1. The most serious side effects of carbamazepine are agranulocytosis and aplastic anemia, which occur at a frequency of 1 in 20,000.
2. Carbamazepine should be discontinued if the total WBC count drops below 3,000, or if the absolute neutrophil count drops below 1,500, or if the platelet count drops below 100,000.
3. Hepatitis may rarely occur, which may require discontinuation of carbamazepine. Mild elevations in liver function tests are seen in most patients and this does not require discontinuation of the drug.
4. Stevens-Johnson syndrome, a severe dermatologic condition, is a rare side effect of carbamazepine and requires immediate discontinuation of therapy and medical consultation. It begins with widespread purpuric macules leading to epidermal necrosis with erosion of mucus membranes, detachment of the epidermis and severe constitutional symptoms.
5. Carbamazepine may also cause ataxia, confusion, and tremors (usually with high doses or toxicity). If this occurs the carbamazepine dose should be decreased to achieve serum levels of 8-12 • g/mL.
6. Carbamazepine is more benign in overdose than lithium. Carbamazepine produces numerous drug-drug interactions. It decreases serum levels of: acetaminophen, antipsychotics, benzodiazepines, oral contraceptives, corticosteroids, cyclosporine, doxycycline, phenytoin, methadone, theophylline, thyroid supplements, valproate, warfarin, and ethosuximide. Serum levels are decreased by clomipramine and phenytoin.
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