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Carbamazepine

Carbamazepine CR 

Carbamazepine CR is an anticonvulsant that is used to manage various types of seizures and pain caused by trigeminal neuralgia (a condition affecting the trigeminal nerve in the face). The CR stands for “controlled release,” which allows the drug to be released into the bloodstream slowly. This drug is available in many forms- tablets, capsules, and suspensions. It is important to note that people take this medication exactly as prescribed by their healthcare provider. Do not alter the dosage without asking your doctor. Patients with ventricular conduction disorders, hypersensitivity to Carbamazepine or tricyclic antidepressants, or who have a history of bone marrow failure are strictly advised against using this drug. 

Product Overview

Carbamazepine CR contains Carbamazepine as its main active ingredient, which is utilized primarily for its anticonvulsant or antiepileptic properties. It can also be used for relieving nerve pain. The medication works by lowering the spread of seizure activity in the cognitive area and restoring the normal balance of nerve activity. 

This drug comes in various oral forms, including immediate-release tablets, extended-release capsules, chewable tablets, and suspensions. Medical professionals prescribe these medications in different forms based on a person’s needs. For example, the standard strength of the Carbamazepine tablet is 200 mg; similar strengths apply to its other variations. Patients should consult their doctor for specific dosing recommendations. It is suitable for adults and children with a prescription, particularly those diagnosed with epilepsy, bipolar disorder, or trigeminal neuralgia. Carbamazepine CR is particularly effective for those needing a consistent release of medication to manage chronic conditions effectively.

Patients may experience side effects like dizziness, drowsiness, nausea, or vomiting. If a dose is missed, take it as soon as possible unless it is near the time for the next dose; do not double up. In case of an overdose, get medical assistance right away. Store Carbamazepine CR at room temperature, away from moisture and light. Regular medical consultations are advised to monitor the drug’s effectiveness and alter the dosage if necessary for safe and effective use of the medication.

Uses of Carbamazepine CR

This drug is prescribed for treating three conditions:

  • Seizures caused by epilepsy further include partial, generalized tonic-clonic, and mixed seizures.
  • Trigeminal neuralgia pain
  • Mania and bipolar disorders

How to Use?

Dosage

Patients need to ask their healthcare provider for dosage recommendations, as this medication is available in different forms.

Form 1: Oral tablet

Strengths: 100, 200, 300, and 400 mg

Form 2: Oral tablet, chewable

Strengths: 100 mg, 200 mg

Form: Oral tablet, extended-release

Strengths: 100 mg, 200 mg, 400 mg

Recommended Dosage for Different Patients

For Epilepsy

  • Adults Above 18 Years of Age: For this age group, experts advised taking 200 mg, twice a day. Depending on the patient’s needs and conditions, these professionals change doses each week. 
  • Children Between 12 to 17 Years: 200 mg 2 times a day with the dosage increasing each week.
  • Children Between the Ages 6 to 12 Years: The recommended dosage is 100 mg, taken 2 times a day. Besides, the doctor might increase their daily dose by 100 mg. 
  • Children Younger Than 5 Years: 10 to 20 mg/kg each day and the medicine should be divided and taken twice or thrice a day.

For Trigeminal Nerve Pain

  • Adult: 100 mg twice a day, with the dosage increasing by 100 mg every 12 hours.
  • Children (0 to 17 Years): Not recommended 
  • Senior: As the digestion process of older adults is generally slow as compared to younger adults, patients might need a lower dosage or different treatment.

[Note: Remember these recommendations may vary depending on person to person. Consult with your healthcare professional, and they’ll customize your dosage accordingly.]

How to Take It?

There are different ways to take Carbamazepine CR, and these are:

If it is a tablet:

  • Take the medication with meals to reduce unwanted side effects such as vomiting and upset stomach.
  • Swallow the tablets as a whole. Do not chew or break it. 
  • Do not take the medication if it is damaged or has cracks in it.
  • Avoid drinking grapefruit juice when taking the tablet, as it can increase the effects of medicine by increasing the amount within the body. 

If it is an oral liquid:

  • Shake well before each use. Measure the dose with a spoon or medicine cup. 
  • Do not use the average household teaspoon, as it may not hold the right amount.
  • Avoid taking it with any other liquid medicine at the same time. 

If it is a capsule:

  • Swallow the extended-release capsule whole.
  • You can also open it and mix the contents of the capsule with a teaspoon of applesauce.
  • Swallow the mixture immediately. 
  • Remember to not crush or chew the capsule or its contents.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Carbamazepine CR Work?

Carbamazepine CR works by balancing the brain and nerve electrical activity. When we talk about epilepsy, this medication works by shutting out the accumulation of electrical signals in brain nerve cells. Additionally, it also reduces the release of the neurotransmitter glutamate, which plays an important part in triggering seizures. For nerve pain, the medicine stabilizes nerve electrical signals, thus preventing pain signals from being sent to the brain. Lastly, the mechanism of action in bipolar disorder treatment is not completely understood, but it is believed that Carbamazepine is involved in reducing the glutamate activity in the brain.\

Important Safety Information

Side Effects

Common side effects of Carbamazepine CR may include:

  • Vomiting
  • Difficulty in walking
  • Dizziness
  • Nausea
  • Unsteadiness
  • Dry mouth
  • Swelling in tongue

Serious side effects of Carbamazepine CR may include:

  • Skin allergies
  • Not feeling hungry
  • Stomach pain
  • Irregular heartbeats
  • Fever
  • Sore throat
  • Nosebleeds
  • Suicidal thoughts
  • Bruising
  • Shortness of breath
  • Weakness
  • Increased Seizures

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Warnings

  • Suicidal Thoughts: It has been said that this drug might cause suicidal actions in some people. If you face any symptoms such as anxiety, panic attacks, violent thoughts, or mood changes, contact your healthcare provider right away. 
  • Anaphylaxis and Angioedema: These drugs can cause severe allergic reactions that can prove to be dangerous to certain people. Immediately stop using your medication if any of these reactions occur. If the situation persists, call your doctor; they might prescribe other drugs to you.

Boxed Warning

  • Haematologic Risks: Although rare, severe adverse effects like agranulocytosis and aplastic anemia have been noticed during the use of Carbamazepine. Besides these effects, leucopenia, thrombocytopenia, and liver problems have also occurred. Therefore, it is important to closely monitor the patients during treatment to detect any signs of blood disorders early. 
  • Dermatologic Concerns: Serious skin reactions, such as Steven ‘s-Johnson Syndrome and Toxic Epidermal Necrolysis, have been observed with Carbamazepine use. While these reactions are infrequent in Caucasian populations, they are more common in some Asian countries. Immediate medical attention is necessary if any skin reaction occurs.

Precautions

  • Regular doctor visits and tests are important to ensure the medication’s effectiveness and monitor for any adverse effects.
  • Avoid combining Carbamazepine with monoamine oxidase inhibitors (MAOIs) or certain other medications without consulting a doctor.
  • Men using this drug may experience infertility. Discuss family planning with the doctor before starting treatment.
  • It may cause agitation, irritability, or other unusual behaviors, mainly in the early stages of treatment. Any such changes should be reported to the doctor right away.
  • Avoid alcohol and other medications that cause dizziness while taking this medication, as they can enhance its effects.
  • These medications can increase the sensitivity to sunlight. So, use sun protection measures and avoid any sun exposure.
  • Do not stop taking the medicines immediately without consulting the doctor, as it may worsen seizures or cause withdrawal symptoms.
  • Carbamazepine may reduce the effectiveness of birth control pills containing estrogen, increasing the risk of unplanned pregnancies. Alternative birth control methods should be used.

Contraindications

  • Hepatic Disease: Patients with liver disease should not take these medications, as it may worsen their condition.
  • Bone-Marrow Depression: People with a history of bone-marrow depression should avoid it due to the risk of exacerbating this condition.
  • Hepatic Porphyria: Those who have hepatic porphyria, including acute intermittent porphyria, variegate porphyria, and porphyria cutanea tarda, should avoid taking this medication due to its ability to worsen the condition.
  • Atrioventricular Heart Block: Patients with such conditions should not take Carbamazepine CR 200 mg.

Missed Dose

  • If you forget the dose of Carbamazepine CR, take the skipped dose as soon as you remember. 
  • If it is almost time for your next dose, you can skip the previous one and continue with your usual dosing schedule. 
  • Remember to not take double doses just to make up for the previous one. 

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Storage

  • Store it at a temperature above 86°F (30°C) If it is an immediate-release tablet.
  • Store these drugs at 77°F (25°C). You can also store them at a temperature between 59°F and 86°F for a short period of time if it is an extended-release tablet.
  • Keep the drug away from light.
  • Try not to keep the medication at high temperatures.
  • Do not store in moist or damp areas like bathrooms.
  • Keep it out of reach of children.
  • Read the packaging of your product for detailed instructions.
  • Keep it away from heat or moisture.
  • Seek expert advice for precise information.

[Note: Discuss with your medical professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Carbamazepine CR Interactions

These oral tablets can interact with other medications that you may be taking, causing harmful effects on your body. Some of the examples are:

  • Heart Drugs: Combining this medication with certain heart drugs will increase the level of Carbamazepine in the body. This can have adverse side effects. So, contact your doctor to check your blood levels if you are taking this drug with diltiazem or verapamil.
  • CYP3A4 Inhibitors: Cytochrome P450 3A4 (CYP3A4) is the main enzyme involved in Carbamazepine metabolism. These inhibitors can increase Carbamazepine levels, leading to harmful reactions. Therefore, be cautious while taking the combination of these drugs.
  • Carbamazepine Induction: Carbamazepine is a potent inducer of CYP3A4 and other liver enzymes, which may decrease plasma concentrations of medications metabolized by CYP3A4.
  • Blood Thinners: Using this medication with certain anticoagulant drugs can reduce the positive effects of blood thinners. This means that they will not work effectively to prevent blood clots. So, avoid using anticoagulant drugs like rivaroxaban, apixaban, dabigatran, and edoxaban in combination with Carbamazepine CR 200 mg.

[Note: This isn’t a complete list, and there could be other medications that interact with Carbamazepine CR. Ensure to tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]

Carbamazepine CR Alternatives

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

Is Carbamazepine CR better than other epilepsy medications?

There are different types of medicines available for treating epilepsy. It is not right to say which one works better. The effects can vary from person to person and depend on how often you use them. So, if you are a patient with epilepsy, choose the right medication based on the seizure types that you have. For a more accurate decision, ask a medical expert.

Can I drive while taking Carbamazepine CR 200 mg tablet?

One of the common side effects of this medication is dizziness and tiredness. So, when you initially take the tablet, you might feel sleepy or drowsy. If you notice any such symptoms usually in daily life after taking this medicine, do not drive or operate any machinery. Additionally, it is against the rules to ride a bike if you are not feeling well. 

Can I drink grapefruit juice while taking Carbamazepine CR?

Avoid grapefruit juice if you are taking this medication, as it can increase the concentration of Carbamazepine in your body. As a result, there are high chances of experiencing side effects associated with it. If you have any concerns or questions about dietary restrictions while taking this drug, consult with your healthcare provider for personalized advice.

Can I stop taking Carbamazepine CR?

Once you stop taking your epilepsy medication, there are chances that you may experience seizures in the future. However, you can prevent these withdrawal seizures by lowering your dose of Carbamazepine slowly. Before stopping your medication, discuss with your doctor. 

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