Carbamazepine (CAR-buh-MAZ-uh-peen) is the generic name (non-brand name) of a widely used type of seizure medicine. The most common brand name for carbamazepine in the U.S is Tegretol. The name or look may be different in other countries. The dose (measured in milligrams, abbreviated "mg") usually will be the same.
Long-acting forms of carbamazepine in the U.S. may be called: carbamazepine XR or ER, Tegretol XR and Carbatrol.
200-mg (capsule-shaped, pink)
One side says "Tegretol" and the other side says "27" on each half. These should be swallowed whole, not chewed.
100-mg Chewable tablets (round, white with red speckles)
One side says "Tegretol" and the other side says "52" on each half. These tablets are flavored and can be either swallowed whole or chewed.
100 mg per 5 mL (yellow-orange, citrus-vanilla flavored liquid).
Used to treat
- Temporal Lobe Epilepsy
- Complex Partial Seizures
- Secondarily Generalized Seizures
- Simple Partial Seizures
- Tonic-clonic Seizures
Various companies make and sell carbamazepine under different names, including Epitol and Atretol. It is generally available in three forms:
- Tablets: 200 milligrams (mg). These should be swallowed whole, not chewed.
- Chewable tablets: 100 milligrams (mg). These can be either swallowed whole or chewed.
- Suspension (liquid): 100 milligrams (mg) per 5 milliliters (mL or ml)
Products from different companies may look different. They all contain the same kind of medicine, but check with your doctor or the pharmacist if you get pills that look different from the ones you have been taking. You need to be careful because pills from a different company may not work the same way in your body.
Using generic medicines rather than brand-name ones is often suggested as a way to save money. Sometimes the savings are large, but with other medicines the price differences are pretty small. Investigate and shop around before deciding whether the savings are worth any possible problems.
People who switch from brand-name Tegretol, for instance, to generic carbamazepine possibly risk having more seizures or side effects during the changeover, because the body does not absorb the different types in the same way. Switching from one company's generic carbamazepine to another company's may have similar risks. So can switching from generic carbamazepine to Tegretol.
All these risks are not fully known. For some people the effects of changing from one type to another are very small. Some use generic carbamazepine successfully by always using the same company's product. Then the dosage can be adjusted to achieve the best results.
What's important is that you and the doctor should know what you're getting from the pharmacy and be able to control what type of seizure medicine you get.
See package insert.
- Immediate-release tablets, chewable tablets and liquid are usually given 3 or 4 times a day.
- Extended-release tablets and controlled-release capsules can be given 2 times a day.
- Taking carbamazepine with food may help avoid an upset stomach. Because food affects the way medicine is used by the body, it’s important to take it the same way each day. A person who usually takes it with meals should do that all the time.
- When using the liquid suspension, shake the bottle first, then pour it into an accurate measuring spoon or a medicine dropper that is properly labeled. Use the same medicine spoon or dropper each time to get an accurate dose. Do not mix this liquid carbamazepine with any other liquid. Also, try not to take it at the same time as another liquid medicine.
- Don't drink grapefruit juice with carbamazepine. The juice can affect how the medicine works in your body.
Take a forgotten dose as soon as you remember. If it almost time for the next dose, it may be a good idea to delay that dose for a few hours so you're not taking two doses very close together. If you're not sure what to do, call the doctor's office for more advice.
Do your best to follow the doctor's directions. The more often a medicine must be taken, the greater the chance of forgetting, and some people need to take carbamazepine four times every day. This can be difficult. If you forget doses often, it may be a good idea to get a special pillbox or watch with an alarm to remind you. Or ask the doctor whether you can switch to another form of carbamazepine that you can take less often.
Taking the right amount of seizure medicine on time every single day is the most important step in preventing seizures!
Brain cells need to work (fire) at a certain rate to function normally. During a seizure, brain cells are forced to work much more rapidly than normal. Carbamazepine helps prevent brain cells from working as fast as a seizure requires them to. In this way, seizures can be stopped when they are just beginning.
After medicine is swallowed, it must be absorbed into the blood so it can move throughout the body. The process of absorbing, digesting, and excreting a medicine or food is called metabolism. The way the body metabolizes a particular medicine affects how often it must be taken. It also determines whether it will interact with other medicines or be affected by conditions such as liver disease.
Like many other medicines, carbamazepine is broken down (digested) in the liver. If the person also takes other medicines that are digested in the liver, things can get complicated. How well each medicine works and how quickly it leaves the body may be changed.
This is why the doctor needs to know about everything that a person takes—not just prescription medicines but even things like vitamins, herbs, and aspirin! These things can affect how much carbamazepine is prescribed.
Many studies suggest that some seizure medications, like carbamazepine, may control seizures in about 70% of people taking the drug.
These promising results are not always matched in everyday life. Sometimes patients don't take all their medicine on time. Not everyone's seizures can be controlled at a dose that can be taken without side effects. Because of individual differences, there is no "best" amount for everyone. Adjustments are often needed to reduce seizures or side effects.
Many studies have compared carbamazepine with other seizure medicines, to see which medicine is best for people who have just begun treatment for epilepsy. On average, the results were about the same for carbamazepine as for several other seizure medicines that are often used.
Differences in side effects may be important in deciding which medicine is best for each person. In one study, people who took carbamazepine had fewer problems with side effects. Because some people do better with carbamazepine and others do better with something else, it's difficult to forecast the results in any given person.
If seizures continue, the doctor probably will change the amount of carbamazepine prescribed. If that doesn't work, the next step may be either to prescribe a different seizure medicine by itself or to prescribe a combination of carbamazepine and another seizure medicine. Many are available. No single combination is best for everyone. The choice of medication should consider a number of factors such as a person's seizure type, possible side effects, drug interactions, other medical conditions the person may have, and cost.
Most people who take carbamazepine don't have too much trouble with side effects. That's one of the reasons it’s used so much. The most common complaints (usually not too severe) are:
- upset stomach
- blurred or double vision
If you notice any of these problems, call the doctor. Sometimes the doctor can help by changing the amount or type of carbamazepine prescribed. No one should stop taking carbamazepine or change the amount they take without their doctor's guidance.
People who have just started taking carbamazepine (or who have just started taking a larger amount) should be careful during activities that might be dangerous, until they know whether they are having any side effects.
About 5% to 10% of people who take carbamazepine have a red rash within in the first month of taking it. If this happens, tell the doctor or nurse, to be sure that it's not the beginning of a serious problem.
A few people have serious reactions to carbamazepine. These serious problems are very rare but everyone who takes this medicine should at least be aware of them because a very small number of people have died because of them. A complete list of all reactions to carbamazepine can be found in the package insert, but it is important to remember that only a tiny number of people have any of these serious problems.
On December 12, 2007, the Food and Drug Administration informed healthcare professionals that dangerous or even fatal skin reactions (called Stevens Johnson syndrome and toxic epidermal necrolysis), that can be caused by carbamazepine, are significantly more common in patients who have a particular type of gene, called “HLA-B*1502”. This gene occurs almost exclusively in patients with ancestry across broad areas of Asia, including South Asian Indians. Patients with ancestry from these areas in which HLA-B*1502 is present should have a blood test by their physicians to see if they have the “HLA-B*1502” gene before starting treatment with carbamazepine. If these individuals test positive, carbamazepine should not be started unless the expected benefit clearly outweighs the increased risk of serious skin reactions. Patients who have been taking carbamazepine for more than a few months without developing skin reactions are at low risk of these events ever developing from carbamazepine. This is even true for patients who test positive for HLA-B*1502. (source: http://www.fda.gov/medwatch/safety/2007/safety07.htm#carbamazepine)
Other serious side effects from carbamazepine are certain kinds of blood abnormalities. Only about 1 in 30,000 people who take carbamazepine will develop one of these disorders, but the risk is higher than the risk for other people. The doctor will probably recommend a complete blood test before starting the carbamazepine. Then it will be possible to recognize and follow any changes that occur. Many people do have some small changes in their blood that reverse on their own.
The first symptoms of a blood disorder may include:
- sore throat
- sores in the mouth
- nosebleeds or other unusual bleeding or bruising
- tiny red spots on the skin
If you notice any of these things, call the doctor right away, but do not stop using the carbamazepine unless the doctor says so.
Liver problems are another serious disorder that occurs in a few people who take carbamazepine. These may be the first symptoms:
- yellow eyes or skin
- loss of appetite
- upset stomach with vomiting
- black or pale bowel movements
Tell the doctor right away if you notice any of these problems, but don't stop using the carbamazepine unless the doctor says so.
On July 10, 2008, an advisory panel was convened by the Food and Drug Administration (FDA) to review data that the FDA had previously collected from drug studies showing an association between many of the antiepileptic drugs (AEDs) and suicidal ideation and behavior, which together are called suicidality. According to the FDA’s Alert, among the patients with epilepsy in these drug studies, 1 out of 1000 people taking the placebo (inactive substance) showed suicidality compared to approximately 3.5 out of 1000 people who took an AED. The FDA advisory panel voted to accept the FDA's data at its meeting on July 10. The FDA has provided the following information for patients, family members, and caregivers at http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm100192.htm.
Taking antiepileptic medicines may increase the risk of having suicidal thoughts or actions;
- Do not make any changes to the medication regimen without first talking with the responsible healthcare professional;
- Pay close attention to any day-to-day changes in mood, behavior and actions. These changes can happen very quickly so it is important to be mindful of any sudden differences.
Be aware of common warning signs that might be a signal for risk of suicide. Some of these are:
- Talking or thinking about wanting to hurt yourself or end your life
- Withdrawing from friends and family
- Becoming depressed or having your depression get worse
- Becoming preoccupied with death and dying
- Giving away prized possessions
We again urge patients and families to contact their doctor before stopping an epilepsy medication because this may possibly lead to seizures and worsening of mood.
Carbamazepine use has been associated with osteoporosis and or osteopenia in both men and women taking this drug. It is essential that if you taking this medication, that one take supplemental calcium of 1000 milligrams per day. Talk to your doctor about bone health. He/She may decide to check Vitamin D levels and other tests to check for the impact of this drug on your bones.
Carbamazepine has been used successfully for many years to treat a type of face pain called trigeminal neuralgia. It has been approved by the Food and Drug Administration (FDA) for that purpose.
Occasionally carbamazepine is also used by patients with some kinds of mental illness. Few studies have shown a definite benefit, however, and this kind of use is not approved by the FDA. It is legal to prescribe medicines for "off-label uses" even though the FDA has not formally approved such use.
Rashes that may be very serious are more likely to occur in persons with a particular gene called “HLA-B*1502”. This gene occurs almost exclusively in patients with ancestry across broad areas of Asia, including South Asian Indians. Patients with ancestry from these areas should have a blood test by their physician to see if they have the “HLA-B*1502” gene before starting treatment. In addition gene HLA-A*3101 is also associated with severe rash in people who take this drug. The gene HLA-A*3101 is reported in people of European descent.
People with liver disease and those who must take certain other types of medicines may need to be more cautious than others about taking carbamazepine. Most of them can take it successfully, however, if they work with the doctor to determine the correct amount to take. That is why it is so important to make sure the doctor knows about any liver disease and about every kind of medicine you are taking.
Sometimes one kind of medicine changes the way another kind of medicine works in the body. This is true not only for prescription medicines, but also for medicines you just pick up off the shelf at the store. It’s also true for herbal products, vitamins, a few kinds of food, and even cigarettes!
Any time a doctor suggests a new prescription, be sure to talk about what other medicines you are already using. If two kinds of medicine affect each other, the doctor may want to prescribe something else or change the amount to be taken.
Does carbamazepine affect other medicines?
Carbamazepine makes birth control pills less effective, so the chances of becoming pregnant are greater. Women who use pills for birth control should talk to the doctor who prescribed them right away if they start taking carbamazepine. The same is true for some other forms of birth control such as Depo-Provera and implants. Carbamazepine does not affect barrier types of birth control, like condoms, IUDs, and diaphragms.
Carbamazepine also affects the way the body handles many other seizure medicines. Some of these are:
- Depakote (valproic acid)
- Dilantin or Phenytek (phenytoin)
- Klonopin (clonazepam)
- Topamax (topiramate)
Do other medicines affect carbamazepine?
Yes, some medicines can cause carbamazepine to build up in the blood. Having too much carbamazepine in the blood makes people feel dizzy, unsteady, or sleepy. Some of the medicines and other things that may have this effect include:
- Depakote and other valproate seizure medicines
- some medicines for high blood pressure, including Cardizem (diltiazem) and verapamil
- Prozac (fluoxetine)
- certain antibiotics, including erythromycin
- cimetidine (Tagamet, also available without a prescription)
- several types of anti-fungus medications
- painkillers Darvon and Darvocet
- grapefruit juice
On the other hand, some medicines reduce the amount of carbamazepine in the blood. More seizures may occur unless a higher dosage of carbamazepine is taken. Medicines that may have this effect include:
- Dilantin or Phenytek (phenytoin)
- Trileptal (oxcarbazepine)
- Felbatol (felbamate)
- Mysoline (primidone)
Carbamazepine is useful in treating many kinds of seizures that occur in children. But other types that are also common can be made worse, so a correct diagnosis is very important.
Children’s bodies break down carbamazepine faster than adults’ bodies do. This means that young children need to take a larger amount, pound for pound, than adults. By the time children reach their early teens, however, they their bodies absorb, digest, and excrete medicines more like adults do, so they may need to take less than before.
Because children absorb carbamazepine so quickly, side effects like sleepiness, double vision, or dizziness can be a problem for children. Parents and doctors also need to watch for problems with thinking or behavior. These problems are uncommon, but if they occur they can interfere with the child’s development and school performance.
Carbamazepine can cause harm to your baby if taken while you are pregnant.
Research studies suggest that there may be an association between the use of carbamazepine during pregnancy and congenital malformations, including spina bifida. There have also been reports that associate carbamazepine with developmental disorders and congenital anomalies (e.g. craniofacial defects, cardiovascular malformations, hypospadias, and anomalies involving various body systems). Developmental delays have been reported. If you are worried about the effects of the drug on your unborn child, you should talk to your doctor and ask about the risks of using the drug while pregnant. You need to weigh the benefits of the drug against the risks. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be aware of the potential risks to your baby.
Studies suggest that, there is a higher risk of malformations associated with the use of more than one anti-seizure drug at any given time. Therefore, if therapy is to be continued, monotherapy may be preferable for pregnant women.
The best amount is the amount that completely controls seizures without causing troublesome side effects. It depends on many factors, which are different for every individual. Follow the doctor's directions. Call if you have any questions.
No one should stop taking carbamazepine or change the amount they take without talking to the doctor first. Stopping any seizure medicine all at once can cause a problem that may be life-threatening.
Don’t use more than the doctor prescribes. If a little extra (such as one or two extra tablets) is taken by accident, call the doctor for advice. For a larger overdose, call a poison control center or emergency room right away unless you have other specific directions from your doctor.
To avoid unwanted side effects, the doctor will prescribe a low dose to start and increase it gradually. People over 12 years of age usually start by taking carbamazepine twice a day. The doctor gradually prescribes more until their seizures are controlled. Most people need to take carbamazepine three or four times a day.
See package insert.
In the United States, companies that manufacture medicines are required to publish certain kinds of information about each product. This document is commonly known as a “package insert” because it is usually included with each package of the medicine.
You can also read these documents (also called "prescribing information") online. The U.S. package insert for Tegretol (carbamazepine) is found at:
Some of the information may differ in other countries.
To learn how to read and understand a package insert, see "How to read a package insert."