carbamazepine
Carbamazepine (Tegretol) is an antiseizure medication used to treat different kinds of seizures. It can also help with trigeminal neuralgia, a type of facial nerve pain. Brand name Equetro is the only formulation that's approved to treat bipolar I disorder. Carbamazepine (Tegretol) available as pills and a liquid. Depending on formulation you take and what medical condition you have, carbamazepine (Tegretol) is taken by mouth 1 to 4 times per day. Common side effects include sleepiness, dizziness, and stomach upset.
What is Carbamazepine (Tegretol)?
What is Carbamazepine (Tegretol) used for?
Mixed seizure patterns
Trigeminal neuralgia (facial nerve pain)
Bipolar I disorder - Equetro brand only
How Carbamazepine (Tegretol) works
Carbamazepine (Tegretol) is an antiepileptic known as a sodium channel blocker. It's thought to work by blocking the activity of certain nerves in your brain.
Drug Facts
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What are the side effects of Carbamazepine (Tegretol)?
Common Side Effects
- Dizziness (44%)
- Sleepiness (32%)
- Nausea (29%)
- Vomiting (18%)
- Difficulty walking or keeping balance (15%)
- Constipation (10%)
- Itching (8%)
- Dry mouth (8%)
- Weakness (8%)
- Rash (7%)
- Blurry vision (6%)
- Speech problems (6%)
Other Side Effects
- Shakiness
- High blood pressure
- Burning or prickling sensation
- Trouble concentrating
- Twitching
Serious Side Effects
- Suicidal behavior or thoughts of self-harm
- Serious allergic and skin reactions: sore throat, fever, fatigue, rash, hives, painful blisters, skin reddening, skin peeling, swollen lymph nodes
- Low blood cell counts: fever, trouble breathing, chills weakness, unusual bruising or bleeding, and blood in urine, stools, or gums
- Liver problems: severe nausea, vomiting, right-sided stomach pain, fatigue, low or no appetite, yellowing of the skin or eyes
- Low blood sodium levels: nausea, fatigue, headache, confusion, disoriented, hallucinations (seeing things that aren't real), seizures, unconsciousness
Source: DailyMed
More on Carbamazepine (Tegretol) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision or double vision
continuous back-and-forth eye movements
Less common
Actions that are out of control
behavioral changes (especially in children)
confusion, agitation, or hostility (especially in the elderly)
diarrhea (severe)
discouragement
fear
feeling of unreality
feeling sad or empty
headache (continuing)
increase in seizures
irritability
lack of appetite
loss of balance control
loss of interest or pleasure
muscle trembling, jerking, or stiffness
nausea (severe)
other problems with muscle control or coordination
sense of detachment from self or body
shakiness and unsteady walk
shuffling walk
stiffness of the arm or leg
sudden, wide mood swings
talking, feeling, and acting with excitement
thoughts or attempts of killing oneself
tiredness
trouble concentrating
trouble sleeping
twisting movements of the body
uncontrolled movements, especially of the face, neck, and back
unusual drowsiness
vomiting (severe)
Rare
Black, tarry stools
blood in the urine or stools
bone or joint pain
darkening of the urine
difficulty with speaking or slurred speech
fainting
hoarseness
irregular, pounding, or unusually slow heartbeat
lower back or side pain
mental depression with restlessness and nervousness or other mood or mental changes
muscle or stomach cramps
nosebleeds or other unusual bleeding or bruising
numbness, tingling, pain, or weakness in the hands and feet
pain, tenderness, swelling, or bluish color in the leg or foot
painful or difficult urination
pale stools
pinpoint red spots on the skin
rapid weight gain
rigidity
ringing, buzzing, or other unexplained sounds in the ears
sores, ulcers, or white spots on the lips or in the mouth
swelling of the face, hands, feet, or lower legs
swollen or painful glands
sudden decrease in the amount of urine
tightness in the chest
trembling
troubled breathing
uncontrolled body movements
unusual tiredness or weakness
visual hallucinations (seeing things that are not there)
yellow eyes or skin
Incidence not known
Blistering, peeling, or loosening of the skin
decreased urine output
dilated neck veins
extreme tiredness or weakness
general feeling of discomfort or illness
irregular breathing
irregular heartbeat
joint or muscle pain
red skin lesions, often with a purple center
red, irritated eyes
swelling of the face, fingers, feet, or lower legs
thickening of bronchial secretions
unusual bleeding or bruising
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Accidental injury
aching joints or muscles
back pain
belching
dryness of the mouth
headache
increased sensitivity of the skin to sunlight (skin rash, itching, redness or other discoloration of the skin, or severe sunburn)
increased sweating
indigestion
irritation or soreness of the tongue or mouth
lack or loss of strength
loss of hair
loss of memory
problems with memory
sexual problems in males
sleepiness
stomach pain, upset, or discomfort
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Carbamazepine (Tegretol)
Pros
Works well for different types of seizures and trigeminal neuralgia (facial nerve pain)
Helps stabilize mood in people with bipolar disorder (Equetro brand only)
Available as a lower-cost generic
Comes in many dosage forms (e.g., chewable tablets, oral pills, liquid form) for people who have difficulty swallowing pills
Cons
Might need to take the immediate-release form of the medication up to 4 times a day
Can cause a lot of side effects
Might require routine blood testing while taking the medication to see how it's affecting your body
Can make hormonal birth control not work as well
Pharmacist tips for Carbamazepine (Tegretol)
Make sure to mark your appointments in your calendar to see your provider and get any blood tests done while taking carbamazepine (Tegretol). Your provider will likely order different tests, including a carbamazepine drug level, to make sure the medication is working well for you and you're not having side effects.
Carbamazepine (Tegretol) can cause hormonal birth control (e.g., Vienva, Amethyst, Jolessa, etc.) to not work as well, which can lead to unwanted pregnancies. Talk to your provider about which methods of birth control would be the best option and if you need to use a back-up method of protection while taking carbamazepine (Tegretol).
Don't change your dose or suddenly stop taking carbamazepine (Tegretol) without talking to your provider first. Doing so can cause your seizures to come back. Follow your provider's instructions to lower your dose slowly over a period of time to stop the medication completely.
Most side effects from carbamazepine (Tegretol) are temporary and get better or go away after you've been taking it for a few weeks. They are more likely to happen with higher doses of this medication. These side effects might return if your dose is changed.
Carbamazepine (Tegretol) can raise the risk of suicidal thoughts. Contact your provider right away if you or your loved ones notice any new or worsening changes in your behavior or mood while taking the medication.
Carbamazepine (Tegretol) can make you sleepy or dizzy. Don't drink alcohol, drive, or do anything that requires concentration until you know how the medication affects you.
Carbamazepine (Tegretol) can potentially cause male infertility (unable to have children). Talk to your provider if this concerns you, you might be able to be switched to a different medication.
Carbamazepine immediate-release or extended-release tablets and suspension should be taken with food. Carbamazepine capsules can be taken with or without food. If the capsules are hurting your stomach, taking with food might help.
Don't crush, break, or chew any extended-release form of carbamazepine. For the capsules, you can open them and sprinkle the beads on applesauce or other soft foods, but don't crush or chew the beads because that will damage the medication.
More tips for the oral suspension (liquid) only:
Each 5 mL contains 100 mg of carbamazepine. Ask your pharmacist or provider if you're not sure how many mL of carbamazepine (Tegretol) suspension you need to take.
Shake the bottle well for 5 to 10 seconds before each dose. Make sure to only use a medication dose cup or syringe from the pharmacy to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
Store the suspension at room temperature in the original bottle it came in from the pharmacy.
Frequently asked questions about Carbamazepine (Tegretol)
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What are the risks and warnings for Carbamazepine (Tegretol)?
Carbamazepine (Tegretol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Severe skin reactions
Risk factors: Asian ancestry | Having a certain gene (HLA-B 1502 gene) that raises your risk of skin or allergic reactions
Carbamazepine (Tegretol) can cause serious and life-threatening skin reactions called Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), especially in Asian people. Most people experienced these reactions within the first few months of starting carbamazepine (Tegretol). If you notice changes in your skin (e.g., sore throat, fever, fatigue, rash, painful blisters, skin reddening, skin peeling) or experience swelling in your face or trouble breathing, stop using carbamazepine (Tegretol) and get medical attention right away.
Low blood cell counts
Although rare, carbamazepine (Tegretol) can lower your blood cell counts. Your provider will likely measure your complete blood count (CBC) before and during treatment to make sure your blood cell counts don't get too low. Contact your provider if you have any symptoms of low blood cell counts (e.g., fever, shortness of breath, chills weakness, unusual bruising or bleeding, and blood in urine, stools, or gums) to your provider right away.
Severe allergic reactions
Risk factors: Having a certain gene (HLA-A 3101 gene) that raises your risk of skin or allergic reactions
Severe allergic reactions to carbamazepine (Tegretol) are possible, including life-threatening reactions like facial swelling and anaphylaxis (e.g., closing of the throat). Carbamazepine (Tegretol) can also cause drug reaction with eosinophilia and systemic symptoms (DRESS), which is characterized by fever, rash, and swollen lymph nodes.
Suicidal thoughts or behavior
Risk factors: Taking other anti-seizure medications
Carbamazepine (Tegretol) raises our risk of having thoughts of suicide or harming yourself. This risk can appear as early as 1 week after you start taking carbamazepine (Tegretol). If you or anyone around you notices that you have suicidal thoughts or unusual behavior (e.g., anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness) while taking carbamazepine (Tegretol), get medical help right away.
Harm to unborn babies
Carbamazepine (Tegretol) isn't recommended for pregnant females because there's a risk it can cause severe harm (e.g., developmental problems, seizures) to unborn babies. Make sure to tell your provider if you're pregnant or thinking of becoming pregnant soon before starting carbamazepine (Tegretol). They can talk with you about safer options.
Withdrawal
As with many other seizure medications, stopping carbamazepine (Tegretol) too suddenly can raise the risk of seizures. Don't stop taking carbamazepine (Tegretol) without first talking with your provider. If you need to stop this medication, your provider will help you do so slowly over time to minimize the risk for seizures.
Difficulty with speech, concentration, and movement
Risk factors: Taking high doses of carbamazepine (Tegretol) | Drinking alcohol | Taking other medications that can cause sleepiness or dizziness
Because carbamazepine (Tegretol) affects how your brain works, some people have experience side effects such as difficulty concentrating, speech or language problems, and problems with coordination. Additionally, carbamazepine (Tegretol) can cause extreme dizziness and sleepiness, which can lower your ability to think, react, and focus. Your risk might be higher if you're taking other medications that can cause you to feel sleepy or dizzy (e.g., benzodiazepines, muscle relaxants, sleep medications). Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider right away if you feel too sleepy from taking carbamazepine (Tegretol).
Liver problems
carbamazepine (Tegretol) can cause liver problems. This is usually mild, but can lead to dangerous liver damage in some rare cases. Your provider will check your liver tests before you start this medication and regularly afterwards to make sure it doesn't become a serious problem. If you notice severe nausea, vomiting, right-sided stomach pain, fatigue, low or no appetite, or yellowing of the skin or eyes, get medical help right away.
Low sodium levels
Risk factors: Age 65 years or older | Dehydration | Taking diuretics (water pills)
Carbamazepine (Tegretol) can cause low sodium levels in the blood. This is more likely to happen if you're over 65 years old or also take diuretic medications ("water pills"). If your sodium goes too low, it can be dangerous and lead to comas or even death. Let your provider know if you notice severe headaches, trouble concentrating, forgetfulness, confusion, weakness, and unsteadiness at any point while taking this medication. Seek immediate medical help if you experience more serious symptoms, such as hallucinations, more seizures than usual, or fainting.
High eye pressure
Risk factors: History of angle-closure glaucoma
Although rare, carbamazepine (Tegretol) can lead to or worsen glaucoma. You might need to see your optometrist regularly and get eye exams to check your eyes and make sure your vision isn't worsening. Contact your provider if you notice changes in your vision after starting carbamazepine (Tegretol).
Heart block (heart rhythm problems)
Risk factors: History of heart rhythm problems
Although rare, carbamazepine (Tegretol) can cause or worsen heart block, which is when your heart beat is slowed down. Contact your provider if you notice symptoms, such as dizziness, chest pain, chest palpitations, or fatigue.
Carbamazepine (Tegretol) dosage forms
Typical dosing for Carbamazepine (Tegretol)
Carbamazepine comes in many different formulations. Some examples include, immediate-release (IR) tablets, IR chewable tablets, IR oral suspensions, and extended-release (XR) tablets. Dosing for different formulations can differ, so follow the directions your provider gave you for your particular medication.
Seizures
All IR forms and the XR tablet:
Ages 12 years and older: The typical starting dose is 200 mg by mouth twice per day (for the IR/XR tablets) or 100 mg (1 teaspoon) by mouth four times per day (for the suspension). The maximum dose is 1,000 mg per day for children ages 12-15 years and 1,200 mg per day for people ages 15 years and older.
Ages 6 to under 12 years: The typical starting dose is 100 mg by mouth twice per day (for the IR/XR tablets) or 50 mg (half a teaspoon) by mouth four times per day (for the suspension). The maximum dose is 1,000 mg per day.
Ages under 6 years Your child's provider will determine the dose based on your child's body weight. The typical starting dose is 10-20 mg/kg of body weight per day. The dose is given in divided doses by mouth two or three times per day (for the tablets) or four times per day (for the suspension). The maximum dose is 35 mg/kg per day.
XR capsules (Carbatrol, Equetro):
Ages 12 years and older: The typical starting dose is 200 mg by mouth twice per day. The maximum dose ranges from 500 mg to 800 mg twice daily, depending on age.
Ages under 12 years: Your child's provider will calculate the dose based on your child's weight and if they were taking IR forms of carbamazepine before. The maximum dose is typically 35 mg/kg by mouth per day.
Trigeminal neuralgia
All IR forms and the XR tablet:
The typical starting dose is 100 mg by mouth twice per day (for the IR/XR tablets) or 50 mg (half a teaspoon) by mouth four times per day (for the suspension). The typical maintenance dose ranges from 400 mg to 800 mg daily.
XR capsules:
The typical starting dose is 200 mg by mouth once per day. The typical maintenance dose ranges from 400 mg to 800 mg daily.
Bipolar I disorder
Equetro only: The recommended starting dose is 200 mg by mouth twice daily. The dose can be raised every day by 200 mg until the ideal effects are reached. The maximum daily dose is 1,600 mg.
Interactions between Carbamazepine (Tegretol) and other drugs
More on Carbamazepine (Tegretol) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Artemether
- Atazanavir
- Boceprevir
- Cabotegravir
- Clorgyline
- Cobicistat
- Daclatasvir
- Darunavir
- Dasabuvir
- Delamanid
- Delavirdine
- Doravirine
- Efavirenz
- Elbasvir
- Elvitegravir
- Fostemsavir
- Furazolidone
- Grazoprevir
- Iproniazid
- Isavuconazonium
- Isocarboxazid
- Linezolid
- Lorlatinib
- Lumefantrine
- Lurasidone
- Maraviroc
- Methylene Blue
- Moclobemide
- Nefazodone
- Nialamide
- Ombitasvir
- Pargyline
- Paritaprevir
- Phenelzine
- Praziquantel
- Procarbazine
- Ranolazine
- Rasagiline
- Rilpivirine
- Ritonavir
- Selegiline
- Telaprevir
- Tenofovir Alafenamide
- Toloxatone
- Tranylcypromine
- Voriconazole
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abemaciclib
- Abiraterone Acetate
- Acalabrutinib
- Acetazolamide
- Adenosine
- Afatinib
- Alfentanil
- Almotriptan
- Alpelisib
- Alprazolam
- Amiodarone
- Amodiaquine
- Amphetamine
- Amprenavir
- Apixaban
- Apremilast
- Aprepitant
- Aripiprazole
- Artesunate
- Avapritinib
- Axitinib
- Bedaquiline
- Bendamustine
- Benzhydrocodone
- Benzphetamine
- Berotralstat
- Betrixaban
- Bictegravir
- Bosutinib
- Brexpiprazole
- Brigatinib
- Buprenorphine
- Bupropion
- Butorphanol
- Cabozantinib
- Calcifediol
- Cannabidiol
- Capmatinib
- Cariprazine
- Cenobamate
- Ceritinib
- Chloroquine
- Chlorpromazine
- Cisatracurium
- Clarithromycin
- Clonazepam
- Clozapine
- Cobimetinib
- Codeine
- Conivaptan
- Copanlisib
- Crizotinib
- Cyclophosphamide
- Cyclosporine
- Dabigatran Etexilate
- Darolutamide
- Dasatinib
- Deflazacort
- Desmopressin
- Desogestrel
- Desvenlafaxine
- Dexamethasone
- Dextroamphetamine
- Dienogest
- Dihydrocodeine
- Diltiazem
- Dolasetron
- Dolutegravir
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Dronedarone
- Drospirenone
- Duloxetine
- Duvelisib
- Edoxaban
- Elexacaftor
- Eliglustat
- Encorafenib
- Entrectinib
- Enzalutamide
- Eravacycline
- Erdafitinib
- Erlotinib
- Erythromycin
- Escitalopram
- Eslicarbazepine Acetate
- Estradiol
- Ethinyl Estradiol
- Ethynodiol
- Etonogestrel
- Etravirine
- Everolimus
- Exemestane
- Ezogabine
- Fedratinib
- Felodipine
- Fenfluramine
- Fentanyl
- Fluconazole
- Fluoxetine
- Fosamprenavir
- Fosaprepitant
- Fosnetupitant
- Fosphenytoin
- Fostamatinib
- Gefitinib
- Gestodene
- Gilteritinib
- Glasdegib
- Glecaprevir
- Granisetron
- Halofantrine
- Hemin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxytryptophan
- Ibrutinib
- Idelalisib
- Ifosfamide
- Imatinib
- Indinavir
- Irinotecan
- Irinotecan Liposome
- Isoniazid
- Istradefylline
- Itraconazole
- Ivabradine
- Ivacaftor
- Ivosidenib
- Ixabepilone
- Ixazomib
- Ketoconazole
- Lamotrigine
- Lapatinib
- Larotrectinib
- Lasmiditan
- Ledipasvir
- Lefamulin
- Lemborexant
- Levomilnacipran
- Levonorgestrel
- Levorphanol
- Linagliptin
- Lisdexamfetamine
- Lomitapide
- Lopinavir
- Loratadine
- Lorcaserin
- Loxapine
- Lumateperone
- Lurbinectedin
- Macimorelin
- Macitentan
- Manidipine
- Medroxyprogesterone
- Mefloquine
- Meperidine
- Mestranol
- Metaxalone
- Methadone
- Methamphetamine
- Midostaurin
- Mifepristone
- Mirtazapine
- Morphine
- Morphine Sulfate Liposome
- Nalbuphine
- Naloxegol
- Nelfinavir
- Neratinib
- Netupitant
- Nifedipine
- Nilotinib
- Nimodipine
- Nintedanib
- Nomegestrol
- Norelgestromin
- Norethindrone
- Norgestimate
- Norgestrel
- Olanzapine
- Olaparib
- Ondansetron
- Orlistat
- Osimertinib
- Oxcarbazepine
- Oxycodone
- Oxymorphone
- Paclitaxel
- Palbociclib
- Paliperidone
- Palonosetron
- Panobinostat
- Pazopanib
- Pemigatinib
- Pentazocine
- Perampanel
- Pexidartinib
- Phenytoin
- Pibrentasvir
- Piperaquine
- Pitolisant
- Ponatinib
- Ponesimod
- Pralsetinib
- Pretomanid
- Primaquine
- Proguanil
- Propoxyphene
- Pyrimethamine
- Quetiapine
- Quinine
- Regorafenib
- Relugolix
- Remifentanil
- Ribociclib
- Rimegepant
- Ripretinib
- Rivaroxaban
- Rolapitant
- Romidepsin
- Saquinavir
- Segesterone
- Selpercatinib
- Selumetinib
- Sertraline
- Simvastatin
- Sofosbuvir
- Sonidegib
- Stiripentol
- Sufentanil
- Sunitinib
- Tacrolimus
- Tafenoquine
- Tamoxifen
- Tapentadol
- Tasimelteon
- Tazemetostat
- Telithromycin
- Temsirolimus
- Terfenadine
- Tezacaftor
- Thioridazine
- Thiotepa
- Ticagrelor
- Tipranavir
- Tivozanib
- Tofacitinib
- Tolvaptan
- Trabectedin
- Tramadol
- Trazodone
- Tucatinib
- Ubrogepant
- Ulipristal
- Upadacitinib
- Valbenazine
- Vandetanib
- Velpatasvir
- Vemurafenib
- Venetoclax
- Verapamil
- Vigabatrin
- Vilazodone
- Vincristine
- Vincristine Sulfate Liposome
- Vinflunine
- Voclosporin
- Vorapaxar
- Vortioxetine
- Voxelotor
- Voxilaprevir
- Zanubrutinib
- Zileuton
- Ziprasidone
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acetaminophen
- Acetylcysteine
- Aminophylline
- Amitriptyline
- Amoxapine
- Anisindione
- Aripiprazole Lauroxil
- Caspofungin
- Dalfopristin
- Danazol
- Desipramine
- Dicumarol
- Doxepin
- Etretinate
- Felbamate
- Flunarizine
- Furosemide
- Ginkgo
- Haloperidol
- Hydrochlorothiazide
- Imipramine
- Influenza Virus Vaccine
- Levetiracetam
- Lithium
- Methylphenidate
- Methylprednisolone
- Metronidazole
- Mianserin
- Midazolam
- Miokamycin
- Nafimidone
- Niacinamide
- Nortriptyline
- Omeprazole
- Ospemifene
- Phenobarbital
- Phenprocoumon
- Pipecuronium
- Primidone
- Protriptyline
- Psyllium
- Quinupristin
- Remacemide
- Rifampin
- Rifapentine
- Risperidone
- Rocuronium
- Rufinamide
- Sabeluzole
- Theophylline
- Tiagabine
- Ticlopidine
- Topiramate
- Troleandomycin
- Valnoctamide
- Valproic Acid
- Vecuronium
- Viloxazine
- Warfarin
How much does Carbamazepine (Tegretol) cost?
Carbamazepine (Tegretol) contraindications
History of bone marrow problems
Sensitivity to medications known as tricyclic medications, such as amitriptyline, imipramine, and nortriptyline (Pamelor)
Have taken monoamine oxidase inhibitors (MAOIs) within 14 days of starting treatment
Taking nefazodone with carbamazepine (Tegretol)
Taking non-nucleoside reverse transcriptase inhibitors (certain HIV antiviral medications) with Equetro or Carbatrol
What are alternatives to Carbamazepine (Tegretol)?
Mixed seizure patterns
Trigeminal neuralgia (facial nerve pain)
Bipolar I disorder - Equetro brand only
Seizures (partial seizures, tonic-clonic seizures)
Seizures of Lennox-Gastaut syndrome - immediate-release only
Bipolar disorder - immediate-release only
What is the latest news about Carbamazepine (Tegretol)?
Carbamazepine (Tegretol) images
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