Medicines

Carbamazepine (oral) for preventing seizures

This leaflet is for parents and carers about how to use this medicine in children. Our information may differ from that provided by the manufacturers, because their information usually relates to adults. Read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Do not stop giving Carbamazepine suddenly, as your child may have more seizures.

Name of medicine

Carbamazepine

Brand names: Tegretol; Modified Release: Carbagen SR, Tegretol Prolonged Release

Carbamazepine is also available as suppositories – these are described in a separate leaflet.

Why is it important for my child to take Carbamazepine?

It is important that your child takes carbamazepine regularly so that they have fewer seizures (seizures may also be called convulsions or fits.)

What is Carbamazepine available as?

  • Tablets: 100 mg, 200 mg, 400 mg
  • Modified-release tablets (Carbagen SR, Tegretol Prolonged Release): 200 mg, 400 mg
  • Liquid medicine: 100 mg in 5 mL

When should I give Carbamazepine

  • Standard tablets and liquid medicine are usually given twice a day. Give one dose in the morning and one in the evening. Ideally, these times are 10–12 hours apart, for example between 7 and 8 am, and between 7 and 8 pm.
  • Modified-release tablets (Carbagen SR, Tegretol Prolonged Release) are usually given once each day, usually in the evening.

Give the medicine at about the same time(s) each day so that this becomes part of your child’s daily routine, which will help you to remember.

How much should I give?

Your doctor may suggest that your child starts with a low dose. They may then increase the dose as your child gets used to the medicine and depending on how they respond to it. Your doctor will explain what to do. If you are not sure how much to give, check with your doctor, nurse or pharmacist.

It is important that you follow your doctor’s instructions about how much to give.

How should I give Carbamazepine?

Tablets

  • Tablets should be swallowed whole with a glass of water, milk or juice. You should not crush the tablet. Your child should not chew the tablet.

Liquid medicine

  • Shake the medicine well. Measure out the right amount using an oral syringe or a medicine spoon. You can get these from your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount.

When should the medicine start working?

It may take a few weeks for Carbamazepine to work properly, so your child may still have seizures during this time. This is because the amount of medicine has to be increased slowly. Continue to give the medicine in the way that you have been told to by your doctor or epilepsy nurse. Carbamazepine may not stop your child’s seizures completely. If you are worried about whether it is helping, contact your doctor but continue to give the medicine.

What if my child is sick (vomits)?

  • If your child is sick less than 30 minutes after having a dose of Carbamazepine, give them the same dose again.
  • If your child is sick more than 30 minutes after having a dose of Carbamazepine, do not give them another dose. Wait until the next normal dose.

If your child is sick again, seek advice from your family doctor, nurse, pharmacist, or hospital. They will decide what to do based on your child’s condition and the specific medicine involved.

What if I forget to give it?

If you usually give it twice a day: If you remember up to 4 hours after you should have given a dose, give your child the missed dose. For example, if you usually give a dose at about 7am, you can give the missed dose at any time up to 11am. If you remember after that time, do not give the missed dose. Give the next dose as usual.

If you usually give it once a day in the evening: If you remember before bedtime, give the missed dose. You do not need to wake a sleeping child to give a missed dose. You can give the missed dose in the morning, as long as this is at least 12 hours before the evening dose is due.

Never give a double dose of Carbamazepine.

What if I give too much?

You are unlikely to cause harm if you give an extra dose of Carbamazepine by mistake. If you are concerned that you may have given too much, contact your doctor or local NHS services (details at end of leaflet). Have the medicine or packaging with you if you telephone for advice.

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side effects).

Side effects you must do something about

If your child has a rash, is generally unwell and has a fever (temperature above 38°c) or unusual bruises or bleeding, take them to your doctor or hospital straight away, as this may indicate a more serious reaction.

If your child develops a blotchy red skin rash anywhere on their body, or gets blisters in their mouth, seems to get more infections than usual (e.g. bad colds, chest or skin infections, stomach upsets), seems to bruise more easily, or has bleeding that doesn’t stop as quickly as you would expect, contact your doctor straight away, as they may be allergic to Carbamazepine.

Other side-effects you need to know about

  • Your child may be drowsy (sleepy), unsteady, dizzy, have blurred or double vision, or may get a tremor (shakiness) when they first start taking Carbamazepine, or they may feel sick (nausea) or be sick (vomit). If these side effects are still a problem after 2 weeks, contact your doctor but continue to give Carbamazepine.

There may sometimes be other side effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side effects to a UK safety scheme at www.mhra.gov.uk/yellowcard

Can other medicines be given at the same time as Carbamazepine?

  • You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.
  • Carbamazepine should not be taken with some medicines. Tell your doctor or pharmacist about any other medicines your child is taking before giving Carbamazepine.
  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal and complementary medicines.

Epilepsy and Pregnancy

  • Pregnancy presents a risk to both the mother with epilepsy and her unborn baby. If your daughter has sex, it is essential that she uses adequate contraception to prevent pregnancy.
  • If your daughter thinks that she may be pregnant, it is important that she sees her family doctor as early as possible. Your daughter should keep taking her epilepsy medicine until she sees her doctor.

Clonazepam and pregnancy

  • Carbamazepine may harm an unborn baby.
  • The oral contraceptive pill may not work properly in women or girls who are taking carbamazepine.

Is there anything else I need to know about this medicine?

  • Carbamazepine may make some types of epilepsy worse (absence seizures, myoclonic seizures). If you think your child’s seizures are getting worse, contact your doctor or epilepsy nurse.

General advice about medicines

Advice about medicines for seizures

  • If your doctor decides to stop a particular medicine, they will discuss this with you. They will usually reduce the dose bit by bit.
  • It is best that your child always has the same brand of each medicine, as there may be differences between brands. Keep a record of which medicines your child has.
  • Try to give medicines at about the same times each day, to help you remember.
  • Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
  • Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
  • Make sure that the medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Do not suddenly stop giving any medicines for seizures to your child. If you are worried, contact your doctor but carry on giving the medicine to your child as usual.

If your child seems to have more seizures than usual, contact your doctor or epilepsy nurse.

Do not change the dose of any medicine without talking to your doctor first.

If you think someone else may have taken the medicine by accident, contact your doctor straight away.

Where should I keep this medicine?

  • Keep the medicine in a cupboard, away from heat and direct sunlight.
  • Make sure that children cannot see or reach the medicine.
  • Keep the medicine in the container it came in.

Who to contact for more information?

Your child’s doctor, pharmacist or nurse will be able to give you more information about Carbamazepine and about other medicines used to treat epilepsy.

England: NHS 111

Tel 111

www.nhs.uk

Scotland: NHS 24

Northern Ireland: NI Direct

Wales: NHS Direct

Tel 111 (free) or 0845 46 47 (2p per minute)

111.wales.nhs.uk/

Epilepsy Action

0808 800 5050

www.epilepsy.org.uk

Epilepsy Society

Young Epilepsy

Copyright disclaimer

Version [2]. © NPPG, RCPCH and WellChild, all rights reserved. Review by December 2016.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.