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Specific Carbamazepine Warnings and Precautions

Some warnings and precautions to be aware of prior to taking carbamazepine include:
  • Carbamazepine can cause very serious cases of anemia or other low blood counts, which may put you at risk of bleeding or serious infections. These problems, while very rare, can be fatal. Your healthcare provider should test your blood counts (using a blood test) before you start taking carbamazepine and periodically thereafter.
  • As with all seizure medications, carbamazepine should not be stopped suddenly (see Carbamazepine Withdrawal).
  • Carbamazepine can increase the pressure within the eye, which can be especially dangerous for people with glaucoma.


  • Be sure to tell your healthcare provider if you have acute intermittent porphyria, since carbamazepine can make this condition worse.

  • Sometimes, carbamazepine can make seizures worse in people with absence seizures (petit mal seizures). Due to this problem (and because carbamazepine is not generally effective at treating absence seizures), carbamazepine is usually not recommended for treating people with absence seizures.


  • Seizure medications, including carbamazepine, may increase the risk of suicidal thoughts or behavior. Let your healthcare provider know immediately if you feel depressed or have any suicidal thoughts (see Seizure Medications and Suicide for more information).


  • Tell your healthcare provider if you have heart, liver, or kidney disease, as carbamazepine may not be the best choice for you. Your body may not handle carbamazepine the way it should, or you may be at an increased risk of certain carbamazepine side effects.
  • Rarely, carbamazepine can cause very dangerous skin reactions known as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). These problems start out as skin rashes but can progress to permanent disfigurement or even loss of life. Not every skin rash in people taking carbamazepine will be related to SJS or TEN. However, because of the seriousness of such problems, it is recommended that people stop taking carbamazepine immediately at the first sign of a rash, unless it is very clear that the rash is not related to carbamazepine. In most (but not all) cases, SJS and TEN reactions occur within the first month of starting carbamazepine.
  • Interestingly, SJS and TEN reactions to carbamazepine are much more common in people of Asian descent, who are more likely to have a specific gene (known as HLA-B*1502) that appears to increase the risk of such problems. If you are of Asian descent, your healthcare provider may choose to test for the gene before recommending carbamazepine for you.
  • Carbamazepine can make agitation, confusion, or psychosis worse. Tell your healthcare provider if you experience any unusual behavior or thought changes during treatment with carbamazepine.
  • Make sure to see how carbamazepine affects you before driving or operating any machinery, as carbamazepine can cause drowsiness and dizziness. In general, you should avoid alcohol while taking carbamazepine, due to the risk of increased drowsiness.
  • Carbamazepine can cause low levels of sodium in the blood (hyponatremia), which can be serious. Let your healthcare provider know if you have possible signs of hyponatremia, such as:


    • Nausea
    • A general ill feeling
    • Headaches
    • Lethargy
    • Confusion
    • Decreased consciousness
    • Worsening of seizures. 


  • Your healthcare provider should check your liver and kidney function (using a blood test) before you start taking carbamazepine and periodically thereafter. Your healthcare provider should also check your eyes regularly, as carbamazepine can cause eye problems.
  • Carbamazepine can cause a decrease in thyroid function (hypothyroidism).
  • Carbamazepine has been reported to interfere with some pregnancy tests.
  • Carbamazepine can potentially interact with certain other medications (see Carbamazepine Drug Interactions).
  • Carbamazepine is considered a pregnancy Category D medication. This means that it is probably not safe for many pregnant women. Talk with your healthcare provider about the risks and benefits of taking the drug during pregnancy (see Carbamazepine and Pregnancy).
  • Carbamazepine passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, discuss this with your healthcare provider prior to taking the drug (see Carbamazepine and Breastfeeding).


  • Early evidence suggests that seizure medications, including carbamazepine, may increase the risk of suicidal thoughts or behaviors (see Seizure Medications and Suicide for more information).
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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