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).

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 how Equetro 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 on the 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).

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.

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.)

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).

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.

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 irregular heart 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.

(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 o o o o o o o

Loss of appetite Nausea or vomiting Irritability Excessive tiredness Confusion Hallucinations Muscle weakness 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

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

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 side effect 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 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).

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

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 does not 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. Carbamazepine is 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 (also known as petit mal seizures).

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 shocklike 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 is one of the medications commonly used to treat trigeminal neuralgia.

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.

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 particular carbamazepine 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.

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 effects or making the medication less effective. In some cases, your

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 o o o o o o

Clarithromycin (Biaxin) Erythromycin (Ery-Tab) Fluconazole (Diflucan) Isoniazid (Nydrazid) Itraconazole (Sporanox) Ketoconazole (Nizoral) Telithromycin (Ketek)

Certain antipsychotic medications, including:

o o o o

Clozapine (Clozaril, FazaClo) Haloperidol (Haldol) Risperidone (Risperdal) Ziprasidone (Geodon)

Certain calcium channel blockers, including:

o o o o o o o o

Amlodipine (Norvasc) Diltiazem (Cardizem, Cartia XT, Dilacor XR, Dilt-CD, Diltia XT, Dilt-XR, Taztia XT, Tiazac) Felodipine (Plendil) Isradipine (Dynacirc, Dynacirc CR) Nicardipine (Cardene) Nifedipine (Adalat CC, Afeditab CR, Nifediac CC, Nifedical XL, Procardia) Nimodipine (Nimotop) 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 o o o o

Isocarboxazid (Marplan) Phenelzine (Nardil) Rasagiline (Azilect) Selegiline (Eldepryl, Emsam, Zelapar) Tranylcypromine (Parnate)

Niacin (Niacor, Niaspan)

Nefazodone (Serzone) Other seizure medications Propoxyphene (Darvon, Darvocet) Protease inhibitors, such as:

o o o o o o o

Amprenavir (Agenerase) Atazanavir (Reyataz) Fosamprenavir (Lexiva) Indinavir (Crixivan) Nelfinavir (Viracept) Ritonavir (Norvir) 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

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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.

Alcohol Generally, you should not drink alcohol if you are taking carbamazepine. Doing so may increase your risk of side effects. Antidepressants Some 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 are many 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 carbamazepine dosage as necessary.

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.

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 Inhibitors Protease 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 medications in 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 heart disease, 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

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: What Should I Tell My Healthcare Provider?

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:

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 is usually 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.

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 consciousness o 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).

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 o o o o o o o o o

Amitriptyline (Elavil) Amoxapine (Asendin) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Sinequan) Imipramine (Tofranil, Tofranil PM) Maprotiline (Ludiomil) Nortriptyline (Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil).

Have taken a monoamine oxidase inhibitor (MAOI) within the past two weeks. Some examples of MAOIs include:

o o o o o

Isocarboxazid (Marplan) Phenelzine (Nardil) Rasagiline (Azilect) Selegiline (Eldepryl, Emsam, Zelapar) 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 during pregnancy. 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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Is Carbamazepine Safe During Pregnancy?

Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol) may not be safe for women who are pregnant. In animal and human studies involving carbamazepine and pregnancy, the drug caused problems in the fetus, including birth defects.

Carbamazepine and Pregnancy Category D

The U.S. Food and Drug Administration (FDA) uses a pregnancy category system to classify the possible risks to a fetus when a specific medicine is taken during pregnancy. Pregnancy Category D is a classification given to medicines that have been shown to present a risk to the fetus in studies of pregnant women, but may still offer benefits that outweigh the risks the drug presents. A pregnancy Category D medicine may still be given to a pregnant woman if the healthcare provider believes that the benefits to the woman outweigh the possible risks to the unborn child. Studies involving women suggest that carbamazepine use during pregnancy increases the risk of birth defects, including head or facial deformities, spina bifida, and heart defects. Animal studies also show these risks. There have also been reports of seizures, breathing problems, vomiting, and diarrhea in newborns whose mothers were taking carbamazepine during pregnancy. It is important to understand that most of the women in these studies were taking carbamazepine for epilepsy, not for other conditions. However, uncontrolled epilepsy can also be dangerous to both a pregnant woman and the fetus. You and your healthcare provider must discuss the specific benefits and risks of using carbamazepine during pregnancy for your particular situation. If your epilepsy is very mild (or if you have not had a seizure in several years), you may consider stopping carbamazepine. However, if your epilepsy is severe or difficult to control, it may be best for you to stay on carbamazepine. No matter what, do not suddenly stop taking carbamazepine (see Carbamazepine Withdrawal). While carbamazepine may be necessary for some pregnant women with epilepsy, it is usually not essential for pregnant women with bipolar disorder, trigeminal neuralgia, or other conditions. Other medications are available that may be less dangerous for the fetus. If you and your healthcare provider decide that it is best for you to continue taking carbamazepine, you may need frequent blood tests to measure your carbamazepine levels. Pregnancy can affect the way your body handles carbamazepine, and it is important to keep your dose at the lowest effective level (to help protect your fetus). Also, it is best if you can take just one seizure medication (rather than multiple seizure medications). Your healthcare provider may suggest a higher-than-usual dose of folic acid, as this may also help protect the fetus.

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 Epilepsy

Active Ingredient Phenobarbital.

Manufacturer 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?

Epilepsy.

Warning!

This medication may cause drowsiness. If affected do not drive or 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 need contraception 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

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 breastfeeding Certain 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 and malformations. 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.

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 known to 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:

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

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 prescribed hormonal 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

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 Advert NETDOCTOR MEMBERSHIP - Start your own online diary. - Leave comments for other members on the forums. - Receive an email every weekday with the latest health news. It's free and simple to join. So what are you waiting for? Become a NetDoctor member

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Phenobarbital
Generic name: Brand names: Phenobarbital

Why is Phenobarbital prescribed?

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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.

More common side effects may include: Allergic reaction, drowsiness, headache, lethargy, nausea, oversedation, sleepiness, slowed or delayed breathing, vertigo, vomiting

Why should Phenobarbital not be prescribed?

Phenobarbital should not be used if you suffer from porphyria (an inherited metabolic disorder), liver disease, or a lung disease that causes blockages or breathing difficulties, or if you have ever had an allergic reaction to or are sensitive to phenobarbital or other barbiturates.

Special warnings about Phenobarbital

Remember that phenobarbital may be habit-forming. Make sure you take the medication exactly as prescribed. Phenobarbital should be used with extreme caution, or not at all, by people who are depressed, or have a history of drug abuse. Be sure to tell your doctor if you are in pain, or if you have constant pain, before you take phenobarbital. Phenobarbital may cause excitement, depression, or confusion in elderly or weakened individuals, and excitement in children. If you have been diagnosed with liver disease or your adrenal glands are not functioning properly, make sure the doctor knows about it. Phenobarbital should be prescribed with caution. Barbiturates such as phenobarbital may cause you to become tired or less alert. Be careful driving, operating machinery, or doing any activity that requires full mental alertness until you know how you react to Phenobarbital.

Possible food and drug interactions when taking Phenobarbital

Phenobarbital may increase the effects of alcohol. Avoid alcoholic beverages while taking phenobarbital. If phenobarbital is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining phenobarbital with the following: Antidepressant drugs known as MAO inhibitors, including Nardil and Parnate Antihistamines such as Benadryl Blood-thinning medications such as Coumadin Doxycycline (Doryx, Vibramycin) Griseofulvin (Fulvicin-P/G, Grifulvin V)

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

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