Carbamazepine
Brand: Tegretol, Equetro
Boxed warning · ISMP high-alert drug
Serious dermatologic reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis (risk strongly tied to the HLA-B*1502 allele, so patients of at-risk ancestry, mostly Asian, are screened before starting); aplastic anemia and agranulocytosis.
- Caution
- Strong enzyme inducer that lowers many drug levels, including contraceptives; low sodium.
- Pregnancy
- Avoid if possible: neural tube defects and other malformations.
Common side effects
- Dizziness and drowsiness
- Low sodium
- Serious skin rash
- Low blood counts
Key interactions
- Induces liver enzymes: lowers many drug levels including contraceptives
- Grapefruit juice raises its level
- Additive sedation with CNS depressants
Counseling points
- Report any new rash immediately
- Blood counts and drug levels are monitored
- A backup contraceptive method may be needed
- Do not stop abruptly
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