A spectrum of hematologic effects has been reported with use (e.g. agranulocytosis, aplastic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia, and anemias: higher risk if previous history of adverse hematologic reaction to any drug). May cause CNS depression (potential additive effects with alcohol). May exacerbate certain seizure types in children with mixed seizure disorders. Not effective in absence, myoclonic, or akinetic seizures (carbamazepine may increase the frequency of these seizures). The smallest effective dose is suggested for use in bipolar disorder to reduce the risk of overdose/suicide. Because of the relationship of carbamazepine to other tricyclic compounds, the possibility of activation of a latent psychosis or, in geriatric patients, confusion or agitation should be kept in mind. Severe reactions, including toxic epidermal necrolysis and Stevens-Johnson syndromes, may result in fatalities (Asian descents should be screened for the variant HLA-B*1502 allele prior to initiating therapy). Potentially serious, fatal multiorgan hypersensitivity reactions reported (associated with lymphatic, hepatic, renal, and/or hematologic organ systems). Has mild anticholinergic activity (caution in sensitivity to anticholinergic effects, such as urinary retention, increased intraocular pressure, constipation). May cause conduction abnormalities (caution if underlying ECG abnormalities, pre-existing cardiac damage, or risk for conduction abnormalities). Use with caution in hepatic impairment or history of hepatic porphyria (risk of hepatic failure). Use with caution in renal impairment. Anticonvulsants should not be discontinued abruptly because of the possibility of increasing seizure frequency. May interact with some pregnancy tests. May produce increased BUN, AST, ALT, ammonia, bilirubin, alkaline phosphatase. May produce decreased calcium, T~3~, T~4~, sodium. May cause false-positive urine immunoassay for tricyclic antidepressants. Bacterial and mammalian mutagenicity studies using carbamazepine have shown no evidence of mutagenicity. Carbamazepine has produced dose-related increases in the incidence of hepatocellular tumors in female rats and benign interstitial cell adenomas in male rats.