What are the side effects of carbamazepine (anticonvulsant medication)?

From the Guidelines

Carbamazepine is associated with several side effects, including dizziness, drowsiness, and skin reactions, and patients should be closely monitored for these adverse effects, particularly those with a history of sensitivity to such medications 1.

Common Side Effects

• Dizziness
• Drowsiness
• Headache
• Nausea
• Vomiting
• Unsteadiness

Serious Side Effects

• Blood disorders (like low white blood cell count)
• Skin reactions (ranging from mild rashes to severe conditions like Stevens-Johnson syndrome)
• Liver problems
• Hyponatremia (low sodium levels) To minimize these effects, patients should start with a low dose of carbamazepine, which can be gradually increased as needed, and regular blood tests should be conducted to monitor complete blood counts, sodium levels, and liver function 1.

Special Considerations

• HLA-B*15:02 screening should be implemented before initiating treatment to reduce the risk of adverse cutaneous reactions, particularly in the Han Chinese population 1.
• The medication should be taken at bedtime to minimize the adverse effect of dizziness caused by carbamazepine 1.
• Patients should stay hydrated, avoid alcohol, and immediately report symptoms like unusual bleeding, fever, sore throat, severe rash, or yellowing of the skin to their healthcare provider. It is essential to note that carbamazepine can induce liver enzymes, potentially decreasing the effectiveness of other medications, including oral contraceptives, and patients should be aware of this interaction 1.

From the FDA Drug Label

Carbamazepine tablets can cause serious side effects, including:

1. Carbamazepine tablets may cause rare but serious skin rashes that may lead to death.
2. Carbamazepine tablets may cause rare but serious blood problems.
3. Carbamazepine tablets may cause allergic reactions or serious problems, which may affect organs and other parts of your body like the liver or blood cells.
4. Like other antiepileptic drugs, carbamazepine tablets may cause suicidal thoughts or actions in a very small number of people, about 1 in 500

The most common side effects of carbamazepine tablets include: dizziness drowsiness problems with walking and coordination (unsteadiness) nausea vomiting

Carbamazepine tablets may cause other serious side effects These include: Irregular heartbeat - symptoms include: Fast, slow, or pounding heartbeat Shortness of breath Feeling lightheaded Fainting Liver problems - symptoms include: yellowing of your skin or the whites of your eyes dark urine pain on the right side of your stomach area (abdominal pain) easy bruising loss of appetite nausea or vomiting

The possible side effects of carbamazepine include:

• Serious skin rashes that may lead to death
• Serious blood problems
• Allergic reactions or serious problems that may affect organs and other parts of the body
• Suicidal thoughts or actions in a very small number of people
• Common side effects such as dizziness, drowsiness, problems with walking and coordination, nausea, and vomiting
• Other serious side effects such as irregular heartbeat and liver problems 2 2

From the Research

Side Effects of Carbamazepine

The side effects of carbamazepine can be severe and life-threatening. Some of the known side effects include:

• Agranulocytosis, a condition characterized by an unusually low number of neutrophils, which can increase the risk of bacterial or fungal infections 3, 4
• Stevens-Johnson syndrome (SJS), a severe skin condition with a high mortality rate 3, 5, 4
• Toxic epidermal necrolysis, a condition similar to SJS but with a higher mortality rate 5
• Neurologic toxicity, including vague neurological symptoms, cardiovascular instability, intractable seizures, and coma 6, 7
• Cardiovascular effects, including conduction system disturbances 7

Rare but Serious Side Effects

Some rare but serious side effects of carbamazepine include:

• Co-existence of agranulocytosis and Stevens-Johnson syndrome, which can increase the risk of morbidity and mortality 3, 4
• Acute carbamazepine intoxication, which can result in both neurologic and cardiovascular dysfunction 7

Management of Side Effects

The management of side effects of carbamazepine includes:

• Aggressive orogastric lavage followed by activated charcoal administration with catharsis in cases of overdose 7
• Continuous electrocardiographic monitoring and close observation until plasma carbamazepine levels fall to therapeutic anticonvulsant levels 7
• Charcoal hemoperfusion in cases of severe intoxication with respiratory failure and prolonged intubation 7