1. About carbimazole
Carbimazole is a medicine used to treat an overactive thyroid (hyperthyroidism). This is when your thyroid gland makes too many thyroid hormones.
Your thyroid controls things like your heart rate and body temperature. When it makes too many hormones, you can have symptoms such as weight loss, mood swings and feeling irritable.
Carbimazole helps to ease these symptoms by reducing the amount of hormones your thyroid produces.
This medicine is only available on prescription.
It usually comes as tablets. If you are unable to swallow tablets, your doctor may be able to prescribe carbimazole as a liquid.
Sometimes your doctor will prescribe carbimazole together with a beta blocker. This can help with your symptoms if you have a fast heartbeat, or feel jittery or anxious.
2. Key facts
- You’ll have blood tests before and during treatment with carbimazole.
- When you first start taking this medicine, it can take up to 3 weeks to see an improvement in your symptoms.
- Side effects usually only happen in the first 8 weeks and tend not to last long.
- One rare side effect can be a sudden drop in your white blood cell count. This makes it harder to fight infections.
- If you are pregnant, your dose of carbimazole needs to be monitored carefully.
3. Who can and cannot take carbimazole
Most adults, children and babies can take carbimazole.
However, carbimazole is not suitable for everyone. To make sure it's safe for you, tell your doctor if you:
- have ever had an allergic reaction to carbimazole or any other medicines
- have had severe pancreas problems (acute pancreatitis) after taking carbimazole
- are due to have radioactive iodine treatment for your overactive thyroid
- have liver problems or a problem with your blood
- have a swollen thyroid (goitre)
- cannot have regular blood tests
- are pregnant or trying for a baby, or there's a chance you could get pregnant
4. How and when to take carbimazole
Always follow the advice of a doctor, and the instructions that come with your medicine.
Swallow the tablets whole, with a drink of water. You can take carbimazole with or without food.
When you first start taking carbimazole, you will take it 2 or 3 times a day. Try to space the doses evenly throughout the day. If you take it 3 times a day, you could take it first thing in the morning, in the middle of the afternoon and at bedtime.
Dosage and strength
Carbimazole comes as 5mg, 10mg, 15mg and 20mg tablets. You may need to take more than 1 tablet to make up your dose.
Doses vary depending on your symptoms, your thyroid hormone levels and whether you have any other health conditions. Your doctor will tell you how many tablets to take.
The usual starting dose for adults is between 20mg and 60mg a day, split into 2 or 3 smaller doses.
Children usually start on 15mg a day, taken once a day, or split into 2 or 3 smaller doses.
Having blood tests during treatment
You need to have blood tests before you start taking carbimazole and during treatment. These tests are important to check the levels of thyroid hormones in your body.
Depending on the results, your doctor may need to increase or reduce your dose to get these hormones to the right levels. When your levels are stable, you can usually go onto a lower dose, taken once a day.
When you first start treatment, you'll have blood tests every 6 weeks or so. Once your hormone levels are stable, you'll have a blood test every 3 months, for as long as you continue to take carbimazole.
However, you may need blood tests more often if you:
- are pregnant
- have symptoms or side effects that could mean your dose is not quite right
What if I forget to take it?
If you forget to take a dose, take it as soon as you remember. If it is time for your next dose, take both doses together.
If you forget doses often, it may help to set an alarm to remind you. You can also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
5. Side effects of carbimazole
Like all medicines, carbimazole can cause side effects, although not everyone gets them. If you do have side effects, these usually happen in the first 8 weeks of taking carbimazole.
Common side effects
Common side effects usually improve as your body gets used to carbimazole.
Talk to a doctor or pharmacist if these side effects bother you or do not go away:
- feeling sick (nausea)
- being sick (vomiting) or diarrhoea
- feeling dizzy
- painful joints
- itchy skin or rash
- thinning hair
Serious side effects
Serious side effects are uncommon.
Stop taking carbimazole and tell a doctor straight away if:
- you have a high temperature, sore throat, mouth sores, toothache or flu-like symptoms – these can be signs of a low white blood cell count
- you have sudden severe stomach (abdominal) pain – this can be a sign of an inflamed pancreas (acute pancreatitis)
- the whites of your eyes or your skin turns yellow (this may be less obvious on brown or black skin), dark pee – this can be a sign of liver problems
- you have swollen glands – this can be a sign of infection
- you feel faint, tired and sweaty – these can be signs of low blood sugar
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction to carbimazole (anaphylaxis).
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of carbimazole. For a full list, see the leaflet inside your medicine packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects of carbimazole
What to do about:
- feeling sick – stick to simple meals and try not eat rich or spicy food. It may help to take your carbimazole with food or just after eating.
- being sick (vomiting) or diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Take small, frequent sips if you are being sick. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Contact a doctor if this lasts for more than a few days. Tell your doctor if you get severe diarrhoea or vomiting from a stomach bug or illness that lasts for more than 2 days..
- feeling dizzy – lie down until the dizziness passes, then get up slowly. Move slowly and carefully. Avoid coffee, cigarettes, alcohol and recreational drugs. Do not drive, cycle or operate machinery until you feel ok again. If the dizziness does not get better, or this keeps happening, speak to a doctor.
- headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away. Talk to your doctor if they last longer than a week or are severe.
- painful joints – cooling treatments can help with joint pain. Try putting an ice pack wrapped in a cloth on the joint for about 15 minutes, and repeat several times a day. Avoid keeping the joint still and take gentle exercise to stop it becoming stiff. Ask a pharmacist to recommend a painkiller. Speak to your doctor if the pain is no better after a week.
- itchy skin or rash – use unperfumed moisturizer or skin lotion, wear loose cotton clothing, keep your nails clean, short and smooth, and pat or tap the skin instead of scratching it. Ask your pharmacist to recommend an antihistamine.
- thinning hair – no one knows if taking carbimazole causes this or if it's the changes in your thyroid hormone levels. Hair usually grows back but this may take a little while because the natural cycle of hair growth takes several months.
7. Pregnancy and breastfeeding
Carbimazole and pregnancy
Carbimazole is not usually recommended in pregnancy. You'll usually be prescribed another thyroid medicine called propylthiouracil (PTU). This is because there's a small chance that carbimazole can cause problems for your baby's development in the first few months of pregnancy.
However, it's important to keep treating an overactive thyroid. If your thyroid hormone levels are too high, this can also cause problems for your baby.
If you become pregnant while taking carbimazole, keep taking your medicine and speak to your doctor.
If you have thyroid problems, then you will be asked to go to an antenatal clinic to see a pregnancy specialist (obstetrician) and a hormone specialist (endocrinologist). They can advise you on the best treatment options for you and your baby.
If you are taking carbimazole and thyroxine together (a "block and replace" regime), this will need to be changed, so it's important that you see a specialist early on in your pregnancy.
When taking carbimazole in pregnancy, you'll need regular blood tests to check you’re on the right dose. You may also have extra scans to check the health of your growing baby.
Carbimazole and breastfeeding
It's usually OK to take carbimazole while you are breastfeeding. Carbimazole passes into breast milk but only in small amounts. This is probably too little to affect your baby.
After a while, your doctor may take a blood test for the baby to check the levels of their thyroid hormones.
If you have any concerns about your baby's health, talk to your midwife, health visitor or doctor straight away.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
For more information about how carbimazole can affect you and your baby during pregnancy, read this leaflet on the best use of medicines in pregnancy (BUMPS) website.
8. Cautions with other medicines
Taking carbimazole can affect the way certain medicines work, while some medicines are affected by your thyroid hormone levels. These levels will change as carbimazole starts to work.
For this reason, your doctor will want to review the medicines you take and possibly change the dosage. Tell your doctor before starting treatment with carbimazole if you take:
- digoxin, a heart medicine
- erythromycin, an antibiotic
- theophylline, used to treat breathing problems
- bladder medicines for urinary incontinence and other bladder problems
- blood pressure medicines called beta blockers – these are often prescribed together with carbimazole and your doctor will tell you how much to take
- anticoagulants such as warfarin
- steroids such as prednisolone
Mixing carbimazole with herbal remedies, supplements and other medicines
Some herbal remedies and supplements can affect the way carbimazole works. This includes black cohosh, sometimes taken to help with menopausal symptoms.
However, biotin supplements can affect the accuracy of thyroid function tests. Do not take biotin without talking to your doctor.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about carbimazole
How does carbimazole work?
When you have an overactive thyroid, also known as hyperthyroidism or thyrotoxicosis, your thyroid gland produces too much of the thyroid hormones. When these hormone levels are too high, you can have mood swings and weight loss.
Your thyroid gland uses a chemical called iodine to produce these hormones. Carbimazole blocks the way your body processes iodine and reduces the amount of thyroid hormones produced. This can then help your symptoms.
How long does carbimazole take to work?
Carbimazole starts working straight away, but it can take 1 to 2 months before your symptoms improve and you start to feel better.
How long will I take carbimazole for?
Once your thyroid hormone levels are under control, your dose of carbimazole may be gradually lowered and then stopped. Depending on your condition, you may need to take carbimazole for 12 to 18 months.
Some people need to continue taking the medicine for several years, possibly for the rest of their life.
However, if carbimazole is not working for you, your doctor may suggest alternatives such as radioactive iodine treatment or surgery to remove part or all of your thyroid.
Is carbimazole safe to take for a long time?
Yes, it's safe to take carbimazole for a long time, even many years.
It's important to have regular blood tests during treatment, to make sure your dose is not too high or too low. Your doctor will make sure you are on the lowest dose that works for you.
Your doctor will be able to explain the risks and benefits of taking carbimazole, compared with the risks of not having treatment for your overactive thyroid.
What will happen if I stop taking carbimazole?
Do not stop taking carbimazole without speaking to your doctor first.
If you stop taking your medicine, your thyroid hormone levels will rise and you will start to feel ill again. This may not happen straight away. It takes time for your thyroid hormone levels to become too high and for your symptoms to come back.
Are there other medicines for an overactive thyroid?
The main treatments for an overactive thyroid are:
- medicines such as carbimazole and propylthiouracil
- a combination of medicines such as carbimazole (for overactive thyroid) and levothyroxine (for underactive thyroid) to help find the right hormone balance (block and replace regime)
- radioactive iodine treatment
You will usually be referred to a specialist in hormonal conditions (endocrinologist). They will be able to help you manage your condition and discuss the best treatment option for you.
Can I drink alcohol with it?
Yes, you can drink alcohol while taking carbimazole. Alcohol does not affect how this medicine works.
However, if carbimazole makes you feel dizzy then it's best to avoid alcohol as it can make this side effect worse.
Is there any food or drink I need to avoid?
Carbimazole is not usually affected by what you eat or drink.
However, to keep your thyroid healthy, your doctor may suggest a low iodine diet. This is because the thyroid gland needs iodine to make the thyroid hormones. Eating foods that are high in iodine can make your symptoms worse. Your doctor may recommend avoiding processed foods, cheese, eggs and salt with added iodine (iodised salt).
If carbimazole makes you feel dizzy, it’s best to avoid alcohol, coffee and other drinks containing caffeine as these can also make the dizziness worse.
Do I need to avoid people with viruses while I'm taking it?
Generally, there is no problem with being around other people, including someone with a virus, when taking carbimazole.
However, there’s one uncommon side effect with carbimazole, which may lower the number of white cells in your blood. This can make you more likely to get an infection.
Tell your doctor if you think you are getting a sore throat or if you have a high temperature.
Will it make me lose or put on weight?
One of the symptoms of an overactive thyroid gland is weight loss. Once you start taking carbimazole, you will stop losing weight as your hormone levels stabilise.
Once you are on the right dose of carbimazole, and your thyroid hormone levels have returned to normal, the treatment will no longer affect your weight.
Do I need to stop taking carbimazole before surgery or before tests?
No, carry on taking carbimazole, following the instructions that come with your medicine.
If you need to make any changes, a doctor will talk to you about it before the surgery.
Will it affect my contraception?
It’s important to use reliable contraception whilst taking carbimazole. You can discuss contraception with your doctor, sexual health or family planning clinic.
If you are vomiting or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Look at the leaflet that comes with your contraceptive pills to find out what to do.
Will it affect my fertility?
There's no clear evidence to suggest that taking carbimazole will reduce fertility in either men or women.
However, speak to your doctor if you're trying to get pregnant as it’s important not to get pregnant while you’re taking carbimazole. Use contraception until your medicine has been reviewed.
Can I drive or ride a bike?
For most people, carbimazole does not affect their ability to drive or ride a bike.
However if carbimazole makes you feel dizzy or unable to concentrate, do not drive a car, cycle, use tools or operate machinery until you feel OK again.
What else can I do for an overactive thyroid?
In addition to taking carbimazole, there are some lifestyle changes that can help with your symptoms. These include weight management, exercise and dealing with stress.
Taking carbimazole will stop the weight loss caused by an overactive thyroid. Your doctor may give you a meal plan to help you gain or lose weight while taking this medicine.
They may also recommend a low iodine diet. This is because the thyroid gland needs iodine to make thyroid hormones. Eating foods that are high in iodine can make your symptoms worse. This may mean avoiding processed foods, cheese, eggs and salt with added iodine (iodised salt).