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Carbamazepine (Tegretol) is a medication that requires careful use due to potential serious side effects and interactions. Below is important safety and warning information that should be considered before and during treatment:

• Serious Skin Reactions: Carbamazepine can cause life-threatening skin conditions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), especially within the first few months of use and predominantly in individuals of Asian descent. A genetic test may be recommended to identify those at increased risk. If symptoms like a rash, blisters, peeling skin, or facial swelling occur, seek immediate medical attention.

• Blood Disorders: Rarely, carbamazepine may lead to serious blood disorders such as aplastic anemia or agranulocytosis. Regular blood count monitoring is essential. Contact your doctor if you experience symptoms like fever, persistent sore throat, fatigue, or unusual bruising or bleeding.

• Allergic Reactions: Severe allergic reactions, including anaphylaxis and DRESS (drug reaction with eosinophilia and systemic symptoms), can occur. Symptoms include fever, rash, and swollen lymph nodes. Those with certain genetic markers may be at higher risk.

• Mental Health Risks: The medication may increase the risk of suicidal thoughts or behavior. Close monitoring for mood changes is advised, and immediate medical assistance should be sought if such symptoms appear.

• Pregnancy Risks: Carbamazepine can harm an unborn baby, leading to developmental issues or seizures. Pregnant individuals or those planning to become pregnant should discuss alternatives with their healthcare provider.

• Withdrawal Symptoms: Abrupt discontinuation can increase seizure risk. If discontinuation is necessary, it should be done gradually under medical supervision.

• Cognitive and Motor Impairments: Patients might experience difficulties with concentration, speech, coordination, and increased sleepiness or dizziness. Exercise caution when driving or operating machinery, and consult your doctor if these effects are significant.

• Liver Health: Regular liver function tests are recommended, as carbamazepine can cause liver damage. Alert your healthcare provider to symptoms such as severe nausea, stomach pain, or jaundice.

• Low Sodium Levels: This medication can cause hyponatremia, especially in older adults or those taking diuretics. Severe symptoms like confusion, severe headaches, or fainting require immediate medical attention.

• Eye and Heart Considerations: Rarely, carbamazepine can affect eye pressure or heart rhythm. Regular eye exams and monitoring for symptoms like chest pain or vision changes are advised, especially for those with a history of eye or heart conditions.

Contraindications:

• Do not use carbamazepine if you have a history of bone marrow issues, are allergic to tricyclic antidepressants, have taken MAOIs within the last 14 days, or are using certain other medications like nefazodone or some HIV treatments.

Always consult with a healthcare professional to weigh the benefits and risks of carbamazepine in your specific situation.

Common side effects:

• nausea
• dizziness
• drowsiness
• constipation
• dry mouth
• unsteadiness

Less common but important to monitor:

• shakiness
• high blood pressure
• burning sensation
• trouble concentrating
• twitching

Serious side effects:

• persistent severe headaches
• signs of liver problems
• continuous nausea
• loss of appetite
• abdominal pain
• jaundice
• dark urine
• symptoms indicating kidney issues
• changes in urination
• mouth sores
• fainting
• irregular heartbeat
• vision changes
• joint pain
• swelling of the extremities
• signs of dangerously low sodium levels
• extreme drowsiness
• confusion
• seizures
• mental health changes
• depression
• suicidal thoughts
• very serious allergic reaction
• rash
• severe dizziness
• breathing difficulties

Interactions with high risk of serious adverse effects and should be avoided:

• MAO inhibitors (isocarboxazid, Linezolid, phenelzine, moclobemide, procarbazine, Rasagiline, Selegiline, Tranylcypromine)
• Isavuconazonium
• Voriconazole
• Orlistat

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Macrolide antibiotics (Erythromycin)
• Rifamycins (Rifabutin)
• St. John's wort
• Artemether/lumefantrine
• Anticoagulants (apixaban, Rivaroxaban)
• Calcium channel blockers (nifedipine, Nimodipine)
• Nefazodone
• Nirmatrelvir
• HIV NNRTIs (Efavirenz, etravirine, rilpivirine)
• Praziquantel
• Ranolazine

Interactions with low risk that usually do not require a change in therapy:

• Hormonal birth control (pills, patch, ring)
• Alcohol
• Marijuana (cannabis)
• Antihistamines (Cetirizine, diphenhydramine)
• Drugs for sleep or anxiety (Alprazolam, Diazepam, Zolpidem)
• Muscle relaxants (Carisoprodol, Cyclobenzaprine)
• Opioid pain relievers (codeine, hydrocodone)