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Patients should be made aware of the early toxic signs and symptoms of a potential hematologic problemas well as dermatologichypersensitivity or hepatic reactionsThese symptoms may includebut are not limited tofeversore throatrashulcers in the moutheasy bruisinglymphadenopathy and petechial or purpuric hemorrhageand in the case of liver reactionsanorexianausea/vomitingor jaundiceThe patient should be advised thatbecause these signs and symptoms may signal a serious reactionthat they must report any occurrence immediately to a physicianIn additionthe patient should be advised that these signs and symptoms should be reported even if mild or when occurring after extended use.

Treatment of Blood Count AbnormalitiesIf evidence of significant bone marrow depression developsthe following recommendations are suggested1stop the drug2perform daily CBCplateletand reticulocyte counts3do a bone marrow aspiration and trephine biopsy immediately and repeat with sufficient frequency to monitor recovery.

Coadministration of carbamazepine and nefazodone may result in insufficient plasma concentrations of nefazodone and its active metabolite to achieve a therapeutic effectCoadministration of carbamazepine with nefazodone is contraindicated.

Anyone considering prescribing Tegretol or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illnessEpilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behaviorShould suicidal thoughts and behavior emerge during treatmentthe prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated.

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