Carbamazepine

Generic Name: Carbamazepine

Tegretol, carbamazepine USP, is an anticonvulsant and specific analgesic for trigeminal neuralgia, available for oral administration as chewable tablets of 100 mg, tablets of 200 mg, XR tablets of 100, 200, and 400 mg, and as a suspension of 100 mg/5 mL (teaspoon). Its chemical name is 5H-dibenz[b,f ]azepine-5-carboxamide, and its structural formula is:

Carbamazepine USP is a white to off-white powder, practically insoluble in water and soluble in alcohol and in acetone. Its molecular weight is 236.27.

Inactive Ingredients

Tablets: Colloidal silicon dioxide, D&C Red No. 30 Aluminum Lake (chewable tablets only), FD&C Red No. 40 (200 mg tablets only), flavoring (chewable tablets only), gelatin, glycerin, magnesium stearate, sodium starch glycolate (chewable tablets only), starch, stearic acid, and sucrose (chewable tablets only). Suspension: Citric acid, FD&C Yellow No. 6, flavoring, polymer, potassium sorbate, propylene glycol, purified water, sorbitol, sucrose, and xanthan gum. Tegretol-XR tablets: cellulose compounds, dextrates, iron oxides, magnesium stearate, mannitol, polyethylene glycol, sodium lauryl sulfate, titanium dioxide (200 mg tablets only).

No health feed found.

Carbamazepine is a sodium channel blocker. It binds preferentially to voltage-gated sodium channels in their inactive conformation, which prevents repetitive and sustained firing of an action potential. Carbamazepine has effects on serotonin systems but the relevance to its antiseizure effects is uncertain. There is evidence that it is a serotonin releasing agent and possibly even a serotonin reuptake inhibitor.

Carbamazepine is typically used for the treatment of seizure disorders and neuropathic pain. It is used off-label as a second-line treatment for bipolar disorder and in combination with an antipsychotic in some cases of schizophrenia when treatment with a conventional antipsychotic alone has failed. It is not effective for absence seizures or myoclonic seizures.

In the United States, the FDA-approved medical uses are epilepsy (including partial seizures, generalized tonic-clonic seizures and mixed seizures), trigeminal neuralgia, and manic and mixed episodes of bipolar I disorder.

The drug is also claimed to be effective for ADHD.

As of 2014, a controlled release formulation was available for which there is tentative evidence showing fewer side effects and unclear evidence with regard to whether there is a difference in efficacy

Carbamazepine oral tablet may cause drowsiness. It can also cause other side effects.

More common side effects

The more common side effects that can occur with carbamazepine include:

  • nausea
  • vomiting
  • problems with walking and coordination
  • dizziness
  • drowsiness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • severe skin reaction, symptoms can include:
    • skin rash
    • hives
    • swelling of your tongue, lips, or face
    • blisters on your skin or the mucous membranes of your mouth, nose, eyes, or genitals
  • low blood cell counts, symptoms can include:
    • sore throat, fever, or other infections that come and go or don’t go away
    • bruising more easily than normal
    • red or purple spots on your body
    • bleeding from your gums or nosebleeds
    • intense fatigue or weakness
  • heart problems, symptoms can include:
    • fast, slow, or pounding heart rate
    • shortness of breath
    • feeling lightheaded
    • fainting
  • liver problems, symptoms can include:
    • yellowing of your skin or the whites of your eyes
    • dark-colored urine
    • pain on the right side of your stomach
    • bruising more easily than normal
    • loss of appetite
    • nausea or vomiting
  • suicidal thoughts, symptoms can include:
    • thoughts about suicide or dying
    • attempts to commit suicide
    • new or worsened depression
    • new or worsened anxiety
    • feeling agitated or restless
    • panic attacks
    • trouble sleeping
    • new or worsened irritability
    • acting aggressive or violent or being angry
    • acting on dangerous impulses
    • an extreme increase in activity or talking
    • other unusual behavior or mood changes
  • low sodium levels in your blood, symptoms can include:
    • headaches
    • new seizures or more frequent seizures
    • concentration problems
    • memory problems
    • confusion
    • weakness
    • trouble balancing

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Drug forms and strengths

Generic: Carbamazepine

  • Form: oral tablet
  • Strengths: 100 mg, 200 mg, 300 mg, 400 mg
  • Form: oral tablet, chewable
  • Strengths: 100 mg, 200 mg
  • Form: oral tablet, extended-release
  • Strengths: 100 mg, 200 mg, 400 mg

Brand: Epitol

  • Form: oral tablet
  • Strength: 200 mg
  • Form: oral tablet, chewable
  • Strength: 100 mg

Brand: Tegretol/Tegretol XR

  • Form: oral tablet
  • Strength: 200 mg
  • Form: oral tablet, chewable
  • Strengths: 100 mg
  • Form: oral tablet (extended-release)
  • Strengths: 100 mg, 200 mg, 400 mg

Dosage for epilepsy

Adult dosage (ages 18 years and older)

  • First dose: 200 mg taken 2 times per day.
  • Typical dosage: 800–1,200 mg per day.
  • Dosage changes: Each week, your doctor may increase your daily dose by 200 mg.
  • Maximum dosage: 1,600 mg per day.

Child dosage (ages 12 to 17 years)

  • First dose: 200 mg taken 2 times per day.
  • Typical dosage: 800–1,200 mg per day.
  • Dosage changes: Each week, your child’s doctor may increase their daily dose by 200 mg.
  • Maximum dosage:
    • ages 12 to 15 years: 1,000 mg per day.
    • 15 years and older: 1,200 mg per day.

Child dosage (ages 6 to 12 years)

  • First dose: 100 mg taken 2 times per day.
  • Typical dosage: 400–800 mg per day.
  • Dosage changes: Each week, your child’s doctor may increase their daily dose by 100 mg.
  • Maximum dosage: 1,000 mg per day.

Child dosage (ages 0 to 5 years)

  • First dose: 10–20 mg/kg per day. The dosage should be divided and taken 2–3 times each day.
  • Dosage changes: Your child’s doctor may increase their dosage weekly.
  • Maximum dosage: 35 mg/kg per day.

Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A normal adult dosage may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dosage or a different treatment schedule.

Dosage for trigeminal nerve pain

Adult dosage (ages 18 years and older)

  • First dose: 100 mg taken 2 times per day.
  • Typical dosage: 400–800 mg per day.
  • Dosage changes: Your doctor may increase your dosage by 100 mg every 12 hours.
  • Maximum dosage: 1,200 mg per day.

Child dosage (ages 0 to 17 years)

None given. The safety and effectiveness of carbamazepine hasn’t been established in children younger than 18 years for treatment of trigeminal nerve pain.

Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dosage or a different treatment schedule.

Carbamazepine oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with carbamazepine are listed below.

Heart drugs

Taking certain heart drugs with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • diltiazem
  • verapamil

Fungal infection drugs

Taking one of these drugs with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • ketoconazole
  • itraconazole
  • fluconazole
  • voriconazole

Altitude sickness drug

Taking acetazolamide with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Anti-allergy drug

Taking loratadine with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Antibiotics

Taking certain antibiotics with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • clarithromycin
  • erythromycin
  • ciprofloxacin

HIV drugs

Taking certain HIV medications with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • ritonavir
  • indinavir
  • nelfinavir
  • saquinavir

Tuberculosis drugs

Taking rifampin with carbamazepine will decrease the level of carbamazepine in your body. This means that it won’t work as well to treat your condition. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Taking isoniazid with carbamazepine may increase your risk of liver damage.

Anti-nausea drug

Taking aprepitant with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Mental health drugs

Taking certain mental health drugs with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • fluoxetine
  • fluvoxamine
  • trazodone
  • olanzapine
  • loxapine
  • quetiapine

Taking nefazodone with carbamazepine will decrease the level of nefazodone in your body. Taking these two drugs together is not recommended.

Taking aripiprazole with carbamazepine will decrease the levels of aripiprazole in your body. Your doctor may increase your dose of aripiprazole.

Anti-spasm drug

Taking dantrolene with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Bladder drug

Taking oxybutynin with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Blood thinners

Taking carbamazepine with certain drugs called anticoagulants can decrease the effects of these drugs. That means they won’t work as well to prevent blood clots. Examples of these drugs include:

  • rivaroxaban
  • apixaban
  • dabigatran
  • edoxaban

Taking ticlopidine with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Heartburn drugs

Taking certain heartburn drugs with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • cimetidine
  • omeprazole

Anti-seizure drugs

Taking certain anti-seizure drugs with carbamazepine will decrease the level of carbamazepine in your body. This means it won’t work as well to treat your condition. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • felbamate
  • methsuximide
  • phenytoin
  • fosphenytoin
  • phenobarbital
  • primidone

Taking other anti-seizure drugs with carbamazepine with one of these drugs may affect how your thyroid hormone works. These drugs include:

  • phenytoin
  • phenobarbital

Taking valproic acid with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Herbal products

Taking niacinamide with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Cancer drugs

Taking certain cancer drugs with carbamazepine will decrease the level of carbamazepine in your body. This means it won’t work as well to treat your condition. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • cisplatin
  • doxorubicin

Taking other cancer drugs with carbamazepine will change the level of the cancer drug in your body. Your doctor should avoid use of these drugs together. However, if they must be used together, you doctor may change the dosage of your cancer drug. Examples of these drugs include:

  • temsirolimus
  • lapatinib

Taking cyclophosphamide with carbamazepine will increase the level of the cancer drug in your body. Your doctor may change your dosage of the cancer drug if you take it with carbamazepine.

Pain drug

Taking ibuprofen with carbamazepine will increase the level of carbamazepine in your body. This can cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with this drug.

Anti-rejection drug

Taking tacrolimus with carbamazepine will change the levels of tacrolimus in your body. Your doctor may monitor your blood levels of tacrolimus and change your dosage.

Bipolar disorder drug

Taking lithium with carbamazepine may increase your risk of side effects.

Hormonal birth control drugs

Taking carbamazepine with hormonal birth control, such as the birth control pill, may make the birth control less effective. You may need to use alternative or back-up methods of contraception.

Respiratory drugs

Taking certain respiratory drugs with carbamazepine will decrease the level of carbamazepine in your body. This means it won’t work as well to treat your condition. Your doctor may monitor your blood levels of carbamazepine if you’re taking it with one of these drugs:

  • aminophylline
  • theophylline

Muscle relaxers

Taking one of these drugs with carbamazepine can decrease the effect of these medications. Your doctor may adjust your dosage of these drugs if you take them with carbamazepine. These drugs include:

  • pancuronium
  • vecuronium
  • rocuronium
  • cisatracurium

Take Carbamazepine with or without food. Do not take in larger amounts than advised. Consult the doctor if you experience any undesirable effects. Do not stop taking the medicine without consulting your doctor as it may cause seizures.

This drug comes with several warnings.

Allergy warning

This drug may cause a severe allergic reaction. Symptoms include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives or rash
  • blistering or peeling skin

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Food interaction warning

Grapefruit juice blocks the enzyme that breaks down carbamazepine. Drinking grapefruit juice while taking this drug can cause higher levels of the drug in your body. This raises your risk of side effects.

Alcohol interaction warning

Drinking alcohol while taking carbamazepine can increase your risk of drowsiness.

Warnings for people with certain health conditions

For people with liver disease: This drug is not recommended for use with severe liver disease as it may make the condition worse. If you have stable liver disease, your doctor will monitor and adjust your dosage of this drug. If your liver disease suddenly gets worse, call your doctor to discuss your dosage and use of this drug.

For people with heart disease: If you have any damage to your heart or an abnormal heart rhythm, this drug may make it worse.

Warnings for other groups

For pregnant women: This drug is a category D pregnancy drug. That means two things:

  1. Studies show a risk of adverse effects to the fetus when the mother takes the drug.
  2. The benefits of taking the drug during pregnancy may outweigh the potential risks in certain cases.

Tell your doctor if you’re pregnant or plan to become pregnant. This drug should be used during pregnancy only if the potential benefit justifies the potential risk.

If you become pregnant while taking this drug, call your doctor right away.

For women who are breastfeeding: This drug passes into breast milk. It may cause serious effects in a child who is breastfed. You and your doctor may need to decide if you’ll take this drug or breastfeed.

For seniors: Older adults may process this drug more slowly. Because of this, your doctor should monitor you more closely while you’re taking this drug.

For children: The safety and effectiveness of this drug for trigeminal neuralgia hasn’t been established in people younger than 18 years.

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