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Carbamazepine, Oral Tablet

Highlights for carbamazepine

  1. Carbamazepine oral tablet is available as brand-name drugs and as a generic drug. Brand names: Tegretol, Tegretol XR, Epitol.
  2. Carbamazepine comes in four forms: oral tablet, oral chewable tablet, oral suspension, and oral extended-release capsule.
  3. Carbamazepine oral tablet is used to treat epilepsy and trigeminal neuralgia.
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Important warnings

Important warnings

FDA warnings
  • This drug has black box warnings. These are the most serious warnings from the Food and Drug Administration (FDA). Black box warnings alert doctors and patients about drug effects that may be dangerous.
  • Severe skin reaction warning: This drug may cause life-threatening allergic reactions called Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These reactions may cause severe damage to your skin and internal organs. Your risk may be higher if you have Asian ancestry with a genetic risk factor. If you’re Asian, your doctor may test you for this genetic factor. You can still develop these conditions without the genetic risk factor. Call your doctor right away if you have any of these symptoms while taking this drug:
    • 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 count warning: This drug may decrease the number of blood cells your body makes. In rare cases, this can cause serious or life-threatening health problems. Tell your doctor if you’ve ever had low blood cells, especially if it was caused by another drug. Call your doctor right away if you have any of these symptoms while taking this drug:
    • 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

Other warnings

  • Risk of suicide warning: This drug may cause suicidal thoughts or actions in a small number of people. Call your doctor right away if you have any of these symptoms:
    • 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
  • Heart problems warning: This drug may cause an irregular heart rate. Symptoms can include:
    • Don’t stop taking this drug without your doctor’s guidance. Stopping this drug suddenly raises your risk of seizures. If you want to stop taking this drug, talk to your doctor about the best way to do it.
    • fast, slow, or pounding heart rate
    • shortness of breath
    • feeling lightheaded
    • fainting
  • Liver problems warning: This drug may raise your risk of live problems. Symptoms can include:
    • yellowing of your skin or the whites of your eyes
    • dark-colored urine
    • pain on the right side of your abdomen
    • bruising more easily than normal
    • loss of appetite
    • nausea or vomiting

About

What is carbamazepine?

Carbamazepine is a prescription drug. It comes in four forms: oral tablet, oral chewable tablet, oral suspension, and oral extended-release capsule.

Carbamazepine oral tablet is available as the brand-name drugs Tegretol, Tegretol XR, and Epitol. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in every strength or form as the brand-name drug.

Why it's used

Carbamazepine belongs to a class of drugs called anticonvulsants. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions.

Carbamazepine is used to treat two conditions:

  • Certain types of seizures caused by epilepsy. These seizures include:
    • partial seizures
    • generalized tonic-clonic (grand mal) seizures
    • mixed seizure patterns, which include the seizure types listed here or other partial or generalized seizures
  • Trigeminal neuralgia, a condition that causes facial nerve pain.

How it works

It’s not completely known how this drug treats epilepsy or trigeminal nerve pain. It is known to block sodium currents in your brain and body. This helps to reduce abnormal electrical activity between your nerve cells.

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Side effects

Carbamazepine side effects

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

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Interactions

Carbamazepine may interact with other medications

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
  • telithromycin
  • chloramphenicol
  • rifampin
  • rifabutin
  • rifapentine

Taking other 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:

  • ritonavir
  • indinavir
  • nelfinavir
  • saquinavir

Tuberculosis drug

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.

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.

Anti-depression drugs

Taking certain anti-depression 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

Taking nefazodone with carbamazepine will decrease the level of nefazodone in your body. Your doctor may monitor your blood levels of nefazodone and change your dosage of that drug.

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 thinner

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

HIV drugs

Taking certain HIV 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:

  • ritonavir
  • indinavir
  • nelfinavir
  • saquinavir

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
  • henobarbital

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 decrease the level of the cancer drug in your body. Your doctor may monitor your blood levels of that cancer drug and change your dosage of that drug if you take it with carbamazepine. 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 monitor your blood levels of that cancer drug and change your dosage of that 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.

Mental health 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:

  • loxapine
  • olanzapine
  • quetiapine

Taking aripiprazole with carbamazepine will decrease the levels of aripiprazole in your body.

Anti-rejection drug

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

Bipolar disorder drug

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

Tuberculosis drugs

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

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 one of these drugs with carbamazepine will make that respiratory drug less effective. This is because carbamazepine makes the body process the drug more quickly, which decreases the amount of it in your blood. These drugs include:

  • 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

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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Other warnings

Carbamazepine warnings

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 breastmilk. 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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Dosage

How to take carbamazepine

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

Brand: Epitol

  • Form: oral tablet
  • Strength: 200 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 12–17 years)

  • 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:
    • ages 12–15 years: 1,000 mg per day.
    • 15 years and older: 1,200 mg per day.

Child dosage (ages 6–12 years)

  • First dose: 100 mg taken 2 times per day.
  • Typical dosage: 400–800 mg per day.
  • Dosage changes: Each week, your doctor may increase your daily dose by 200 mg.
  • Maximum dosage: 1,000 mg per day.

Child dosage (ages 0–5 years)

  • First dose: 10–20 mg/kg per day. The dosage should be divided and taken 2–3 times each day.
  • Dosage changes: Your doctor may increase your 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 0–17 years)

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

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.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

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Take as directed

Take as directed

Carbamazepine oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you skip or miss doses: You may not see a full benefit of this drug for the treatment of your condition. If you double up your dose or take it too close to your next scheduled time, you may have a higher risk of serious side effects.

If you take too much: You may see an increased risk of side effects associated with this medication. If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, only take one dose at your scheduled time.

Never try to catch up by taking two doses at once. This could cause dangerous side effects.

If you don’t take it at all: Your condition won’t be treated and your symptoms may get worse.

How to tell if the drug is working: If you’re taking this drug for epilepsy: You should have fewer seizures.

If you’re taking this drug for trigeminal neuralgia: Your facial pain should get better.

Important considerations

Important considerations for taking carbamazepine

Keep these considerations in mind if your doctor prescribes carbamazepine for you.

General

  • You should take carbamazepine tablets with meals.
  • Follow these guidelines for consuming the tablet:
  • The extended-release tablets shouldn’t be crushed or chewed.
  • The 100-mg immediate-release tablet can be chewed.
  • The 200-mg immediate-release tablet can be crushed, but should not be chewed.

Storage

This drug must be stored at the right temperature.

  • Immediate-release tablets:
    • Don’t store this drug above 86°F (30°C).
    • Keep this drug away from light.
    • Keep it away from high temperature.
    • Don’t store this medication in moist or damp areas, such as bathrooms.
  • Extended-release tablets:
    • Store these tablets at 77°F (25°C). You can store them briefly at a temperature between 59°F and 86°F (15°C and 30°C).
    • Keep this drug away from light.
    • Keep it away from high temperature.
    • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Before and during your treatment with this drug, your doctor may do the following tests:

  • blood tests, such as:
    • genetic tests
    • blood cell counts
    • liver function tests
    • blood levels of carbamazepine
    • kidney function tests
    • electrolyte tests
  • eye exams
  • thyroid function tests
  • heart rhythm monitoring
  • monitoring for changes in your behavior

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Hidden costs

During your treatment with this drug, you may need to have monitoring tests such as:

  • blood tests
  • eye exams
  • thyroid function tests
  • heart rhythm monitoring

The cost of these tests will depend on your insurance coverage.

Self-management

Do not stop taking carbamazepine suddenly. Doing so raises your risk of seizures. If you want to stop taking this drug, talk to your doctor about the best way to do it.

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Alternatives

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained here in is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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