Carbamazepine is a commonly used psychiatric medication that treats a variety of conditions such as epilepsy and trigeminal neuralgia. Dentists should be aware of its potential implications for dental treatment and prescribing:
Generic Name: Carbamazepine
Brand Name(s): Carbatrol, Epitol, Equetro, Tegretol, Tegretol XR, Teril
Pronunciation: kar ba MAZ e peen
About this drug:
Carbamazepine is an anticonvulsant used to treat seizures, bipolar disorder, and nerve-related pain such as trigeminal neuralgia and diabetic neuropathy.
It is not for common aches and pains.
Dentistry-related tidbits:
Carbamazepine’s oral manifestations include glossitis, stomatitis, and thrombocytopenia.
Carbamazepine may also cause xerostomia. Dental providers can consider prescribing a fluoride supplement if the patient has a high rate of caries and increasing the frequency of dental exams.
Monitor heart rate when administering local anesthetics (e.g. Articaine, Lidocaine) to a patient taking Carbamazepine, as the combination may increase the risk of bradycardia.
Do not prescribe narcotics, benzodiazepines, muscle relaxants, or any other sedating medication, including over-the-counter, to avoid the risk of respiratory and severe CNS depression and impaired psychomotor function.
Carbamazepine may decrease steroid levels.
Combining Carbamazepine with quinolone antibiotics (e.g. Levofloxacin, Ofloxacin), penicillin antibiotics (e.g. Amoxicillin, Ampicillin), antivirals (e.g. Acyclovir, Valacyclovir), or the NSAID Ketorolac may decrease the seizure threshold.
The oxazolidinone antibiotic Linezolid in combination with Carbamazepine may also increase the risk of serotonin syndrome and hyponatremia, and decrease Linezolid levels and efficacy. Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.
Fun facts:
Carbamazepine decreases seizures by blocking sodium channels, thereby decreasing the overacting signals in the brain.
This anticonvulsant has two FDA Black Box Warnings:
It may increase the risk of a severe life-threatening skin reaction in patients with the HLA-B*1502 allele. Any rash should be reported to the physician.
Carbamazepine may decrease the number of blood cells produced by the body. In rare cases, the number of blood cells may decrease enough to cause serious or life-threatening health problems.
Aplastic anemia and agranulocytosis risk is higher than the general population. Regular blood work should be done while patients are on this medication.
Carbamazepine may cause the skin to burn more easily in the sunlight. Remind patients to apply sunscreen SPF 30 or higher when outdoors.
The use of marijuana and alcohol with Carbamazepine should be avoided as it increases the risk of CNS depression and diminished psychomotor function
Carbamazepine is a potent inducer that may decrease the effectiveness of birth control pills. It is recommended to use backup non-hormonal medication such as condoms or diaphragm with spermicide.
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