Carbamazepine (Intravenous)

As a treatment for those who experience seizures, Carbamazepine, also known as Carnexiv, can be given directly into the vein.

Overview

Carbamazepine is a prescription-only drug that is used to treat people that suffer from seizures. It is available as a solution that can be administered via the intravenous route on a short-term basis (up to seven days), after which time the patient should be transferred to the oral version of the medication.

Seizures happen when there are changes in the brain's electrical activity. These changes result in uncontrolled movements that can range from mild to severe, and often include violent spasms and shaking, which the person is unable to control. Mild seizures may also be a sign of an underlying medical condition and should be reported to a health care professional immediately. There are various types of seizures that people can suffer from. The first are non-epileptic seizures, which result from injuries such as a trauma to the head. The second group is partial seizures, which happen when a person has the condition epilepsy. Epileptic seizures take place on one side of the brain only, thus impacting that one side of the body.

The third type of seizures are generalized seizures, and these happen on both sides of the body. These are the types of seizures that can be experienced in a mild form, with many having very few physical symptoms. One common symptom of these seizures is when people "zone out"for several seconds at a time.

Carbamazepine is part of a family of drugs called anticonvulsants, and it works by acting on the chemical activity that happens when a person has a seizure. The drug helps to regulate that unusual activity and reduce or stop the seizure. The drug can also be used to treat patients with bipolar disorder.

Carbamazepine is also marketed and sold under the brand name Carnexiv in the United States.

Type of medicine

  • Solution, administered via the intravenous route

Conditions treated

  • Seizures
  • Epilepsy
  • Nerve pain
  • Bipolar disease

Side effects

Side effects are common in those that take any form of prescription medication, and carbamazepine is no exception. Most side effects are normal as the body adapts to having the drug in its system. This drug can cause some severe side effects in a rare minority of patients and, if these side effects are detected, the treatment should be stopped straight away to prevent further health complications. Severe side effects include:

  • Changes in behavior (mood swings, depression) - this is particularly common in children
  • Confusion
  • Agitation
  • Irritability
  • Hostility - particularly common in elderly patients
  • Fear or dread
  • Severe diarrhea
  • Feeling of sadness or emptiness
  • Severe and persistent headache
  • Increased number of seizures
  • Stiffness of the limbs
  • Shakiness or unsteadiness when on your feet
  • Lack of interest or pleasure in things you would usually have enjoyed
  • Trembling of the muscles
  • Lack of balance and coordination
  • Lack of appetite
  • Shuffling walk
  • Jerking of the muscles
  • Hyperactivity followed by extreme exhaustion
  • Unusual drowsiness
  • Uncontrolled movements in parts of the body, particularly in the neck, face and back
  • Difficulty getting to sleep (insomnia)
  • Difficulty maintaining concentration
  • Suicidal thoughts or thoughts of self-harm

Very rare side effects have included the below and could be a sign of a more severe reaction. Contact a doctor immediately if you notice any of the following in yourself or someone else that is taking carbamazepine:

  • Chest pain
  • Joint pain
  • Bone pain
  • Blood in the urine
  • Blood in the feces
  • Darkening of the urine
  • Slurred speech or inability to form coherent sentences
  • Red spots on the skin
  • Lower back pain
  • Stomach cramps
  • Irregular heartbeat
  • Fainting or feeling as if you are going to faint
  • Rapid or sudden weight gain
  • Difficulty urinating
  • Pale stools
  • Ringing or buzzing sound in the ears
  • Tingling sensation or numbness in the hands or feet
  • Strange bluish color in your hands or feet
  • Severely sore throat or fever
  • Tight feeling in the chest
  • Swelling in various areas of the body, including the feet, face, hands, and lower legs
  • Chills throughout the body
  • Difficulty breathing
  • Jaundice (yellow skin or eyes)
  • Trembling

Common side effects that are usually nothing to worry about include:

  • Mild nausea or vomiting
  • Tiredness
  • Changes in sleeping patterns
  • Blurry vision or double vision
  • Eye movements in a back and forth motions
  • Headaches

Dosage

The normal dosage of carbamazepine that is prescribed to adults with seizures is 10mg/mL (200mg/20mL single-dose vial). This is given as an initial dose, and then the patient will usually be switched to the oral form of the drug as a maintenance treatment.

Carbamazepine intravenous is intended as a short-term treatment, or as a temporary administration method. Treatment usually lasts for up to seven days using this administration method, and is only recommended for the following seizure types:

  • Partial seizures
  • Mixed seizure patterns
  • Generalized tonic-clonic seizures

The dosage that is given via injection is usually 70 percent of the total daily PO dose given. The injection is given daily throughout the treatment until an improvement is seen (maximum seven days).

Each dose is divided into four separate infusions, which are given to the patient over 30-minute periods. Each sitting is set six hours apart.

After the IV treatment has finished, the patient should be transferred to oral carbamazepine. There are no studies that have been carried out to find out the impact of treating a patient via the IV route for more than seven days.

Major drug interactions

Although carbamazepine is a widely used treatment for those with seizures, there are also a large number of drugs that interact with it, and therefore these combinations should be avoided at all costs. A drug interaction is when two or more substances cause a reaction when mixed together. This reaction can range from mild to severe. There are 1,129 drugs (including 6,827 generic and brand names) that have a reaction with carbamazepine. Almost 200 (198) of these reactions have been classed as major. If you are taking any drug that has been found to have a major reaction with carbamazepine, you should not take this drug to treat your seizures; another drug will instead be recommended.

The drugs that have a major reaction with this one are:

  • abacavir, dolutegravir, lamivudine
  • abemaciclib
  • abiraterone
  • acetaminophen, caffeine, chlorpheniramine, hydrocodone, phenylephrine
  • acetaminophen, hydrocodone
  • acetaminophen, oxycodone
  • acetaminophen, propoxyphene
  • amoxicillin, clarithromycin, lansoprazole
  • amoxicillin, clarithromycin, omeprazole
  • apixaban
  • apremilast
  • artemether, lumefantrine
  • aspirin, caffeine, propoxyphene
  • aspirin, hydrocodone
  • aspirin, oxycodone
  • atazanavir, cobicistat
  • axitinib
  • bedaquiline
  • benzoic acid, hyoscyamine, methenamine, methylene blue, phenyl salicylate
  • boceprevir
  • bortezomib
  • bosutinib
  • brigatinib
  • brompheniramine, hydrocodone, phenylephrine
  • brompheniramine, hydrocodone, pseudoephedrine
  • bupivacaine, fentanyl
  • buprenorphine
  • buprenorphine, naloxone
  • butorphanol
  • carbinoxamine, hydrocodone, phenylephrine
  • carbinoxamine, hydrocodone, pseudoephedrine
  • caspofungin
  • ceritinib
  • chlorpheniramine, guaifenesin, hydrocodone, pseudoephedrine
  • chlorpheniramine, hydrocodone
  • chlorpheniramine, hydrocodone, phenylephrine
  • chlorpheniramine, hydrocodone, pseudoephedrine
  • clarithromycin
  • clozapine
  • cobicistat
  • cobicistat, darunavir
  • cobimetinib
  • copanlisib
  • crizotinib
  • cyclosporine
  • dabigatran
  • daclatasvir
  • dasabuvir, ombitasvir, paritaprevir, ritonavir
  • deferiprone
  • deflazacort
  • delavirdine
  • desogestrel, ethinyl estradiol
  • dexbrompheniramine, hydrocodone, phenylephrine
  • dexchlorpheniramine, hydrocodone, phenylephrine
  • dienogest, estradiol
  • diltiazem
  • diltiazem, enalapril
  • diphenhydramine, hydrocodone, phenylephrine
  • dolutegravir
  • droperidol, fentanyl
  • drospirenone, estradiol
  • drospirenone, ethinyl estradiol
  • drospirenone, ethinyl estradiol, levomefolate calcium
  • efavirenz, emtricitabine, tenofovir
  • elbasvir, grazoprevir
  • eliglustat
  • elvitegravir
  • emtricitabine, lopinavir, ritonavir, tenofovir
  • emtricitabine, nelfinavir, tenofovir
  • erythromycin
  • erythromycin, sulfisoxazole
  • estradiol, levonorgestrel
  • estradiol, norethindrone
  • estradiol, norgestimate
  • ethinyl estradiol
  • ethinyl estradiol, ethynodiol
  • ethinyl estradiol, etonogestrel
  • ethinyl estradiol, folic acid, levonorgestrel
  • ethinyl estradiol, levonorgestrel
  • ethinyl estradiol, norelgestromin
  • ethinyl estradiol, norethindrone
  • ethinyl estradiol, norgestimate
  • ethinyl estradiol, norgestrel
  • etonogestrel
  • etravirine
  • everolimus
  • fentanyl
  • fentanyl, ropivacaine
  • flibanserin
  • furazolidone
  • glecaprevir, pibrentasvir
  • guaifenesin, hydrocodone
  • guaifenesin, hydrocodone, pheniramine, phenylephrine, phenylpropanolamine
  • guaifenesin, hydrocodone, pheniramine, phenylpropanolamine, pyrilamine
  • guaifenesin, hydrocodone, phenylephrine
  • guaifenesin, hydrocodone, pseudoephedrine
  • guanfacine
  • homatropine, hydrocodone
  • hydrocodone
  • hydrocodone, ibuprofen
  • hydrocodone, pheniramine, phenylephrine, phenylpropanolamine, pyrilamine
  • hydrocodone, phenylephrine
  • hydrocodone, phenylephrine, pyrilamine
  • hydrocodone, phenylpropanolamine
  • hydrocodone, potassium guaiacolsulfonate
  • hydrocodone, potassium guaiacolsulfonate, pseudoephedrine
  • hydrocodone, pseudoephedrine
  • hydrocodone, pseudoephedrine, triprolidine
  • hyoscyamine, methenamine, methylene blue, phenyl salicylate
  • hyoscyamine, methenamine, methylene blue, phenyl salicylate, sodium biphosphate
  • hyoscyamine, methenamine, methylene blue, sodium biphosphate
  • ibrutinib
  • ibuprofen, oxycodone
  • idelalisib
  • irinotecan
  • irinotecan liposomal
  • isavuconazonium
  • isocarboxazid
  • ivabradine
  • ivacaftor
  • ivacaftor, lumacaftor
  • ixazomib
  • ledipasvir, sofosbuvir
  • leflunomide
  • letrozole, ribociclib
  • leuprolide, norethindrone
  • levomethadyl acetate
  • levonorgestrel
  • linezolid
  • lomitapide
  • lopinavir, ritonavir
  • lurasidone
  • macitentan
  • maraviroc
  • mestranol, norethindrone
  • methylene blue
  • midostaurin
  • mipomersen
  • naldemedine
  • naloxegol
  • naloxone, oxycodone
  • naltrexone, oxycodone
  • nefazodone
  • neratinib
  • netupitant, palonosetron
  • nilotinib
  • nimodipine
  • nintedanib
  • norethindrone
  • norgestrel
  • olaparib
  • osimertinib
  • oxycodone
  • palbociclib
  • panobinostat
  • phenelzine
  • procarbazine
  • propoxyphene
  • quetiapine
  • ranolazine
  • rasagiline
  • ribociclib
  • rilpivirine
  • rivaroxaban
  • rolapitant
  • selegiline
  • simeprevir
  • sodium oxybate
  • sofosbuvir
  • sofosbuvir, velpatasvir
  • sofosbuvir, velpatasvir, voxilaprevir
  • sonidegib
  • suvorexant
  • tasimelteon
  • telaprevir
  • telithromycin
  • temsirolimus
  • teriflunomide
  • ticagrelor
  • tofacitinib
  • tolvaptan
  • trabectedin
  • trandolapril, verapamil
  • tranylcypromine
  • troleandomycin
  • valbenazine
  • venetoclax
  • verapamil
  • vorapaxar
  • voriconazole

If you are in doubt about any drug combinations you are taking, you should always ask a trained medical professional for advice - don't wait until your symptoms become too severe.

Warnings

There are various health warnings that come with taking carbamazepine that patients should be aware of. When taking a prescription of carbamazepine, it is your responsibility to ensure it doesn't conflict with any other conditions or lifestyle habits you have.

Other diseases and conditions

Just like there are other drugs that react with this one, there are also diseases and conditions that can cause a reaction with carbamazepine. If you have any other medical conditions, you should mention these in as much detail as possible to your health care provider before your treatment starts. If you have one of the below conditions, it may not be safe for you to take carbamazepine, so you will need to undergo an alternative treatment:

Depression and mood-related disorders

It is important to note that carbamazepine can leave those that suffer from any form of depression vulnerable to their conditions worsening. If you have a history of mood disorders, suicidal thoughts, psychosis or personality disorders, you may be recommended something else. If you are taking carbamazepine and notice any changes in your mood or mental health, you should consult a doctor and stop taking the drug immediately.

Children

For those that are under the age of 12, there is an increased risk of depression and other mood-related disorders. It is important to closely monitor children that are taking this medication for any signs of changes in mental health.

Absence seizures

This medication is not intended for treating absence seizures. Alternative medication must be used.

Pregnancy and breastfeeding

This drug is generally not suitable for those that are pregnant or breastfeeding. Studies on animals have shown there to be a risk of an unborn fetus being harmed during pregnancy when the drug is being taken. The substance can also enter the breast milk, and therefore could be consumed by a nursing baby. The impact on babies is not known, so those that are breastfeeding should proceed only on their doctor's advice. In some cases, the doctor may deem the health benefits of the drug to be greater to the mother than the risk to an unborn or newborn baby.

Allergies

Always tell your doctor if you are allergic to anything. Your doctor will need to know whether you have had any adverse reactions to carbamazepine or any similar medications. You should also mention if you are allergic to any other common irritants, such as pet hair, dust, pollen or preservatives. Any allergies you have may impact the prescription you are given or may alter the dose.

Alcohol and nicotine

You should also refrain from consuming alcohol and smoking while you are on this medication, as either substance can interact and cause unpleasant side effects with carbamazepine. If you drink while you are taking this medication, you may be more vulnerable to the effects of alcohol, such as impaired judgment, headache, nausea or vomiting, depression or hyperactivity. You should also refrain from driving when you are taking the intravenous version of this drug as your judgment could be seriously impacted.

Storage

This medication should be stored in its solution form at room temperature. Once it has been mixed into its injection form, it should be used up within 24 hours. During this time, the solution can be stored at temperatures between 20 and 25 degrees centigrade, for a maximum of four hours. Alternatively, it can be refrigerated at temperatures of between two and eight degrees centigrade for up to 24 hours.

Always keep any medications in the container with which they were supplied. Always make sure the containers are clearly labeled to avoid mix-ups. This medication should always be kept out of the sight and reach of children, and any lockable lids should be kept shut when the drug is not being used.

Disposal

Medical professionals should always correctly dispose of any unused solution by flushing any excess solution away. The drain should then be fully rinsed clean.

The FDA also offers take-back schemes throughout the country, for both individuals and medical organizations. This scheme aims to conveniently collect any medication that is out of date or unwanted, responsibly and safely recycling or disposing of it to prevent it from getting into the wrong hands or causing harm to the environment.

Summary

Carbamazepine is relatively safe to use and is administered by a medical professional that will closely monitor the patient. It has not been found to cause any defects or abnormalities in the body; however, there have been studies that have found there to be a risk of patients developing neural tube defects. If the patient experiences any major signs of this condition developing, it is advised that the medication is stopped immediately.

Carbamazepine is a short-term treatment that is highly successful at controlling bouts of seizures and can be used to drastically improve the quality of life of the patient. Although there is not a cure for seizure conditions such as epilepsy, carbamazepine can be used to help those whose lives are impacted by the condition on a regular basis. Although serious side effects of the drug are rare, there are some health complications that can arise as a result of taking this medication. The drug has also been linked to various mood disorders such as depression; patients that have had a history of depression should generally not be put on carbamazepine, as there is a serious risk of the depression reaching severe forms, and instances of suicidal thoughts are sometimes reported by patients.

There are also many drugs that can interact with carbamazepine, so doctors should be extra careful when administering this drug to find out about the patient's full medical history. Patients can also help to decrease their chances of drug interactions by telling their doctors about anything and everything else they are currently taking.

 

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Last Reviewed:
January 31, 2018
Last Updated:
April 02, 2018