Carbamazepine (Tegretol): Uses, Dosage, Side Effects, & More

What Is Carbamazepine (Tegretol)?

Carbamazepine, often sold under the brand name Tegretol, falls within the anticonvulsant drug class. This medication is primarily designed to stabilize electrical activity in the brain, effectively reducing the likelihood of seizures.¹

This medication has been approved by the FDA, meaning that the drug’s effect has been reviewed and determined to provide benefits and meets safety standards for the population it is approved for. Carbamazepine is frequently prescribed to address a range of conditions, including epilepsy, trigeminal neuralgia, and the treatment of acute manic and mixed episodes in bipolar I disorder.

Is Carbamazepine the Same as Xanax?

No, carbamazepine (Tegretol) and Xanax (alprazolam) are not the same. While both are used to treat seizures, carbamazepine is taken daily to prevent seizures, and Xanax is sometimes used to stop seizures in an emergency situation. Carbamazepine has additional FDA-approved uses for nerve pain, bipolar disorder, and different types of seizures. Xanax, on the other hand, is primarily prescribed for panic attacks and anxiety disorders, serving distinct medical purposes.²

Is Carbamazepine the Same as Gabapentin?

Carbamazepine and gabapentin are not the same. While both have been used in the treatment of neuropathic pain, they operate differently and may have different levels of efficacy and safety for specific conditions. Recent evidence suggests that gabapentin might be more effective and safer than carbamazepine for certain neuropathic pain conditions like PTN (postherpetic neuralgia), but further research through randomized controlled trials is needed to confirm this conclusion and provide evidence-based guidance for medical practice.³

How Does Carbamazepine Work?

Carbamazepine works by calming down the electrical activity in the brain. This helps reduce the excessive signals that can trigger seizures or certain types of nerve pain. Stabilizing these electrical impulses can alleviate the symptoms associated with conditions like epilepsy and neuropathic pain, making them more manageable for patients.

How Does Carbamazepine Make You Feel?

Carbamazepine can make some people feel drowsy and dizzy, which may affect their balance and coordination. Additionally, nausea and vomiting are potential side effects. It’s important to note that not everyone will experience these effects, and individual responses may vary.¹

If you’re prescribed carbamazepine and are concerned about how it makes you feel, it’s crucial to discuss any side effects with your healthcare provider for proper guidance.

What Is Carbamazepine Used to Treat?

Carbamazepine is a medication approved by the FDA to treat specific conditions. It’s mainly used for epilepsy to prevent seizures, for trigeminal neuralgia to ease severe facial pain, and for managing manic and mixed episodes in bipolar I disorder.

Sometimes, doctors may also use carbamazepine for things it wasn’t officially approved for. This is called “off-label” use. For example, it might be used to help with some symptoms of schizophrenia, restless leg syndrome, or to calm down patients with dementia.⁴

Common Side Effects of Carbamazepine

Common side effects of carbamazepine may include dizziness, drowsiness, unsteadiness, nausea, and vomiting. While not everyone experiences these side effects, they can sometimes affect one’s daily activities. It’s important to consult a healthcare provider if these side effects become severe or bothersome, as they can provide guidance on managing them or adjusting the medication if necessary.

Common side effects of carbamazepine include:¹

• Dizziness
• Drowsiness
• Uncoordination
• Nausea
• Vomiting
• Headache
• Blurred vision

*All medications, including carbamazepine, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Carbamazepine

Carbamazepine tablets can have severe side effects that necessitate immediate medical attention. These may include rare but serious skin rashes, unusual blood problems, and allergic reactions. If you experience any of these, contact your healthcare provider without delay.

Serious side effects of carbamazepine include:¹

• Severe skin rashes
• Blood problems
• Allergic reactions affecting organs
• Suicidal thoughts or actions
• Liver issues
• Yellowing of the skin or eyes (jaundice)
• Muscle pain
• Swelling of the face, lips, or tongue
• Difficulty swallowing or breathing
• Unusual bruising or bleeding

*All medications, including carbamazepine, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Carbamazepine Warnings & Precautions

Carbamazepine comes with important warnings and precautions that may require immediate medical attention. Rare cases of anaphylaxis and angioedema have been reported, which can be life-threatening. It’s crucial to discuss these concerns with your healthcare provider before using this medication.

Avoid taking carbamazepine if you:¹

• Have a history of severe skin reactions or have a genetic predisposition like HLA-B1502: Carbamazepine may lead to severe skin reactions like Stevens-Johnson syndrome, especially in people with a specific genetic variant (HLA-B1502), and those with a history of such reactions.
• Have a history of hypersensitivity reactions to anticonvulsants: If you’ve experienced hypersensitivity to medications such as phenytoin, primidone, and phenobarbital, the risk of a similar reaction to carbamazepine should be carefully considered.
• Are positive for the HLA-A*3101 gene variant: In individuals with this genetic variant, there’s a moderate association with hypersensitivity reactions when taking carbamazepine, so its use should be weighed carefully against the potential risks.
• Have a history of aplastic anemia or agranulocytosis: If you’ve experienced adverse hematologic reactions to any drug in the past, you may be at increased risk of bone marrow depression when taking carbamazepine.
• Experience anaphylaxis or angioedema: Rare cases of these life-threatening reactions have been reported after carbamazepine use. If you’ve experienced such reactions, it’s essential to avoid rechallenge with the drug.

Carbamazepine Dosages for FDA-Approved Treatment

Carbamazepine dosages vary based on age and condition. For epilepsy in adults and children over 12, an initial dose is 200 mg twice daily (400 mg/day) and can be increased to 1,000 mg daily for those over 15. Children 6-12 start at 100 mg twice daily, not exceeding 1,000 mg daily. Children under 6 receive doses based on their weight. Consult a healthcare provider for personalized guidance.

Carbamazepine Forms & Strengths

Carbamazepine is available in various forms and strengths, including conventional tablets (100 mg, 200 mg), extended-release tablets (100 mg, 200 mg, 300 mg, 400 mg), suspensions, and solutions. The choice of form and strength depends on individual factors, with prescribers considering the patient’s age, medical condition, and treatment response.

Carbamazepine is available in the following forms and strengths:¹

• 100 milligrams (mg) conventional oral tablet
• 200 milligrams (mg) conventional oral tablet
• 100 milligrams (mg) extended-release oral tablet
• 200 milligrams (mg) extended-release oral tablet
• 300 milligrams (mg) extended-release oral tablet
• 400 milligrams (mg) extended-release oral tablet
• Suspension
• Solution

How Should I Take Carbamazepine?

To take carbamazepine effectively, follow your healthcare provider’s instructions closely. Don’t crush or chew extended-release tablets. Tegretol and Tegretol XR should be taken with food, and if you’re using Carbatrol capsules, you can open them and sprinkle the contents on food if needed.

Typically, adults start with 200 mg twice daily, and children under 12 take 100 mg twice daily. Your dose may increase gradually until it reaches the minimum effective level. For adults and children over 12, this is usually between 800 mg and 1,200 mg daily for epilepsy treatment. For children aged six to 12, it’s typically 400 mg to 800 mg daily for epilepsy treatment. Always take your medication as prescribed, and if you have questions, consult your healthcare provider.

What Happens If I Miss a Dose of Carbamazepine?

If you miss a dose of carbamazepine, take it as soon as you remember, unless it’s close to the time for your next dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to make up for a missed one. It’s essential to follow your prescribed dosing regimen to maintain consistent levels of the medication in your system for effective treatment. If you’re unsure about what to do, consult your healthcare provider or pharmacist for guidance.

Can You Overdose on Carbamazepine?

Yes, an overdose of carbamazepine is possible and can be dangerous. Signs of an overdose include issues with muscles and nerves, irregular breathing, heart problems, and more. In severe cases, it can lead to coma.

If you suspect an overdose, seek immediate medical help. There’s no specific antidote, but various treatments can be used to manage it, including inducing vomiting and stomach irrigation. Specific symptoms, like breathing difficulties or seizures, will also need treatment. It’s crucial to act quickly in the event of an overdose.

What Should You Do If You Take Too Much Carbamazepine?

If you take too much carbamazepine, seek immediate medical attention. Contact your local poison control center or go to the nearest hospital emergency room. In case of overdose, prompt medical evaluation and intervention are crucial for your safety and well-being.

What to Avoid When Taking Carbamazepine

When taking carbamazepine, avoid it if you have a history of bone marrow depression or hypersensitivity to the drug or related tricyclic compounds. Additionally, it’s not recommended to use carbamazepine with monoamine oxidase inhibitors (MAOIs). Prior to starting carbamazepine, your prescriber will advise you about stopping your MAOIs, usually for at least 14 days. Being cautious about these interactions and following your healthcare provider’s guidance is essential to ensure the safe and effective use of carbamazepine.

10 substances you should avoid while taking carbamazepine include:

• Monoamine oxidase inhibitors (MAOIs): Using carbamazepine with MAOIs can lead to dangerous interactions. Therefore, it’s essential to discontinue MAOIs for at least 14 days before starting carbamazepine to prevent adverse effects.
• Nefazodone: Combining carbamazepine with nefazodone can result in reduced concentrations of nefazodone, which may affect how effective it is. Using these medications together is not recommended.
• Tricyclic antidepressants: If you have a known sensitivity to tricyclic antidepressants like amitriptyline, desipramine, imipramine, or protriptyline, you should avoid carbamazepine, as cross-sensitivity can occur.
• Alcohol: Alcohol consumption may increase the risk of side effects and reduce the effectiveness of carbamazepine. It’s advisable to limit alcohol intake or avoid it while on this medication.
• Grapefruit juice: Grapefruit juice can interfere with the metabolism of carbamazepine, potentially leading to higher blood levels of the drug. It’s best to avoid grapefruit juice during carbamazepine treatment.
• Oral contraceptives: Carbamazepine may reduce the effectiveness of oral contraceptives, increasing the risk of unintended pregnancies. It’s crucial to discuss alternative birth control methods with your healthcare provider.
• Warfarin: Carbamazepine can affect the blood-thinning effects of warfarin, leading to potential complications. Close monitoring is necessary when using both drugs.
• Theophylline: Carbamazepine can reduce the effectiveness of theophylline, potentially worsening conditions like asthma. Adjustments in theophylline dosage may be needed when used in conjunction with carbamazepine.

How to Get a Prescription for Carbamazepine

Carbamazepine is a prescription-only medication, which means you cannot obtain it without a prescription from a licensed healthcare provider. To get a prescription for carbamazepine, you’ll need to consult a qualified healthcare professional, such as a medical doctor or a neurologist.

Your healthcare provider may also order specific tests, such as blood work or diagnostic imaging, to help make an informed decision. Always follow their guidance and take the medication exactly as prescribed to ensure your safety and the best treatment outcomes.

Questions to Ask Your Healthcare Provider About Carbamazepine

If you are considering carbamazepine as a treatment option, speak with your healthcare provider, psychiatrist, or therapist. They can help you understand the medication’s potential benefits and side effects, how it might interact with other medications you’re taking, and any necessary monitoring. If you need to change prescribers or explore this treatment online, online psychiatry services can be a valuable option. These services offer access to licensed professionals who can provide guidance and prescriptions tailored to your needs.

Questions to ask your care team about carbamazepine include:

• How safe is carbamazepine, and what are the common side effects?
• How long does it typically take to adjust to taking carbamazepine, and what can I expect during this adjustment period?
• Are there any specific risks or interactions to be aware of if I’m already taking other medications?
• What is the recommended dosage to balance effectiveness and minimize side effects for my specific condition?
• How will my progress be monitored while taking carbamazepine?
• Are there any lifestyle changes, dietary restrictions, or activities I should avoid while on carbamazepine?
• What should I do if I miss a dose of carbamazepine?
• Can I drink alcohol while taking this medication?
• Are there potential interactions with over-the-counter drugs or herbal supplements I should be aware of?
• Should I be concerned about the risk of suicidal thoughts or behavior while on carbamazepine?
• What are the long-term implications of using carbamazepine for my condition?
• Is it safe to become pregnant or continue pregnancy while on carbamazepine, and if not, what alternatives should I consider?

For Further Reading

• How Is Bipolar Disorder Diagnosed?
• How to Help Someone With Schizophrenia: 10 Tips From a Therapist
• What Are Bipolar Disorders?