Safety in overdose
Serious symptoms may
occur at 10–20 times normal serum levels. Symptoms include
nausea, vomiting, CNS depression, respiratory depression, and seizures. Management
includes gastric lavage, forced emesis, assisted ventilation.
Carbamazepine has not
been associated with a withdrawal syndrome with rapid discontinuation.
However, as with other mood stabilizers, rapid discontinuation is
associated with an increased risk of rapid relapse. In bipolar patients, decrease
dose over 6 months. In nonbipolar patients, dose may be decreased
by 25% every 3 days.
Drugs that may carbamazepine
levels include: cimetidine, ciprofloxacin, diltiazem, fluoxetine,
fluvoxamine, doxycycline, erythromycin, fluconazole, grapefruit
juice, INH (isoniazid), ketoconazole, macrolide antibiotics (erythromycin,
clarithromycin, troleandomycin), nefazodone, norfloxacin, prednisolone,
propoxyphene, protease inhibitors (e.g., ritonavir), TCAs, valproate, verapamil,
Drugs whose blood levels are by
coadministration with carbamazepine include: atypical antipsychotics, benzodiazepines,
doxycycline, ethosuximide, fentanyl, glucocorticoids, haloperidol,
methadone, oral contraceptives, phenothiazines, phenytoin, sertraline, TCAs,