Editing Carbamazepine (section)

== Adverse effects ==
In the US, the label for carbamazepine contains warnings concerning:<ref name="Tegretol FDA label" />
* effects on the [[Hematology|body's production of red blood cells, white blood cells, and platelets]]:  rarely, there are major effects of [[aplastic anemia]] and [[agranulocytosis]] reported and more commonly, there are minor changes such as decreased [[Leukocyte|white blood cell]] or [[platelet]] counts, but these do not progress to more serious problems.<ref name="carbamazepinelabel">{{cite web|title=Carbamazepine Drug Label|url=http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7a1e523a-b377-43dc-b231-7591c4c888ea|url-status=live|archive-url=https://web.archive.org/web/20141208063739/http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7a1e523a-b377-43dc-b231-7591c4c888ea|archive-date=8 December 2014}}</ref>
* increased risks of suicide<ref name=stats>{{cite journal | vauthors = Vukovic Cvetkovic V, Jensen RH | title = Neurostimulation for the treatment of chronic migraine and cluster headache | journal = Acta Neurologica Scandinavica | volume = 139 | issue = 1 | pages = 4–17 | date = January 2019 | pmid = 30291633 | doi = 10.1111/ane.13034 | s2cid = 52923061 | doi-access = free }}</ref>
* increased risks of [[hyponatremia]] and [[SIADH]]<ref name="carbamazepinelabel"/><ref>{{cite journal | vauthors = Gandelman MS | s2cid = 36758508 | title = Review of carbamazepine-induced hyponatremia | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 18 | issue = 2 | pages = 211–33 | date = March 1994 | pmid = 8208974 | doi = 10.1016/0278-5846(94)90055-8 }}</ref>
* risk of seizures, if the person stops taking the drug abruptly<ref name="carbamazepinelabel"/>
* risks to the fetus in women who are pregnant, specifically congenital malformations like [[spina bifida]], and developmental disorders.<ref name="carbamazepinelabel"/><ref>{{cite journal | vauthors = Jentink J, Dolk H, Loane MA, Morris JK, Wellesley D, Garne E, de Jong-van den Berg L | title = Intrauterine exposure to carbamazepine and specific congenital malformations: systematic review and case-control study | journal = BMJ | volume = 341 | pages = c6581 | date = December 2010 | pmid = 21127116 | pmc = 2996546 | doi = 10.1136/bmj.c6581 }}</ref>
* [[Pancreatitis]]
* [[Hepatitis]]
* [[Dizziness]]
* Bone marrow suppression
* [[Stevens–Johnson syndrome]]

Common [[adverse drug reaction|adverse effects]] may include drowsiness, dizziness, headaches and migraines, [[ataxia]], nausea, vomiting, and/or constipation. [[alcohol (drug)|Alcohol]] use while taking carbamazepine may lead to enhanced depression of the [[central nervous system]].<ref name="carbamazepinelabel"/>  Less common side effects may include increased risk of seizures in people with [[Causes of seizures#Diseases|mixed seizure disorders]],<ref>{{cite journal | vauthors = Liu L, Zheng T, Morris MJ, Wallengren C, Clarke AL, Reid CA, Petrou S, O'Brien TJ | s2cid = 7693614 | title = The mechanism of carbamazepine aggravation of absence seizures | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 319 | issue = 2 | pages = 790–8 | date = November 2006 | pmid = 16895979 | doi = 10.1124/jpet.106.104968 }}</ref> [[Heart arrhythmia|abnormal heart rhythms]], blurry or [[Diplopia|double vision]].<ref name="carbamazepinelabel"/>  Also, rare case reports of an auditory side effect have been made, whereby patients perceive sounds about a [[semitone]] lower than previously; this unusual side effect is usually not noticed by most people, and disappears after the person stops taking carbamazepine.<ref>{{cite journal | vauthors = Tateno A, Sawada K, Takahashi I, Hujiwara Y | title = Carbamazepine-induced transient auditory pitch-perception deficit | journal = Pediatric Neurology | volume = 35 | issue = 2 | pages = 131–4 | date = August 2006 | pmid = 16876011 | doi = 10.1016/j.pediatrneurol.2006.01.011 }}</ref>

=== Pharmacogenetics ===
Serious skin reactions such as [[Stevens–Johnson syndrome]] (SJS) or [[toxic epidermal necrolysis]] (TEN) due to carbamazepine therapy are more common in people with a particular [[human leukocyte antigen]] gene-variant ([[allele]]), [[HLA-B75|HLA-B*1502]].<ref name="carbamazepinelabel"/> [[Odds ratio]]s for the development of SJS or TEN in people who carry the allele can be in the double, triple or even quadruple digits, depending on the population studied.<ref>{{cite journal | vauthors = Kaniwa N, Saito Y | title = Pharmacogenomics of severe cutaneous adverse reactions and drug-induced liver injury | journal = Journal of Human Genetics | volume = 58 | issue = 6 | pages = 317–26 | date = June 2013 | pmid = 23635947 | doi = 10.1038/jhg.2013.37 | doi-access = free }}</ref><ref name="pmid24597466">{{cite journal | vauthors = Amstutz U, Shear NH, Rieder MJ, Hwang S, Fung V, Nakamura H, Connolly MB, Ito S, Carleton BC | title = Recommendations for HLA-B*15:02 and HLA-A*31:01 genetic testing to reduce the risk of carbamazepine-induced hypersensitivity reactions | journal = Epilepsia | volume = 55 | issue = 4 | pages = 496–506 | date = April 2014 | pmid = 24597466 | doi = 10.1111/epi.12564 | hdl = 2429/63109 | s2cid = 41565230 | hdl-access = free }}</ref> [[HLA-B75|HLA-B*1502]] occurs almost exclusively in people with ancestry across broad areas of Asia, but has a very low or absent frequency in European, Japanese, Korean and African populations.<ref name="carbamazepinelabel"/><ref>{{cite journal | vauthors = Leckband SG, Kelsoe JR, Dunnenberger HM, George AL, Tran E, Berger R, Müller DJ, Whirl-Carrillo M, Caudle KE, Pirmohamed M | title = Clinical Pharmacogenetics Implementation Consortium guidelines for HLA-B genotype and carbamazepine dosing | journal = Clinical Pharmacology and Therapeutics | volume = 94 | issue = 3 | pages = 324–8 | date = September 2013 | pmid = 23695185 | pmc = 3748365 | doi = 10.1038/clpt.2013.103 }}</ref> However, the HLA-A*31:01 allele has been shown to be a strong predictor of both mild and severe adverse reactions, such as the [[Drug reaction with eosinophilia and systemic symptoms|DRESS]] form of severe cutaneous reactions, to carbamazepine among Japanese, Chinese, Korean, and Europeans.<ref name="pmid24597466"/><ref name="pmid28345177">{{cite journal | vauthors = Garon SL, Pavlos RK, White KD, Brown NJ, Stone CA, Phillips EJ | title = Pharmacogenomics of off-target adverse drug reactions | journal = British Journal of Clinical Pharmacology | volume = 83 | issue = 9 | pages = 1896–1911 | date = September 2017 | pmid = 28345177 | pmc = 5555876 | doi = 10.1111/bcp.13294 }}</ref> It is suggested that carbamazepine acts as a potent antigen that binds to the antigen-presenting area of HLA-B*1502 alike, triggering an everlasting activation signal on immature CD8-T cells, thus resulting in widespread cytotoxic reactions like SJS/TEN.<ref>{{cite journal | vauthors = Jaruthamsophon K, Tipmanee V, Sangiemchoey A, Sukasem C, Limprasert P | title = HLA-B*15:21 and carbamazepine-induced Stevens-Johnson syndrome: pooled-data and in silico analysis | journal = Scientific Reports | volume = 7 | issue = 1 | pages = 45553 | date = March 2017 | pmid = 28358139 | pmc = 5372085 | doi = 10.1038/srep45553 | bibcode = 2017NatSR...745553J }}</ref>