Summary: Children with brain
damage severe enough to cause cerebral palsy, mental retardation, hydrocephalus,
microcephaly, etc., may have concomitant epileptic fits originating from the
damaged areas of brain. Such children may be given carbamazepine for control of
their fits. This section discusses a few guidelines for the parent/caregiver of
the disabled child. This section is a simplified account of that given in USP
DI, and is included here only as a guide and with no commercial interest. Last
revised January 21, 2007
CARBAMAZEPINE: ANTI-EPILEPTIC IN CP/MR
Brands available in India include Tegretol and Majetol, in strengths of 100,
200 and 400 mg tablets as well as oral suspensions for smaller children.
What is it ?
Carbamazepine is an anti-epileptic drug, used for various purposes by the
doctor, which includes control some types of seizures and relieving pain due to
some types of nerve diseases. In a CP/MR child, the only uses likely will be
control of seizures.
Is it safe for your child ?
No drug on earth is absolutely safe. Not every doctor writes this drug. The
few that do, usually know about its uses and risks. It is given only when the
benefits of the drug outweigh the potential risks of NOT giving the drug.
How to make it easier for the doctor to decide about
its use ?
Be sure to inform the doctor about any history of allergy or drug
intolerance, especially to carbamazepine use in the past, antidepressants of
tricyclic family, or to any other substances, such as food items, cosmetics
or other chemicals and household goods.
Pregnancy: Most drugs are absolutely contraindicated in the first three
months of pregnancy, and relatively contraindicated in the next six months,
because we do not know for sure whether it is safe, nor can we do clinical
trials in pregnancy since it is ethically not permitted. Hence we rely on
animal usage data. As per animal data, carbamazepin can cause a wide variety
of birth defects in off springs when given to the pregnant animals. Hence,
be sure to tell the doctor if there is pregnancy or a chance of pregnancy in
near future.
Lactation: Carbamazepine is excreted in breast milk, and may therefore
drug the baby. This is undesirable, hence the drug is best avoided during
lactation. If that is not possible, then lactation should be avoided.
Unwanted effects
Children: The drug is a brain acting drug, and may cause behavioral
changes in children
Adults: Even adults may suffer from confusion, restlessness, nervousness;
palpitation or irregular or slow heart beats, chest discomfort, etc..
Drug to drug interaction
Anticoagulants to thin the blood: their effects may be decreased.
Regular monitoring of the blood thinning effects is needed.
Clarithromycin, a popular antibiotic for respiratory and other
infections: increases the blood levels of carbamazepine to cause adverse effects
described earlier.
Corticosteroids, may be used for severe inflammations,
asthma, severe allergies, etc. Carbamazepine decreases the effects of
corticosteroids.
Diltiazem, Verapamil, Erythromycin or Propoxyphene
: These drugs increase the blood levels of carbamazepine to increase sedation
and other sucj\h adverse effects.
Estrogens (female hormones) or Birth Control pills
containing estrogen or Quinidine : Carbamazepine decreases the
effects of these drugs and may lead to hormonal disturbances, failure of birth
control, or loss of control of heart rhythm, respectively.
Isoniazid is a common anti-TB drug., whose liver side
effects may be increased.
Itraconazole or Ketoconazole are systemic
anti-fungal drugs, whose effects may be decreased.
Monoamine oxidase inhibitors, furazolidone, selegiline, etc.: Use of
carbamazepine within 2 weeks after these drugs may cause sudden high
temperature, high BP, fits, etc.
Other drug interactions involve
Other Anti-epileptic drugs
Risperidone
Alcohol abuse
Anemia or other blood problems
Behavioral problems
Glaucoma
Heart or blood vessel disease
Urinary obstructive disorders
Diabetes mellitus
Kidney or Liver disease
How to use this drug
Take after food to avoid stomach upsets
Long acting preparations do not have the above limitations. However, these
preparations should not be broken into two parts unless there is a dividing
line provided by the manufacturers.
Carbamazepine is not an ordinary pain reliever, but a critical
brain-acting drug. it must be taken at the exact dose prescribed, and
exactly at the times advised, for the exact duration advised. Never suddenly
stop taking this medicine without first checking with the doctor .
Store this medicine in a cool dark dry place, away from the reach of
children. Store away from heat and direct light. Do not freeze the liquid
form of this medicine. Discard outdated medicine or medicine no longer
needed.
Make regular follow up visits to the doctor at prescribed intervals, as he
may want to adjust the dose or do some blood tests and check-ups to ensure
that there are no adverse effects.
Stay out of direct sunlight, and wear protective clothing, hat,
sunglasses, sunscreens, etc.
When to make emergency calls to doctor
When any of the following occur: Black, tarry stools; blood in urine or
stools; bone or joint pain; cough or hoarseness; darkening of urine; lower back
or side pain; nosebleeds or other unusual bleeding or bruising; painful or
difficult urination; pain, tenderness, swelling, or bluish color in leg or foot;
pale stools; pinpoint red spots on skin; shortness of breath or cough; sores,
ulcers, or white spots on lips or in the mouth; sore throat, chills, and fever;
swollen or painful glands; unusual tiredness or weakness; wheezing, tightness in
chest, or troubled breathing; yellow eyes or skin.
How to know that there is an overdose
Brain related: Body spasm in which head and heels are bent backward and
body is bowed forward; clumsiness or unsteadiness; convulsions (seizures)—especially
in small children; dizziness (severe) or fainting; drowsiness (severe); large
pupils; nausea or vomiting (severe); overactive reflexes followed by under
active reflexes; poor control in body movements (for example, when reaching or
stepping) Heart / B.P. related: fast or irregular heartbeat; high or low blood
pressure (hypertension or hypotension); irregular, slow, or shallow breathing Body function related: sudden decrease in amount of urine; trembling,
twitching, or abnormal body movements Miscellaneous:
More common: Blurred vision or double vision; continuous back-and-forth
eye movements
Less common: Behavioral changes (especially in children); confusion,
agitation, or hostility (especially in the elderly); diarrhea (severe);
headache (continuing); increase in seizures; nausea and vomiting (severe);
skin rash, hives, or itching; unusual drowsiness
Rare: Chest pain; difficulty in speaking or slurred speech; fainting;
frequent urination; irregular, pounding, or unusually slow heartbeat; mental
depression with restlessness and nervousness or other mood or mental
changes; muscle or stomach cramps; numbness, tingling, pain, or weakness in
hands and feet; rapid weight gain; rigidity; ringing, buzzing, or other
unexplained sounds in the ears; sudden decrease in amount of urine; swelling
of face, hands, feet, or lower legs; trembling; uncontrolled body movements;
visual hallucinations (seeing things that are not there)
Other side effects that are often self limiting and do not usually require
medical remedial action include:
Common: clumsiness or unsteadiness; dizziness (mild); drowsiness (mild);
light-headedness; nausea or vomiting (mild)
Less common or rare: aching joints or muscles; constipation; diarrhea;
dryness of mouth; headache; increased sensitivity of skin to sunlight (skin
rash, itching, redness or other discoloration of skin, or severe sunburn);
increased sweating; irritation or soreness of tongue or mouth; loss of
appetite; loss of hair; sexual problems in males; stomach pain or
discomfort.
This is not a full list of side effects. If any side effect not listed
above is noted, inform the doctor.
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