Jeffrey Panko NP Psychiatry · Patient education
Carbamazepine
Tegretol / Carbatrol / Equetro / Generic formulations
A guide for adults taking carbamazepine.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Immediate-release and extended-release tablets, chewable tablets, extended-release capsules, and liquid suspension have different schedules and handling instructions.
What it is used for
Carbamazepine treats certain seizures and trigeminal neuralgia. Equetro is approved for acute manic or mixed episodes of bipolar I disorder; other psychiatric uses or formulations may be off-label.
How it works
It limits repeated nerve firing through sodium channels. It also increases the activity of liver enzymes that clear many medications, including carbamazepine itself, so interactions and blood levels can change over time.
What to expect over time
The dose usually rises gradually. During the first weeks, the body may clear carbamazepine faster, so follow-up levels and dose reviews are useful. Do not adjust doses based on symptoms alone.
Taking your medication
- Follow the instructions for your exact formulation and take consistently with respect to food.
- Do not crush or chew extended-release tablets. Some capsules allow sprinkling; use only that formulation’s instructions.
- Shake suspension and measure with a dosing device. Check before taking it at the same time as other liquid medicines.
- If you miss a dose, take it when you remember unless it is almost time for the next dose. Then skip it. Do not double a dose.
- Consult with your provider before stopping or restarting after several missed days.
When to get help
Emergency symptoms. Stop and obtain urgent medical assessment for a new rash, especially with blistering, mouth sores, fever, or swelling. Call 911 for breathing difficulty, collapse, or a seizure that is prolonged or repeated.
Prompt medical advice. Seek prompt care for fever or sore throat, unusual bruising, yellow skin or eyes, marked confusion, or severe unsteadiness. These can signal blood, liver, sodium, or toxicity problems.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Dizziness, drowsiness, or unsteadiness
- Nausea or vomiting
- Blurred or double vision
- Low blood sodium or changes in blood counts
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Blood counts, liver tests, sodium, and sometimes a carbamazepine level are checked. Follow instructions about blood-draw timing.
Genetic testing for HLA-B*1502 is recommended before treatment for people with ancestry in populations at increased risk. Other genetic factors may also matter; a negative result does not eliminate rash risk.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss blood disorders, prior drug rashes, heart problems, low sodium, liver or kidney disease, and pregnancy plans. Carbamazepine can harm a developing baby and reduce effectiveness of some contraceptives. Discuss contraception and breastfeeding with your provider.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
It can lower levels of many psychiatric medicines, anticoagulants, and hormonal contraceptives. Stopping it can make some other medication levels rise.
Certain antibiotics and antifungals, grapefruit, and other medicines can raise carbamazepine levels. Avoid alcohol. MAOIs and medicines affecting blood counts require specific review.
Everyday tips
Keep laboratory appointments and a complete medication list.
Discuss a reliable contraception method before starting.
Your questions answered
Can I stop when my mood improves?
Consult with your provider. Sudden stopping can cause seizures or a return of mood symptoms, and can change the effects of other medications.
Why repeat blood levels?
Dose, interacting medicines, and the body’s changing breakdown of carbamazepine affect exposure. A level helps interpret benefit and side effects.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.