We investigated the effect of long-term exposure to carbamazepine (CBZ) on the enzymatic alterations and RNA/DNA ratio in intestine tissue of rainbow trout. Fish were exposed to sublethal concentrations of CBZ (1.0 microg/l, 0.2 or 2.0 mg/l) for 42 days. Digestive enzymes (proteolytic enzymes and amylase) and energy metabolic enzyme (Na(+)-K(+)-ATPase) and antioxidant enzymes (superoxide dismutase [SOD], catalase [CAT], glutathione peroxidase [GPx], and glutathione reductase [GR]) in fish intestine were measured. In addition, intestinal RNA/DNA ratio was determined after 42 days exposure. Carbamazepine exposure at 2.0 mg/l led to significantly inhibited (P < 0.05) activity of Na(+)-K(+)-ATPase. Activities of the antioxidant enzymes SOD, CAT, and GPx in CBZ-treated groups gradually increased at lower concentration of CBZ (1.0 microg/l and 0.2 mg/l), then significantly inhibited (P < 0.05) at 2.0 mg/l. After 42 days, the RNA/DNA ratio in fish intestine was significantly lower (P < 0.05) in groups exposed to CBZ at 2.0 mg/l than in other groups. However, there was no statistical significance (P > 0.05) in the activities of digestive enzymes (proteolytic enzyme and amylase) and GR in all groups. In short, prolonged exposure to CBZ resulted in different responses of various enzymes and significantly lower RNA/DNA ratio in fish intestine. Furthermore, molecular and genetic mechanisms of these physiological responses in fish are not clear, which need to be further studied.