Carbamazepine significantly reduces the effectiveness of many other medicines. A full review of all your current medicines is essential before starting. This includes HIV medicines and contraceptives.
What it treats
Which conditions is Carbamazepine used for?
Overview
What is Carbamazepine?
Carbamazepine is an anticonvulsant and mood stabiliser that has been in clinical use since the 1960s. In psychiatry, it is used for bipolar disorder, particularly when lithium has not worked or when there are specific features such as rapid mood cycling. In neurology, it is a first-line treatment for partial seizures and trigeminal neuralgia.
It is listed in Kenya's Essential Medicines List 2023 under both mental health and epilepsy categories, and is available from Level 3 upwards.
Carbamazepine is highly effective, but it speeds up the breakdown of many other medicines in the body by activating liver enzymes. This means it can significantly reduce how well other medicines work, including antiretroviral medicines for HIV and the oral contraceptive pill. A full medicines review is essential before starting.
How it works
What does it do in the brain?
Formulations in Kenya
How is it available?
Availability across Africa
Where is it available in Africa and what is it called?
| Country | Common Brand Name(s) | Notes |
|---|---|---|
| Uganda | Tegretol, Carbamazepine (generic) | On the Uganda EML from health centre level; widely used for epilepsy across the country. |
| Tanzania | Tegretol, Carbamazepine (generic) | On the national EML; available from health centre level for epilepsy. |
| Ethiopia | Carbamazepine (generic) | Widely available; on the Ethiopian EML. The ARV interaction is a common clinical issue managed daily. |
| Rwanda | Carbamazepine (generic) | Available through the RBC pharmacy network. |
| South Africa | Tegretol, Carbamazepine (generic) | Widely available; standard treatment for partial epilepsy in public sector guidelines. |
| Nigeria | Tegretol, Carbamazepine (generic) | Widely available at government and private hospitals across all regions. |
| Ghana | Tegretol, Carbamazepine (generic) | On the Ghana EML; available at district hospitals and above. |
| Zambia | Carbamazepine (generic) | On the Zambia EML; widely available for epilepsy. |
Side effects
What might you feel while taking it?
These are the most commonly reported effects. Not everyone experiences them, and many settle within the first few weeks.
- Dizziness and unsteadiness, particularly when starting or after dose increases
- Double or blurred vision
- Nausea
- Fatigue
- Low sodium in the blood, more common in elderly patients
- Mild reduction in white blood cell count, usually not significant but monitored
- Stevens-Johnson Syndrome, a serious skin reaction. Any new rash while taking carbamazepine should be assessed by a doctor without delay.
- Severe reduction in blood cells, report fever, sore throat, unusual bruising, or signs of infection immediately
- Severe low sodium causing confusion or seizures, particularly in elderly patients
Who should not take it
Important warnings before starting
- Certain heart rhythm problems
- History of bone marrow depression or blood disorders
- Currently taking or recently having taken a medicine from the MAOI class
Special care needed
Situations that need extra attention
- A full review of all medicines you take is essential before starting, particularly HIV medicines and the contraceptive pill
- Women of reproductive age must use effective contraception, as the oral contraceptive pill is significantly less effective with carbamazepine
- Elderly patients have a higher risk of low sodium levels
- Report any skin rash without delay
- Do not stop carbamazepine suddenly
Associated with increased risk of birth defects. High-dose folic acid and specialist monitoring are required if it must be continued. Speak to your doctor well in advance if planning a pregnancy.
Low levels in breast milk. Generally considered acceptable but specialist review is recommended.
Other medicines
Medicines and substances that can interact with it
- Antiretroviral medicines for HIV: Carbamazepine substantially reduces ARV levels, which can cause treatment failure and drug resistance. Tell your HIV doctor before starting.
- Oral contraceptive pill: Carbamazepine makes the pill significantly less effective. Alternative contraception is necessary.
- Lamotrigine: Reduces lamotrigine levels significantly. Your doctor will adjust the lamotrigine dose if both are needed.
- Valproate: A complex two-way interaction. Both medicines affect each other's levels.
- Many other medicines: Carbamazepine affects a very wide range of medicines via liver enzyme induction. Every new medicine added must be checked for this interaction.
Tests and follow-up
What your doctor will monitor
- Blood carbamazepine levels at initiation, after dose changes, and periodically during stable treatment
- Full blood count at baseline and every three months for the first year
- Liver function at baseline and periodically
- Sodium levels in blood, particularly in elderly patients
- A full medicines interaction review at every prescription change
Stopping this medicine
What happens if you stop taking it?
In Kenya
What you should know about this medicine in Kenya
Carbamazepine is one of the most affordable and accessible medicines in Kenya, available from health centre level for both epilepsy and mental health indications.
The interaction with antiretroviral medicines is a critical issue in Kenya, where HIV prevalence is significant. Any person on ARVs being considered for carbamazepine needs this interaction reviewed explicitly, valproate or lamotrigine are generally safer alternatives in this context.
The interaction with the oral contraceptive pill must not be left unaddressed in clinical practice. Women taking carbamazepine need effective contraception discussed and arranged.
Sources
References
- Ministry of Health, Kenya. (2023). Kenya Essential Medicines List 2023. Nairobi: Ministry of Health.
- Ministry of Health, Kenya. (2023). Kenya National Medicines Formulary, 1st Edition. Nairobi: Ministry of Health.
- World Health Organization. (2023). Model List of Essential Medicines, 23rd Edition. Geneva: WHO.
- National Institute for Health and Care Excellence. (2022). Epilepsies in children, young people and adults (NG217). London: NICE.