Tegretol (carbamazepine) - a safe option?

One of the older but still more frequently prescribed drugs that is still used to treat peripheral neuropathy, is Carbamazepine (Tegretol). It's a well-known anti-seizure drug but has recently come under scrutiny regarding its interaction with certain HIV anti-retrovirals, especially Prezista (see here). Now, while I accept that reading every leaflet accompanying drugs can scare the life out of you and even if the side effects below are a worst case scenario, this drug information from drugs.com (see link below) shows that there are quite a few other considerations to bear in mind before taking Tegretol. I'm not an expert so concede that there may be very good reasons but question as to why it is still being promoted by the manufacturer and widely prescribed by doctors, when the potential side effects are so patently unpleasant and for certain HIV-patients, so dangerous?

Tegretol
Generic Name: carbamazepine (oral) (kar ba MAZ e peen) Brand Names: Carbatrol, Epitol, Equetro, TEGretol, TEGretol XR

What is Tegretol?

Tegretol (carbamazepine) is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain.
Tegretol is used to treat seizures and nerve pain such as trigeminal neuralgia and diabetic neuropathy. Carbamazepine is also used to treat bipolar disorder.
Tegretol may also be used for purposes not listed in this medication guide.

Important information about Tegretol

Tegretol may cause severe or life-threatening skin rash, especially in people of Asian ancestry. Your doctor may recommend a blood test before you start the medication to determine your risk of this skin reaction. Seek emergency medical attention if you have a fever, sore throat, headache and skin pain, followed by a red or purple skin rash that spreads and causes blistering and peeling.

You should not take Tegretol if you have a history of bone marrow suppression, if you are also taking nefazodone, or if you are allergic to an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), desipramine (Norpramin), imipramine (Tofranil), or nortriptyline (Pamelor).

Tegretol may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby. Tell your doctor right away if you become pregnant while taking Tegretol for seizures. Do not start or stop taking Tegretol during pregnancy without your doctor's advice.

Do not use Tegretol if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days.

Before you take Tegretol, tell your doctor if you have heart disease, high blood pressure, high cholesterol, liver or kidney disease, glaucoma, a thyroid disorder, lupus, porphyria, or a history of mental illness or psychosis.

You may have thoughts about suicide while taking Tegretol. Your doctor will need to check you at regular visits. Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

There are many other drugs that can interact with Tegretol. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Do not stop using Tegretol without first talking to your doctor, even if you feel fine. You may have increased seizures or unpleasant withdrawal symptoms if you stop using Tegretol suddenly.

Before taking Tegretol

Do not use Tegretol if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. You should not take Tegretol if you are allergic to carbamazepine, or if you have:
•a history of bone marrow suppression
•if you are also taking nefazodone; or
•if you are allergic to an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), desipramine (Norpramin), imipramine (Tofranil), or nortriptyline (Pamelor).

Tegretol may cause severe or life-threatening skin rash, especially in people of Asian ancestry. Your doctor may recommend a blood test before you start the medication to determine your risk of this skin reaction.

To make sure you can safely take Tegretol, tell your doctor if you have any of these other conditions:
•heart disease, high blood pressure, high cholesterol or triglycerides;
•liver or kidney disease;
•glaucoma;
•a thyroid disorder;
•lupus;
•porphyria; or
•a history of mental illness or psychosis.

Patients of Asian ancestry may have a higher risk of developing a rare but serious skin reaction to Tegretol. Your doctor may recommend a blood test before you start the medication to determine your risk of this skin reaction.

You may have thoughts about suicide while taking Tegretol. Tell your doctor if you have new or worsening depression or suicidal thoughts during the first several months of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.

FDA pregnancy category D. Tegretol may cause harm to an unborn baby. Do not start taking Tegretol without telling your doctor if you are pregnant or planning to become pregnant. Use effective birth control while you are taking this medicine. Although Tegretol may harm an unborn baby, having a seizure during pregnancy could harm both mother and baby. If you become pregnant while taking Tegretol, do not stop taking the medicine without your doctor's advice. Seizure control is very important during pregnancy. The benefit of preventing seizures may outweigh any risks posed by taking Tegretol. Follow your doctor's instructions about taking this medicine while you are pregnant.

Carbamazepine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using Tegretol. Carbamazepine can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking Tegretol.

How should I take Tegretol?

Take Tegretol exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

Do not crush, chew, or break an extended-release Tegretol tablet. Swallow the pill whole. Breaking the pill would cause too much of the drug to be released at one time.

Shake the Tegretol oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and call your doctor promptly if this medicine seems to stop working as well in preventing your seizures. Tegretol can lower blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill.

To be sure Tegretol is not causing harmful effects, your blood cells and kidney function may need to be tested often. Do not miss any follow up visits to your doctor for blood or urine tests. Your doctor may also recommend having your eyes checked regularly while you are taking this medicine.

Do not stop using Tegretol without first talking to your doctor, even if you feel fine. You may have increased seizures or unpleasant withdrawal symptoms if you stop using this medicine suddenly. Wear a medical alert tag or carry an ID card stating that you take Tegretol. Any medical care provider who treats you should know that you take seizure medication.

Store this medicine at room temperature away from moisture, heat, and light.

What should I avoid while taking Tegretol?

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid drinking alcohol. It can increase some of the side effects of Tegretol, and can also increase your risk of seizures.

Avoid exposure to sunlight or tanning beds. Tegretol can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Grapefruit and grapefruit juice may interact with Tegretol and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

Tegretol side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Tegretol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have a serious side effect such as:
•pale skin, feeling light-headed, rapid heart rate, trouble concentrating;
•fever, chills, sore throat, mouth and throat ulcers;
•easy bruising or bleeding, severe tingling, numbness, pain, muscle weakness;
•confusion, agitation, vision problems, hallucinations;
•feeling short of breath, swelling of your ankles or feet;
•urinating less than usual;
•jaundice (yellowing of the skin or eyes); or
•severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious Tegretol side effects may include:
•feeling dizzy, drowsy, or unsteady;
•nausea, vomiting, diarrhea, constipation, stomach pain;
•headache, ringing in your ears;
•dry mouth, swollen tongue; or
•joint or muscle pain, leg cramps.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Tegretol?

Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, other seizure medicines, and medicine for depression or anxiety can add to sleepiness caused by Tegretol. Tell your doctor if you regularly use any of these other medicines.

This list is not complete and there are many other drugs that can interact with Tegretol. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

http://www.drugs.com/tegretol.html