Other Names: Altretol, Carbatrol, Epitrol, Tegretol XR

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This medication is an anticonvulsant used to treat grand-mal, psychomotor, and mixed seizure patterns, as well as trigeminal neuralgia and glossonpharyngeal neuralgia. It seems to work by reducing nerve stimulation, but the exact method is unknown. Tegretol does not appear to control absence seizures.

Other clinically accepted uses include the treatment of: Alzheimer's related aggression, bipolar disorder, clicking tinnitus, cocaine withdrawal, diabetic neuropathy, diaphragm flutter causing belching and hiccups, hemifacial spasm, migraine prevention, nerve problems caused by thiamine deficiency, phantom limb pain, post-traumatic stress disorder, resistant schizophrenia, schizoaffective disorders, and tabes dorsalis.

Evaluation of treatment is recommended every three months, along with tests for kidney and liver function. Regular blood counts, eye examinations, and bone density tests are also recommended.

Tegretol is only available by prescription.

Tegretol Side Effects

Common Side Effects: Clumsiness, difficult urination, dizziness (mild), dry mouth, dry throat, lightheadedness (mild), mild nausea or vomiting (mild), sun sensitivity.

Less Common Side Effects: Constipation, decreased appetite, diarrhea, hair loss, headache, joint aches, male sexual dysfunction, mood changes, muscle aches, stomach cramping or discomfort, sweating.

Uncommon to Rare Side Effects: Altered heartbeat (irregular, pounding, or slow), chest pain, difficult or slurred speech, fainting, frequent urination, mental depression with restlessness or nervousness, muscle cramps, rigidity, sudden decrease in amount of urine, swelling (face, hands, feet, or lower legs), trembling, uncontrolled body movements, unexplained sensations in hands and feet (numbness, pain, tingling, or weakness), rapid weight gain, unexplained sounds in the ears (buzzing, ringing, etc.), visual hallucinations (seeing things that are not there)

Adverse Side Effects:

Mild : Agitation, allergy (drug fever, hives, itching, rash), behavioral changes (usu. children), blurry or double vision, confusion, continuing headache, diarrhea (severe), difficulty speaking, hostility (usu. elderly), leg or foot conditions (unexplained bluish color, pain, pinpoint red spots on skin, swelling, or tenderness), lower back pain, male infertility, mental depression, more frequent seizures, nausea and vomiting (severe), side pain, tightness in chest, unexplained sounds, uncontrolled body movements (severe). Contact your doctor as soon as possible if any of these occur. If the symptom seems particularly severe or bothersome, and your doctor is unavailable, seek medical attention at a hospital.

Serious : Agranulocytosis, allergy (peeling skin, sore mouth or tongue, swollen lymph glands), aplastic anemia, black or tarry stools, bloody urine, cough or shortness of breath, dark urine, difficult urination (severe), increased urination, fever with sore throat, nosebleeds, painful bones or joints, pale stools, psychosis, spots on lips or mouth (sores, ulcers, white spots), thyroid depression, troubled breathing or wheezing, unusual bleeding or bruising, unusual fatigue or weakness, yellow skin or eyes. Seek immediate medical attention if any of these occur. If your doctor is unavailable, contact emergency services.

Overdose : Altered heartbeat (fast or irregular), body spasm with body bent forward and head and heels bent backward, cardiac arrest, convulsions (esp. children), decreased urination, disorientation, fainting, flushed skin, high or low blood pressure, large pupils, overactive reflexes, poorly controlled movements, severe clumsiness, severe fatigue, severe nausea or vomiting, stupor progressing to coma, tremor or twitching, troubled breathing (irregular, shallow, or slow), underactive reflexes. Seek emergency medical attention if you suspect an overdose, or experience any of these symptoms, especially if several appear together.

Cautions: This medication may not be suitable for everyone. To ensure safe and effective medical care, discuss any history or active case of any of the following conditions with your doctor when planning your treatment.

• Alcohol Abuse: Alcohol should not be used without the approval of your doctor during treatment, as it may cause the medication to be less effective. A long history of heavy alcohol use may indicate a weakened liver and a need for lower doses.
• Allergies: If you have had an allergic reaction to this drug, you will not be able to use it. If you develop one during treatment, you will have to discontinue use. Also inform your doctor if you have ever had an allergic reaction to any tricyclic antidepressant or Dilantin (phenytoin) in the past, as this may be an important factor in determining proper treatment. Any food or dye allergies should be mentioned as well, to ensure that the form of treatment you are prescribed doesn't cause a reaction.
• Anemia or Other Blood Cell Conditions: This medication may be unsuitable for you, or require lower dosing and more careful monitoring during treatment. Your doctor will have to make this decision on a case by case basis. This is of special concern if the condition is drug induced.
• Bone Marrow Conditions: This medication may be unsuitable for you, or require lower dosing and more careful monitoring during treatment. Your doctor will have to make this decision on a case by case basis. This is of special concern if the condition is drug induced.
• Depression or Other Psychiatric Disorder: Be sure to discuss treatment with your mental health care professional, and be aware that it may interact with certain treatments for these conditions. Latent psychosis may be revealed with Tegretol treatment.
• Diabetes: May increase levels of glucose in the urine, altering test results.
• Glaucoma: Your doctor will want to carefully monitor your condition during treatment.
• Heart or Coronary Disease: May worsen these conditions.
• Kidney or Liver Problems: This medication will need to be prescribed in much lower doses. Patients with active liver disease should not use Tegretol.
• Lupus: May be activated by Tegretol treatment. Individuals with the disease, or who are at high risk for it (i.e., have a family history of it) may want to discuss this with their doctor while planning treatment.
• Osteoporosis: May be worsened, as this drug reduces the availability of vitamin D to the body.
• Other Medication: Discuss all prescription and over the counter medication you use with your doctor. Inform all medical personnel that you take this medication, and carry identification to alert emergency personnel to your treatment if you should be unconscious.
• Pregnancy: If you plan to become pregnant, discuss this with your doctor. This drug is contraindicated for pregnancy due to increased risk of birth defects. The use of effective birth control during treatment is recommended, though Tegretol decreases the effectiveness of oral contraceptives. Breast feeding during treatment is not recommended.
• Thrombophlebitis: Inform your doctor of any history of this condition.

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This medication is not suitable to mix with all other prescription or over the counter treatments. It's important that every medical professional that you deal with is informed of your treatment, and some form of medical ID is recommended in case you should require care while unconscious. Certain of the following medications may require dosage adjustments in one of the medications or more careful monitoring. Some should not be used together at all.

• Acetaminophen (Tylenol, others) - Increases risk of liver toxicity.
• Adenocard (adenosine) - These medications should not be used within four days of each other, increases risk of heart block.
• Adrenocorticosteroids - May be less effective in combination with this treatment.
• Alcohol - May decrease the effectiveness of treatment. Avoid use unless your doctor has specifically set up guidelines for safe and acceptable use.
• Anticoagulants - Medications like Coumadin (warfarin) may become less effective when used with carbamazepine, requiring dosing adjustments and more frequent monitoring of blood levels.
• Antiseizure medications like Cerebyx (fosphenytoin) and Dilantin (phenytoin) may cause fluctuations in each others blood levels, causing ineffective seizure control.
• Azole antifungals - Drugs like Diflucan (fluconazole), Nizoral (ketoconazole), and Sporanox (itraconazole), may either become less effective in combination with this treatment or increase blood levels of carbamazepine.
• Benzodiazepines (a class of antidepressants, anti-panic agents, sleep medications, and muscle relaxants) such as Valium (diazepam), Halcion (triazolam), Restoril (temazepam), Librium (chlordiazepoxide), Tranxene-SD (clorazepate), Klonopin (clonazepam), Paxipam (halazepam), Ativan (lorazepam), ProSom (estazolam), Xanax (alprazolam), or Versed (midazolam) may be less effective when these treatments are combined, and may also increase the risk of oversedation.
• Bronchodilators of the xanthine (thioxanthine) class (Aminophylline, Dyphylline, Oxtriphylline, Somophyllin, Theo-Dur, etc...) - Both medications may be less effective when used together.
• Calcium channel blockers - Medications like Bepadin (bepridil), Calan (verapamil), Cardene (nicardipine), Cardizem (diltiazem), DynaCirc (isradipine), Nimotop (nimodipine), Plendil (felodipine), Procardia (nifedipine), or Sibelium (flunarizine) may increase the effects of carbamazepine.
• Clozaril (clozapine) - Severe bone marrow depression may result.
• Corticosteroids (cortisone, prednisone, others) - May be less effective when combined with this treatment.
• Danocrine (danazol) - May increase the effects of carbamazepine.
• Darvon/Darvocet (propoxyphene) - May increase the effects of carbamazepine.
• Depakene (valproic acid) - May be less effective when these treatments are combined.
• Doxil (doxorubicin) - Carbamazepine may be less effective in combination with this drug.
• Felbatol (felbamate) - Carbamazepine may be less effective in combination with this drug, leading to an increased risk of seizures.
• Flu shots - May increase the effects of carbamazepine.
• Ginseng - Do not use this herb with carbamazepine.
• Isoniazid - May increase the effects of carbamazepine.
• Kava Kava - May increase drowsiness.
• Kola Nut - May increase nervous system stimulation leading to unwanted effects.
• Lamictal (lamotrigine) - May be less effective when these treatments are combined.
• Lithium (Eskalith, Lithobid) - Serious neurological problems may result, including confusion, fatigue, tremor or twitching, unsteadiness, or weakness.
• Macrolide Antibiotics - Most of these increase the effects of carbamazepine, and should not be combined with it.
• Ma Huang - May increase nervous system stimulation leading to unwanted effects.
• MAO inhibitors - Carbamazepine must never be mixed with MAO (monoamine oxidase) inhibitors, a class of antidepressants and antisenility drugs, such as Eldepryl (selegiline), Furoxone (furazolidone), Nardil (phenelzine), Marplan (isocarboxazid), or Parnate (tranylcypromine). Never use Aventyl within 2 weeks of starting or stopping an MAO inhibitor. This combination could produce dangerously high blood pressure, increased temperature, severe convulsions, and serious drug toxicity. Speak with your doctor if you will be transferring from one of these treatments to the other to make sure you leave sufficient time between their use.
• Mysoline (primidone) - Carbamazepine may be less effective in combination with this drug.
• Nicotinamide - May increase the effects of carbamazepine.
• Oncovin (vincristin) - May be less effective when these treatments are combined.
• Oral Contraceptives - May make birth control less effective, leading to unwanted pregnancy. Some other form of contraception should be used to prevent pregnancy.
• N-acetylcysteine (NAC) - This may decrease seizure control. Check vitamin or amino acid supplements for this compound before using.
• Phenothiazines - Medications like Compazine (prochlorperazine), Mellaril (thioridazine), Phenergan (promethazine), Prolixin (fluphenazine), Serentil (mesoridazine), Sparine (promazine), Stelazine (trifluoperazine), Temaril (trimeprazine), Tindal (acetophenazine), Thorazine (chlorpromazine), Trilafon (perphenazine), and Vesprin (triflupromazine). These tranquilizers and antipsychotics should never be combined with carbamazepine, as it will cause them to be passed in the stool as a rubbery, orange substance.
• Platinol (cisplatin) - Carbamazepine may interact with this drug.
• Plendil (felodipine) - May be less effective when these treatments are combined.
• Prilosec (omeprazole) - May increase the effects of carbamazepine.
• Prograf (tacrolimus) - May be less effective when these treatments are combined.
• Protease inhibitors like Agenerase (amprenavir), Norvir (ritonavir), Viracept (nelfinavir), Zovirax (acyclovir), and possibly others may increase the effects of carbamazepine or be made less effective.
• Rescription (delavirdine) - May be less effective when these treatments are combined.
• Rifadin (rifampin) - May increase the effects of carbamazepine.
• Risperdal (risperidone) - This medication may be less effective when the treatments are combined.
• Roaccutane (isotretinoin) - Dosage adjustments may be necessary.
• Sandimmune (cyclosporine) - May be less effective when these treatments are combined.
• Seldane (terfenadine) - Carbamazepine may be less effective in combination with this drug.
• Selective serotonin reuptake inhibitors (SSRIs) like Celexa (citalopram), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline) may increase the risks of toxicity and oversedation.
• Serzone (nefazodone) - May increase the effects of carbamazepine.
• St. John's Wort - May increase sun sensitivity.
• Synercid (dalfopristin, quinupristin) - May increase the effects of carbamazepine.
• Tagamet (cimetidine) - Increases blood levels of carbamazepine, as well as the risk of serious side effects.
• Tetracycline antibiotics - May be less effective.
• Toradol (ketorolac) - Carbamazepine may be less effective in combination with this drug.
• Tricyclic antidepressants such as Elavil (amitriptyline), Asendin (amoxapine), Anafranil (clomipramine), Pertofrane or Norpramin (desipramine), Sinequan (doxepin), Tofranil (imipramine), Aventyl or Pamelor (nortriptyline), Vivactil (protriptyline), and Surmontil (trimipramine), may decrease the effectiveness of the medication, making seizure more likely to occur. There is also a risk of excessive sedation. Your doctor will advise you if dosage adjustments are necessary or if blood levels will need to be more closely monitored.
• Ultram (tramadol) - May be less effective when these treatments are combined.
• Valerian - May increase drowsiness.
• Viagra (sildenafil) - May alter carbamazepine blood levels.
• Wellbutrin/Zyban (bupropion) - May be less effective when these treatments are combined.
• Zyprexa (olanzapine) - May be less effective when these treatments are combined.

This drug is available in the following forms:

• Chewable Tablets - 100 mg
• Extended Release (Tegretol XR) - 100 mg, 200 mg, 400 mg
• Oral Suspension - 100 mg/5 ml
• Tablets - 200 mg

The following are general prescribing guidelines for adults. If your doctor gives you a different dose or schedule, follow their instructions exactly.

• Epilepsy: 200 mg every 12 hours (tablets & XR), or 100 mg four times daily (suspension), to start with. Dosage may be increased by 200 mg per week as needed and tolerated, to a usual maximum of 1,200 mg per day. In rare cases, 1,600 mg daily have been used. Dosage schedules will vary depending on the form of medication you are using.
• Trigeminal Neuralgia: 200 mg daily, divided into 2-4 equal doses depending on the form of the medication.
• Migraine Prevention: 10-20 mg per kg, per day, divided into two equal doses.

For maximum effectiveness, this medication needs to be maintained in steady levels in the body. Take your doses at the same time every day, and take missed doses as soon as you remember. If you miss a dose and it's almost time for your next one, skip the missing dose and resume your normal schedule. If you miss two doses in a row, call your doctor.

If you are taking this medication for seizures, stopping it suddenly could cause an increase in seizure events. Do not stop using it without getting guidelines to follow from your doctor. If you are taking this medication for trigiminal neuralgia, be aware that this is not a preventative therapy for that condition, and should not be used when it is in remission.

Tegretol should be taken after or with food, which reduces stomach upset. The capsules can be opened, and the tablets can be crushed. Do not use discolored capsules. The extended release form of Tegretol should not be crushed or altered in any way.

The oral suspension form should be shaken thoroughly before measuring, and must not be taken with other liquids or medications. Do not allow it to freeze, store as recommended on the packaging.

Store Tegretol away from direct light and heat. Store in a dry location; avoid storing it in the bathroom, near sinks, or other areas where it may become damp. Do not use after the expiration date.

Keep Tegretol away from children; both when storing it, and when discarding any unused medication.

Tegretol may cause drowsiness or disorientation, and you should familiarize yourself with your reaction to it before engaging in potentially hazardous activities. Be cautious if you plan to drive or operate heavy machinery, avoid these activities if you find yourself feeling tired or experience slowed reactions.

Carry identification so that emergency personnel will be aware that you take this drug.

Tegretol and Pregnancy

This medication has caused severe birth defects in animal studies, and is contraindicated during pregnancy. This medication also passes into breast milk, and may adversely affect the developing infant. Do not breast feed while using this medication.

Tegretol and Children

This drug has been approved for use in children as young as six years old, and may be used safely and effectively in even younger children depending on the circumstances. Children are more likely to experience behavioral changes while undergoing treatment.

Use and dose will have to be determined for the individual child, though over the age of 12, many individuals are given adult doses.

Tegretol and Seniors

Altered heartbeat (irregular, pounding, or unusually slow), chest pain, confusion, nervousness, and restlessness are more likely in seniors. Doctors will likely begin by prescribing lower doses, and more careful monitoring may be necessary.

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Tegretol is a trademark of Novartis

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The information contained in this document is provided for educational purposes and information only. It is not a substitute for consultation with a physician or Health professional, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor, physician or Health professional can say if a medication, a drug alternative or drug combination, is safe for you. Information intended for US residents only.