Certain types of unwanted reactions, for example, from the central nervous system (dizziness, headache, ataxia, drowsiness, fatigue, diplopia), from the digestive system (nausea, vomiting), as well as allergic skin reactions, occur very often or often, especially at the beginning of treatment with the drug, or with an excessively high initial dose of the drug or in the treatment of elderly patients.
Dose-dependent adverse reactions usually occur within a few days, both spontaneously and after a temporary dose reduction. The development of adverse reactions from the central nervous system may be due to a relative overdose of the drug or significant fluctuations in the concentration of the active substance in the blood plasma.In such cases it is recommended to monitor the concentration of active substance in the blood plasma.
When assessing the incidence of various adverse reactions, the following grades were used: very often 10% or more, often 1-10%, sometimes 0.1-1%, rarely 0.01-1.1%, very rarely less 0.01%.
The development of adverse reactions from the central nervous system may be due to a relative overdose of the drug or significant fluctuations in the concentration of carbamazepine in the blood plasma.
From the central nervous system: often - dizziness, ataxia, drowsiness, general weakness, headache, paresis of accommodation; sometimes - abnormal involuntary movements (eg, tremor, "fluttering" tremor - asterixis, dystonia, tics); nystagmus; rarely hallucinations (visual or auditory), depression, loss of appetite, anxiety, aggressive behavior, psychomotor agitation, disorientation, psychosis activation, orofacial dyskinesia, oculomotor disorders, speech disorders (eg, dysarthria or slurred speech), choreoathetoid disorders, peripheral neuritis, paresthesia, muscle weakness and symptoms of paresis; very rarely - taste disorders, malignant neuroleptic syndrome, dysgeusia.
Allergic reactions: very often - allergic dermatitis; often - hives; sometimes exfoliative dermatitis, erythroderma, multiorgan hypersensitivity reactions of delayed type with fever, skin rashes, vasculitis (including erythema nodosum, manifestation of cutaneous vasculitis), lymphadenopathy, signs resembling lymphoma, arthralgia, leukopenia, eosinophilia, hepatosplenomegaly and altered indicators of liver function (these manifestations occur in various combinations). Other organs (for example, lungs, kidneys, pancreas, myocardium, large intestine), aseptic meningitis with myoclonus and peripheral eosinophilia, anaphylactoid reaction, angioedema, allergic pneumonitis, or eosinophilic pneumonia may also be involved. If the above-mentioned allergic reactions occur, the drug should be discontinued, rarely - lupus-like syndrome, skin itching, exudative erythema multiforme (including Stevens-Johnson syndrome), erythema nodosum, toxic epidermal necrolysis (Lyell's syndrome), photosensitivity.
On the part of the organs of hematopoiesis: often - leukopenia, thrombocytopenia, eosinophilia; rarely - leukocytosis, lymphadenopathy, folic acid deficiency, agranulocytosis, aplastic anemia, true erythrocyte aplasia, megaloblastic anemia, acute "intermittent" porphyria, reticulocytosis, hemolytic anemia, splenomegaly; very rarely - pancytopenia, late cutaneous porphyria, variegate porphyria.
From the digestive system: often - nausea, vomiting, dry mouth, increased activity of gamma-glutamyltransferase (due to the induction of this enzyme in the liver), which usually has no clinical significance, increased activity of alkaline phosphatase; sometimes - higherwactivity of "hepatic" transaminases, diarrhea or constipation, abdominal pain; rarely glossitis, gingivitis, stomatitis, pancreatitis, hepatitis of cholestatic, parenchymal (hepatocellular) or mixed type, jaundice, granulomatous hepatitis, hepatic insufficiency, destruction of intrahepatic bile ducts with a decrease in their number.
From the side of the cardiovascular system: rarely - violations of intracardiac conduction, a decrease or increase in blood pressure, bradycardia, arrhythmias,atrioventricular blockade with syncope, collapse, aggravation or development of chronic heart failure, exacerbation of coronary heart disease (including the appearance or increasing episodes of angina pectoris), thrombophlebitis, thromboembolic syndrome.
From the endocrine system and metabolism: often - swelling, fluid retention, weight gain, hyponatremia (decreased plasma osmolarity due to an effect similar to that of an antidiuretic hormone, which in rare cases leads to hyponatremia of the dilution, accompanied by lethargy, vomiting, headache, disorientation and neurologic disorders); rarely - an increase in the concentration of prolactin (may be accompanied by galactorrhea and gynecomastia); decrease in concentration L-tiroxine and increasing the concentration of thyroid-stimulating hormone (usually not accompanied by clinical manifestations); disturbance of calcium-phosphorus metabolism in bone tissue (decrease in calcium concentration and 25-OH-cholecalciferol in blood plasma): osteomalacia, osteoporosis, hypercholesterolemia (including high-density lipoprotein cholesterol), hypertriglyceridemia and enlarged lymph nodes, hirsutism.
From the genitourinary system: rarely interstitial nephritis, renal insufficiency, renal dysfunction (eg, albuminuria, hematuria, oliguria, urea / azotemia increase), frequent urination, urinary retention, decreased potency, impaired spermatogenesis (decreased sperm count and motility).
From the side of the musculoskeletal system: very often - fatigue, rarely - muscle weakness, arthralgia, myalgia or convulsions.
From the sense organs: often - disruption of accommodation (including blurred vision), rarely - a violation of taste, increased intraocular pressure, clouding of the lens, conjunctivitis; hearing impairment, and so on. noise in the ears, hyperacusia, hypoacusia, changes in perception of the height of sound.
Disturbances from the respiratory system, chest and mediastinal organs: very rarely - hypersensitivity reactions characterized by fever, dyspnea, pneumonitis, or pneumonia.
Laboratory and instrumental data: very rarely - hypogammaglobulinemia.
Other: disorders of skin pigmentation, purpura, acne, sweating, alopecia.
Undesirable phenomena according to postmarketing observations (frequency unknown)
Immune system disorders: drug rash with eosinophilia and systemic manifestations.
Disturbances from the skin and subcutaneous tissues: acute generalized eczematous pustulosis, lichenoid keratosis, onychomadesis.
Infectious and parasitic diseases: reactivation of the herpes simplex virus type 6. Violations of the blood and lymphatic system: bone marrow failure.
Disturbances from the nervous system: memory impairment.
Disorders from the gastrointestinal tract: colitis.
Disturbances from musculoskeletal and connective tissue: fractures.