment with your child’s neurologist or arranged to collect more medication.

Keep away from children;#Keep in a cool, dry place, away from direct sunlight;#

​Check with your doctor or pharmacist if you want to give any other medicines, supplements or herbal products to your child.

If your child is consulting with a different doctor, inform him/her that your child is currently taking carbamazepine before he/she prescribes any other medication.