CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Bipolar disorder - Management
How should I monitor someone taking carbamazepine?
- Measure full blood count, liver function tests, urea, and electrolytes before starting treatment and every 6 months during treatment.
- Stop treatment if leucopenia develops that is severe, progressive, or accompanied by clinical symptoms (e.g. fever or sore throat), or if there is any evidence of significant bone marrow depression.
- Stop treatment immediately if acute liver dysfunction develops.
- Monitor body weight in people who gain weight rapidly.
- Measure plasma levels of carbamazepine every 6 months to exclude toxicity, because therapeutic levels and toxic levels are close.
- A plasma level of at least 7 mg/L seems to be required in affective illness.
- Most adverse effects of carbamazepine increase in severity and frequency when the plasma level is greater that 12 mg/L, but this varies substantially from person to person.
Basis for recommendation
© NHS Institute for Innovation and Improvement