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Bipolar disorder - Management
What adverse effects of carbamazepine should I be aware of?

  • Common adverse effects include nausea and vomiting, sedation, dizziness, and ataxia.
    • These adverse effects are dose-related and are most common at the start of treatment.
  • Allergic skin reactions (including urticaria, which may be severe) are also common.
    • Withdraw carbamazepine if a skin reaction worsens or is accompanied by other symptoms.
  • Rarely, serious dermatological adverse effects, including Stevens–Johnson syndrome and exfoliative dermatitis, can occur.
    • People who are Han Chinese, Hong Kong Chinese, or of Thai origin should be screened for the presence of the HLA-B*1502 allele before taking carbamazepine.
    • People who test positive should not start carbamazepine unless the benefits clearly outweigh the risks of Stevens–Johnson syndrome.
  • Hyponatraemia occurs in 20% of people taking carbamazepine, but is usually mild.
    • If the hyponatraemia is clinically significant, restriction of fluid intake or a slight reduction in the dose of carbamazepine usually resolves the issue.
  • Leucopenia (very common) and other blood disorders, including thrombocytopenia, agranulocytosis, and aplastic anaemia (rare), can occur with carbamazepine treatment.
  • There is a small risk of suicidal thoughts and behaviour, which may be seen as early as one week after starting treatment.
    • People taking carbamazepine and healthcare professionals should be alert to any mood changes, distressing thoughts, or feelings about suicide or harming themselves at any point during treatment.

[ABPI Medicines Compendium, 2008c; BNF 56, 2008; MHRA, 2008a; Micromedex, 2009; MHRA, 2008b]

Basis for recommendation
  • Information regarding adverse effects is taken from the British National Formulary, Micromedex, the Summary of Product Characteristics for Tegretol®, and the Medicines and Healthcare products Regulatory Agency [ABPI Medicines Compendium, 2008c; BNF 56, 2008; MHRA, 2008b; Micromedex, 2009].
  • The recommendation to screen people who are Han Chinese, Hong Kong Chinese, or of Thai origin for the presence of the HLA-B*1502 allele before starting carbamazepine comes from the Medicines and Healthcare products Regulatory Agency [MHRA, 2008a].

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