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Carbamazepine is used for:

• Controlling certain types of seizures and relieving pain in patients with nerve pain in the face, jaw, tongue, or throat.
• Carbamazepine is an anticonvulsant. It works by controlling abnormal nerve impulses in the brain. In trigeminal neuralgia, it reduces the activity of nerve impulses in the nerves to the face, decreasing pain.

Do NOT use Carbamazepine if:

• • you are allergic to any ingredient in Carbamazepine
  • you are allergic to tricyclic antidepressants (eg, amitriptyline, imipramine, desipramine) or similar medications
  • you have a history of bone marrow depression, the blood disorder porphyria, or other serious blood disorders
  • you have a heart condition known as atrioventricular block
  • you are taking or have taken a monoamine oxidase (MAO) inhibitor (eg, phenelzine) within the last 14 days
• Contact your doctor or health care provider right away if any of these apply to you.

Before using Carbamazepine :

• Some medical conditions may interact with Carbamazepine . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you are allergic to other seizure medicines (eg, phenytoin, phenobarbital)
  • if you have a history of increased pressure in the eye (glaucoma), liver or kidney problems, blood problems, heart problems or congestive heart failure, mood or mental problems, seizures, multiple sclerosis, or severe skin reactions (eg, Stevens-Johnson syndrome)
  • if you consume alcohol-containing beverages or have a history of alcoholism
• Some MEDICINES MAY INTERACT with Carbamazepine . Tell your health care provider if you are taking any other medicines, especially any of the following:
  • Androgens (eg, testosterone), cimetidine, clarithromycin, diltiazem, fluconazole, fluoxetine, fluvoxamine, HIV protease inhibitors (eg, ritonavir), isoniazid, itraconazole, ketoconazole, lamotrigine, loratadine, macrolide antibiotics (eg, erythromycin), nefazodone, niacinamide, progabide, propoxyphene, stiripentol, terfenadine, theophylline, tricyclic antidepressants (eg, amitriptyline), troleandomycin, valproic acid, verapamil, or viloxazine because the side effects of Carbamazepine may be increased
  • Lithium because the risk of severe nervous system side effects may be increased
  • Antineoplastics (eg, cisplatin, doxorubicin), felbamate, hydantoins (eg, phenytoin), phenobarbital, primidone, rifampin, or theophylline because the effectiveness of Carbamazepine may be decreased
  • Acetaminophen, anticoagulants, (eg, warfarin), butyrophenones (eg, haloperidol), clozapine, trazadone, tricyclic antidepressants (eg, amitriptyline), or valproic acid because the side effects of these medicines may be increased by Carbamazepine
  • Anticoagulants (eg, warfarin), benzodiazepines (eg, alprazolam), birth control pills (eg, ethinyl estradiol/norethindrone) or any other hormone-type contraceptive (eg, levonorgestrel implant), butyrophenones (eg, haloperidol), clozapine, corticosteroids (eg, hydrocortisone), cyclosporine, doxycycline, erlotinib, ethosuximide and its derivatives, etretinate, felbamate, felodipine, HIV protease inhibitors (eg, ritonavir), HMG-CoA reductase inhibitors (eg, simvastatin), imatinib, itraconazole, lamotrigine, methylphenidate, nifedipine, nondepolarizing muscle relaxants (eg, vecuronium), praziquantel, quetiapine, sertraline, tiagabine, topirimate, tricyclic antidepressants (eg, amitriptyline), or voriconazole because the effectiveness of these medicines may be decreased
• This may not be a complete list of all interactions that may occur. Ask your health care provider if Carbamazepine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Carbamazepine :

• Use Carbamazepine as directed by your doctor. Check the label on the medicine for exact dosing instructions.
  • Carbamazepine may be taken with or without food.
  • Take Carbamazepine regularly to receive the most benefit from it.
  • Taking Carbamazepine at the same time each day will help you remember to take it.
  • Eating grapefruit or drinking grapefruit juice may affect the amount of Carbamazepine in your blood. Talk with your doctor before including grapefruit or grapefruit juice in your diet.
  • If you miss a dose of Carbamazepine , take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
• Ask your health care provider any questions you may have about how to use Carbamazepine .

Important safety information:

• Important safety information about Carbamazepine :
  • Carbamazepine may cause drowsiness, dizziness, or blurred vision. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Carbamazepine . Using Carbamazepine alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.
  • Carbamazepine may cause increased sensitivity to the sun. Avoid exposure to the sun, sunlamps, or tanning booths until you know how you react to Carbamazepine . Use sunscreen or protective clothing if you must be outside for a prolonged period of time.
  • Before you have any medical or dental surgery, tell your doctor or dentist that you are taking Carbamazepine .
  • Carbamazepine may interfere with certain lab tests, including thyroid function tests. Be sure your doctor or laboratory personnel know you are taking Carbamazepine .
  • This medicine may interfere with some pregnancy test results. Check with your doctor or pharmacist if you are taking Carbamazepine and have questions or concerns about the result of a pregnancy test.
  • LAB TESTS, including blood cell counts, blood iron levels, liver function, kidney function, eye exams, and carbamazepine blood levels, may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.
  • PREGNANCY and BREAST-FEEDING: Carbamazepine has been shown to cause harm to the fetus. Avoid becoming pregnant while taking Carbamazepine . If you think you may be pregnant, discuss with your doctor the benefits and risks of using Carbamazepine during pregnancy. Carbamazepine is excreted in breast milk. Do not breast-feed while taking Carbamazepine .

Possible side effects of Carbamazepine :

• All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
  • Blurred vision
  • confusion
  • dizziness
  • drowsiness
  • dry mouth or throat
  • headache
  • nausea
  • unsteadiness
  • vomiting.
• Seek medical attention right away if any of these SEVERE side effects occur:
  • Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue)
  • bone, joint, or muscle pain
  • chills
  • fainting
  • fast or irregular heartbeat
  • fever
  • hair loss
  • hallucinations
  • involuntary muscle movements
  • pain, tenderness, or unusual swelling in the neck, groin, or under the arms
  • rapid eye movement
  • reddened, blistered, or swollen skin
  • ringing in the ears
  • seizures
  • severe sweating
  • shortness of breath
  • sore throat
  • stomach pain
  • swelling of ankles or fingers
  • ulcers or sores in the mouth
  • unusual bruising or bleeding
  • vision changes
  • yellowing of the eyes or skin.

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Drug Name

Lamictal (Lamotrigine)

Drug Uses

Lamictal is used in combination with other anti-seizure drugs in the treatment of some types of seizures. It also is used alone for treating partial seizures in patients of 16 years old and older when converting from the anti-epileptic drug valproate.

How Taken

The initial dose of lamictal in patients, not taking valproic acid (Depakote), is 50 mg once daily for two weeks, followed by 100 mg daily, given in two divided doses for two weeks. Thereafter, the usual maintenance dose is 300 to 500 mg daily, given in two divided doses. In patients taking valproic acid, the initial dose of lamictal is 25 mg every other day for two weeks, then 25 mg once daily for two weeks, slowly increasing the dose (by 25 to 50 mg per day) every one to two weeks) until a dose of 100 to 150 mg daily is reached. Standard doses of lamictal are given twice daily.

Drug Class and Mechanism

Lamictal is an oral drug that is used for treating seizures. It is chemically unrelated to other anti-seizure drugs. The precise mechanism by which lamictal exerts its anti-seizure action is not known.

Missed Dose

Try to take each dose at the scheduled time. If you miss a dose, take it as soon as remembered; do not take it if it is near the time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not “double-up” the dose to catch up.

Storage

Store this medication at room temperature at 77 degrees F (25 degrees C) away from heat, light, and moisture. Brief storage between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Do not store in the bathroom. Keep this and all medications out of the reach of children.

Warnings/Precautions

Rarely, serious (sometimes fatal) skin rashes have occurred while using this medication. These rashes (e.g., Stevens-Johnson syndrome) are more common in children (less than 16 years old) than in adults. Therefore, lamictal should only be used in children who have partial seizures or seizures, associated with Lennox-Gastaut syndrome. Immediately notify your doctor if you develop any type of rash. If this medication is the cause of the rash, the drug must be stopped.

Even after stopping this medication, it is still possible for the rash to cause permanent or life-threatening scarring along with other problems. The possibility of a rash may be increased by using too much of this medication when treatment begins, increasing the dose beyond what your doctor prescribes during treatment, or taking valproic acid with lamictal. Most life-threatening rashes have occurred within 2 to 8 weeks of starting this medication.

However, such serious rashes have also occurred after 6 months of use. Tell your doctor if you have: other illnesses, heart problems, liver problems, kidney problems, allergies (especially drug allergies). Sunscreen and/or protective clothing is recommended to protect against a possible severe rash, triggered by sunlight. Use caution operating machinery or engaging in activities, requiring alertness. Limit alcohol intake while taking this drug. This medication should be used only if clearly needed during pregnancy. Discuss the risks and benefits with your doctor. This drug is excreted into breast milk. Due to possible risks to nursing infants, breast-feeding while using this drug is not recommended. Consult your doctor.

Possible Side Effects

Headache, fatigue, drowsiness, dizziness, blurred vision, weakness, clumsiness may occur the first several days as your body adjusts to the medication. If any of these effects continue or become bothersome, inform your doctor. If you develop a rash, stop using this drug and seek immediate medical attention. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, hives, fever, swollen glands, swelling of the lips or tongue, painful sores in the mouth or around the eyes, severe dizziness, trouble breathing. If you notice other effects, not listed above, contact your doctor or pharmacist.

More Information

Laboratory tests may be done periodically while taking this medication to monitor the effects. See your doctor regularly.

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.

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What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.

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What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.

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What is divalproex sodium?

It is used in the UK and U.S. for the treatment of the manic episodes of bipolar disorder, and increasingly taken long-term for prevention of both manic and depressive phases of bipolar disorder, especially the rapid-cycling variant. It is also used in the US for the treatment of epilepsy.

Divalproex sodium affects chemicals in the body that may be involved in causing seizures.

Divalproex sodium is used to treat various types of seizure disorders. Divalproex sodium is sometimes used together with other seizure medications.

Divalproex sodium may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about divalproex sodium?

In rare cases, divalproex sodium has caused life-threatening liver failure, especially in children younger than 2 years old. Children of this age may be at even greater risk for liver problems if they use more than one seizure medication, if they have a metabolic disorder, or if they have a brain disease causing mental impairment (such as Creutzfeldt-Jacob disease, Huntington disease, multiple sclerosis, or a brain injury or infection). Divalproex sodium has also caused rare cases of life-threatening pancreatitis (inflammation of the pancreas). Pancreatitis can come on suddenly and symptoms may start even after you have been taking divalproex sodium for several years. Seek emergency medical attention if the person taking this medicine has nausea, vomiting, stomach pain, or loss of appetite, low fever, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes). These symptoms may be early signs of liver damage. Some of these symptoms may also be early signs of pancreatitis. Divalproex sodium can cause birth defects. Do not use this medication without your doctor’s consent if you are pregnant. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment. Do not stop taking the medication even if you feel better. It is important to take divalproex sodium regularly to prevent seizures from recurring. Call your doctor promptly if this medicine does not seem to be working as well in preventing your seizures. Do not crush, chew, break, or open a delayed-release or extended-release tablet or capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time. Carry an ID card or wear a medical alert bracelet stating that you are taking divalproex sodium, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking divalproex sodium.

Avoid using other drugs that make you sleepy (such as other seizure medicines, alcohol, cold medicine, pain medication, muscle relaxers, and medicine for depression or anxiety). They can add to sleepiness caused by divalproex sodium.

What should I discuss with my healthcare provider before taking divalproex sodium?

In rare cases, divalproex sodium has caused life-threatening liver failure, especially in children younger than 2 years old. Children of this age may be at even greater risk for liver problems if they use more than one seizure medication, if they have a metabolic disorder, or if they have a brain disease causing mental impairment (such as Creutzfeldt-Jacob disease, Huntington disease, multiple sclerosis, or a brain injury or infection). Divalproex sodium has also caused rare cases of life-threatening pancreatitis (inflammation of the pancreas). Pancreatitis can come on suddenly and symptoms may start even after you have been taking divalproex sodium for several years. Do not take divalproex sodium if you have liver disease or a urea cycle disorder.

Before taking divalproex sodium, tell your doctor if you have:

• a bleeding or blood clotting disorder;
• a history of head injury, brain disorder, or coma;
• a family history of a urea cycle disorder;
• a family history of infant deaths with unknown cause; or
• HIV or CMV (cytomegalovirus) infection.

If you have any of these conditions, you may not be able to use divalproex sodium, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use divalproex sodium without your doctor’s consent if you are pregnant. Tell your doctor if you become pregnant during treatment. Divalproex sodium can cause birth defects. Use an effective form of birth control while you are using this medication. Divalproex sodium passes into breast milk and could harm a nursing infant. Do not take divalproex sodium without telling your doctor if you are breast-feeding a baby. Divalproex sodium should not be given to a child younger than 2 years of age without a doctor’s consent. Older adults may be more sensitive to sleepiness caused by this medicine.

How should I take divalproex sodium?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Take each dose with a full glass of water. Drink plenty of water while you are taking this medication. Your dose may need to be changed if you do not get enough fluids each day.

To be sure this medication is not causing harmful effects, your liver function will need to be tested. It is important that you not miss any scheduled visits to your doctor.

Do not stop taking the medication even if you feel better. It is important to take divalproex sodium regularly to prevent seizures from recurring. Get your prescription refilled before you run out of medicine completely. Call your doctor promptly if this medicine does not seem to be working as well in preventing your seizures. Do not crush, chew, break, or open a delayed-release or extended-release tablet or capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.

You may open the divalproex sodium sprinkle capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow this mixture right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

Carry an ID card or wear a medical alert bracelet stating that you are taking divalproex sodium, in case of emergency. Any doctor, dentist, or emergency medical care provider who treats you should know that you are taking divalproex sodium. Store divalproex sodium at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a divalproex sodium overdose may include sleepiness or drowsiness, shallow breathing, weak pulse, or loss of consciousness.

What should I avoid while taking divalproex sodium?

Avoid drinking alcohol, which can increase some of the side effects of divalproex sodium.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by divalproex sodium.

Divalproex sodium can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Divalproex sodium can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.

Divalproex sodium side effects

Seek emergency medical attention if the person taking this medicine has nausea, vomiting, stomach pain, or loss of appetite, low fever, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes). These symptoms may be early signs of liver damage. Some of these symptoms may also be early signs of pancreatitis. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• unexplained weakness with vomiting and confusion or fainting;
• easy bruising or bleeding, unusual weakness;
• fever, skin rash, swollen glands;
• fever, chills, body aches, flu symptoms;
• urinating less than usual;
• blood in your urine;
• hallucinations (seeing things that aren’t there);
• weakness, lack of coordination;
• a red, blistering, peeling skin rash;
• extreme drowsiness;
• unusual bleeding or bruising; or
• double vision or back-and-forth movements of the eyes.

Continue using divalproex sodium and talk with your doctor if you have any of these less serious side effects:

• drowsiness or weakness;
• diarrhea, constipation, upset stomach;
• depression, anxiety, or other emotional changes;
• changes in your menstrual periods;
• enlarged breasts;
• tremor (shaking);
• hair loss;
• weight changes;
• a red, blistering, peeling skin rash;
• vision changes; or
• unusual or unpleasant taste in your mouth.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect divalproex sodium?

Before taking divalproex sodium, tell your doctor if you are using any of the following drugs:

• topiramate (Topamax);
• tolbutamide (Orinase);
• a blood thinner such as warfarin (Coumadin);
• aspirin or acetaminophen (Tylenol);
• zidovudine (Retrovir);
• clozapine (Clozaril, Fazaclo);
• diazepam (Valium);
• meropenem (Merrem);
• rifampin (Rifadin, Rimactane, Rifater);
• ethosuximide (Zarontin); or
• another seizure medicine such as phenytoin (Dilantin), carbamazepine (Tegretol, Carbatrol), phenobarbital (Luminal, Solfoton), felbamate (Felbatol), lamotrigine (Lamictal), or clonazepam (Klonopin).

If you are using any of these drugs, you may not be able to use divalproex sodium, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect divalproex sodium. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.

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