Tegretol (Carbamazepine) Oral: Uses, Side Effects, Dosage - Verywell Health
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What Is Tegretol?
Tegretol (carbamazepine) belongs to a class of drugs calledanticonvulsants, also known as anti-seizure or anti-epileptic drugs (AEDs). It is used to treat seizures and a nerve pain disorder called trigeminal neuralgia. Tegretol is also sometimes prescribed as a mood stabilizer in bipolar disorder. It works by decreasing abnormal electrical activity in the brain and nerves.
This prescription medication is available as a tablet, capsule, or liquid syrup. Carbamazepine is also available in generic versions and under several other brand names, including Carbatrol and Epitol, among others.
Drug Facts
Generic Name: Carbamazepine
Brand Name(s): Tegretol, Carbatrol, Epitol, Equetro, Tegretol-XR
Drug Availability: Prescription
Therapeutic Classification: Anticonvulsant
Available Generically: Yes
Controlled Substance: N/A
Administration Route: Oral
Active Ingredient: Carbamazepine
Dosage Form(s): Tablet, capsule, suspension
What Is Tegretol Used For?
Carbamazepine prevents and treats certain types of seizures, specifically focal (partial) seizures and generalized tonic-clonic seizures, known as the "classic" type of seizure.
A seizure refers to a burst of abnormal electrical activity that occurs in the brain. Seizures can cause uncontrolled movements, behaviors, and sensations and can cause you to pass out.
Carbamazepine also treats pain associated with trigeminal neuralgia, a condition that causes severe, stabbing nerve pain in the face.
Verywell / Dennis Madamba
How to Take Tegretol
Take this medication with meals to help prevent an upset stomach.
Carbamazepine is available as a tablet, chewable tablet, extended-release (long-acting) tablet, extended-release capsule, and liquid formulation.
The tablet, chewable tablet, and liquid suspension are taken three to four times a day, while extended-release tablets are taken twice a day.
Extended-Release Tablets
If you take the extended-release tablets, swallow them whole with a glass of water. Do not crush, chew, or break them. Be sure to tell your doctor if you are unable to swallow a pill whole.
Extended-Release Capsules
You do not need to take extended-release capsules with meals unless you experience an upset stomach. Do not crush or chew the capsule; you can sprinkle the contents of the capsule over a teaspoon of applesauce or similar food.
Liquid Form
If you are taking the liquid form of Tegretol, shake the bottle well before each use and avoid mixing it with other liquid medications. Also, use the dosing syringe or spoon provided by the pharmacist. Although using a device from home, like a kitchen spoon, may seem convenient, it can lead to accidental overdosing or underdosing.
Finally, it's important to always take Tegretol exactly as instructed by your doctor. Never stop taking the drug on your own.
If you have epilepsy—a condition that causes repeated seizures—stopping Tegretol suddenly can make you develop status epilepticus. Status epilepticus is a potentially life-threatening condition in which a person essentially has continuous seizure activity.
If at any time you have questions about your Tegretol, or you feel like it isn't helping you, don't hesitate to reach out to your healthcare team.
Storage
Store the Tegretol liquid suspension in a tightly closed, light-resistant container. Keep the tablets and chewables away from moisture and light.
Store the extended-release Tegretol tablets at room temperature and the other formulations at room temperature or at a temperature below 86 degrees F. Make sure your medication is out of reach of children and pets.
Off-Label Uses
Healthcare providers sometimes prescribe Tegretol off-label to treat other health conditions not specified by the FDA, including:
How Long Does Tegretol Take to Work?
It takes one to two weeks or more for Tegretol to reach a stable level in the bloodstream. However, you might feel its effects (e.g., pain relief from trigeminal neuralgia) within two to three days after starting the medicine or increasing its dose.
What Are the Side Effects of Tegretol?
This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
Here are the common, severe, and long-term side effects of taking Tegretol.
Common Side Effects
Some patients experience mild side effects when first starting Tegretol or when there is a dose increase. Your prescriber will start you at a low dose initially and then slowly increase it over time.
Common side effects include:
- Dizziness
- Sleepiness
- Problems with walking and balance
- Nausea and vomiting
Severe Side Effects
Serious side effects rarely occur when taking Tegretol.
Knowing which ones warrant an immediate call to your healthcare provider versus calling 911 or going to the nearest emergency room is helpful. That said, only basic guidance, not medical advice, is provided below. Always call 911 if you think your symptoms are potentially life-threatening.
Tegretol may increase your risk of suicidal thoughts and behavior.
Call your healthcare provider if you are experiencing:
- Depression, anxiety, or irritability that is new or getting worse
- Agitation or restlessness
- Trouble sleeping
- Panic attacks
- Angry, violent, aggressive, or impulsive outbursts
- Symptoms of mania (e.g., extreme energy or talking excessively fast)
- Any unusual or sudden changes in behavior or mood
Tegretol may also cause serious blood, heart, liver, or eye problems.
Call your healthcare provider if you are experiencing:
- Red or purple dots/spots/patches on your body
- Bleeding gums or nosebleeds
- Fever, sore throat, or persistent cold or flu symptoms
- Severe or unusual tiredness
- Easy bruising
- Fast, slow, or irregular heartbeat
- Unusual loss of appetite
- Nausea and/or vomiting
- Yellowing of your skin (jaundice)
- Dark urine
- Pain on the right side of your abdomen
- Blurry vision
Low sodium levels may also occur as a result of taking Tegretol.
Call your healthcare provider if you are experiencing:
- Headache
- New or increased number of seizures
- Problems with concentration or memory
- Confusion
- Weakness
- Feeling unsteady, like you might fall
Call 911 or go to your nearest emergency room if you or someone you know is experiencing:
- Thoughts of suicide or attempts at suicide
- Signs of a potentially fatal skin reaction to Tegretol (e.g., rash, hives, mouth sores, blistering or peeling skin)
- Signs of a dangerous allergic reaction to Tegretol (e.g., swelling of the face, eyes, lips, or tongue, or difficulty in swallowing or breathing)
- Signs of a severe drug reaction to Tegretol (e.g., fever, rash, swollen lymph nodes, and/or facial swelling)
People with specific genes—HLA-B*1502 and HLA-A*3101—have a greater chance of experiencing a severe skin or allergic reaction, respectively, to Tegretol. To prevent these reactions from occurring in the first place, your healthcare provider may test you for these genes before you begin taking Tegretol.
Long-Term Side Effects
If you are taking Tegretol for a long time, you are at risk of developing osteoporosis—a disease that causes your bones to weaken and break more easily.
Dosage: How Much Tegretol Should I Take?
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (extended-release capsules):
- For bipolar disorder:
- Adults—At first, 200 milligrams (mg) 2 times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 1600 mg per day.
- Children—Use and dose must be determined by your doctor.
- For epilepsy:
- Adults and children 12 years of age and older—At first, 200 milligrams (mg) 2 times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 500 to 800 mg 2 times a day.
- Children younger than 12 years of age—Dose is based on body weight and must be determined by your doctor. However, the dose is usually not more than 1000 mg per day.
- For trigeminal neuralgia:
- Adults—At first, 200 milligrams (mg) once a day. Your doctor may increase your dose as needed and tolerated. However, the dose is usually not more than 1200 mg per day.
- Children—Use and dose must be determined by your doctor.
- For bipolar disorder:
- For oral dosage form (extended-release tablets):
- For epilepsy:
- Adults—At first, 200 mg 2 times a day. Your doctor may adjust your dose if needed. However, the dose is usually not more than 1000 to 1600 mg per day.
- Children 6 to 12 years of age—At first, 100 mg 2 times a day. Your doctor may adjust your dose if needed. However, the dose is usually not more than 1000 mg per day.
- Children younger than 6 years of age—Dose is based on body weight and will be determined by your doctor. The dose is usually 10 to 20 milligram (mg) per kilogram (kg) per day, taken 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 35 mg per kg of body weight per day.
- For trigeminal neuralgia:
- Adults—At first, 100 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1200 mg per day.
- Children—Use and dose must be determined by your doctor.
- For epilepsy:
- For oral dosage form (oral liquid):
- For epilepsy:
- Adults—100 milligrams (mg) or 1 teaspoon 4 times a day (400 mg per day). Your doctor may adjust your dose as needed. However, the dose is usually not more than 1000 to 1600 mg per day.
- Children 6 to 12 years of age—At first, 50 milligrams (mg) or one-half teaspoon 4 times a day (200 mg per day). Your doctor may adjust your dose as needed. However, the dose is usually not more than 1000 mg per day.
- Children younger than 6 years of age—Dose is based on body weight and will be determined by your doctor. The dose is 10 to 20 milligrams (mg) per kilogram (kg) of body weight per day, taken 4 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 35 mg per kg of body weight per day.
- For trigeminal neuralgia:
- Adults—At first, 50 milligrams (mg) or one-half teaspoon 4 times a day (200 mg per day). Your doctor may adjust your dose as needed. However, the dose is usually not more than 1200 mg per day.
- Children—Use and dose must be determined by your doctor.
- For epilepsy:
- For oral dosage forms (tablets or chewable tablets):
- For epilepsy:
- Adults—At first, 200 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1000 to 1600 mg per day.
- Children 6 to 12 years of age—At first, 100 mg 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1000 mg per day.
- Children younger than 6 years of age—Dose is based on body weight and will be determined by your doctor. The dose is 10 to 20 milligrams (mg) per kilogram (kg) of body weight per day, taken 3 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 35 mg per kg of body weight per day.
- For trigeminal neuralgia:
- Adults and teenagers—At first, 100 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1200 mg per day.
- Children—Use and dose must be determined by your doctor.
- For epilepsy:
Modifications
Tegretol breaks down faster in children's bodies than in adults' bodies. Children's blood levels of Tegretol also tend to vary widely, which affects their dosing schedule. For instance, a child may need to take smaller doses more frequently throughout the day.
If you are pregnant or plan on becoming pregnant, talk to your health provider. Tegretol, like other anti-seizure medications, is associated with possible physical and mental congenital However, results from a 2021 study of women who took anti-seizure medication(s) during pregnancy found that the mental risks to the baby may not be as high as was once thought.
Keep in mind that most women in the above study took Lamictal (lamotrigine) and/or Keppra (levetiracetam), not Tegretol.
In general, it's best to talk with your healthcare provider well before becoming pregnant about the best medication to use for your seizures.
If you do take Tegretol or any anti-seizure medication while pregnant, you will need extra monitoring. You will likely be asked to enroll in a registry that collects information about the safety of drugs like Tegretol during pregnancy.
When you are pregnant, it's also important to talk with your health provider if you are thinking about breastfeeding. There is a potential for side effects in babies exposed to Tegretol through breast milk. Together, you and your provider can make the best decision for both your and your baby's health.
Missed Dose
If you miss a dose of your Tegretol, take it as soon as you think about it. An exception to this rule is if it's close to the time for your next dose. In that case, skip your "missed dose" and take the Tegretol at the next normally scheduled time.
As a reminder, don't take two doses simultaneously or an extra dose to make up for the missed dose. If you are missing doses often, talk with your healthcare provider to help you figure out why. You may consider using a pill container or setting an alarm on your phone or watch.
You may also consider asking to switch to the extended-release Tegretol tablet, which requires less frequent daily dosing.
Overdose: What Happens If I Take Too Much Tegretol?
Symptoms of a Tegretol overdose usually begin one to three hours after taking the drug.
Although not an exhaustive list, overdose symptoms may include:
- Muscle twitching and shaking
- Unusual movements
- Dizziness
- Fast heartbeat
- Nausea and vomiting
What Happens If I Overdose on Tegretol?
If you think you or someone else may have overdosed on Tegretol, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking Tegretol, call 911 immediately.
Precautions
It is very important that your doctor check you or your child's progress at regular visits. Your doctor may want to have certain tests done to see if you are receiving the right amount of medicine or if certain side effects may be occurring without you knowing it. Also, the amount of medicine you or your child are taking may have to be changed often.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
Do not take carbamazepine together with a monoamine oxidase inhibitor (MAOI) or during the first 14 days after you stop taking a MAOI. MAOIs are used for depression and some examples are isocarboxazid (Marplan®), phenelzine (Nardil®), procarbazine (Matulane®), selegiline (Eldepryl®), or tranylcypromine (Parnate®). Do not use this medicine together with nefazodone (Serzone®) and certain medicines for HIV/AIDS (such as delavirdine, efavirenz, Atripla®, Sustiva®, Rescriptor®).
Carbamazepine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these unwanted effects, tell your doctor right away.
Check with your doctor right away if a fever, sore throat, rash, ulcers in the mouth, nosebleeds, bleeding gums, swollen glands, or small red or purple spots on the skin occur. These could be symptoms of a serious blood problem.
Serious skin reactions can occur with this medicine. Check with your doctor right away if you or your child have blistering, peeling, or loose skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, a fever, or chills while you are using this medicine.
Check with your doctor right away if you have a fever, chills, cough, swelling of the face, sore throat, swollen, painful, or tender lymph glands in the neck, armpit, or groin, or yellow skin or eyes while using this medicine. These could be symptoms of a serious condition called drug reaction with eosinophilia and systemic symptoms (DRESS).
This medicine may cause serious allergic reactions, including anaphylaxis and angioedema. These can be life-threatening and require immediate medical attention. Tell your doctor right away if you or your child have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after using this medicine.
This medicine will add to the effects of alcohol and other CNS depressants (medicines that cause drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures (eg, barbiturates), muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you or your child are using this medicine.
This medicine may cause some people to become drowsy, dizzy, lightheaded, or less alert than they are normally, especially when they are starting treatment or increasing the dose. It may also cause blurred or double vision, weakness, or loss of muscle control in some people. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
Check with your doctor immediately if blurred vision, difficulty in reading, or any other changes in vision occur during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
Some people who take carbamazepine may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine:
- Stay out of direct sunlight, especially between the hours of 10:00 AM and 3:00 PM, if possible.
- Wear protective clothing, including a hat. Also, wear sunglasses.
- Apply a sun block product that has a sun protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor.
- Apply a sun block lipstick that has an SPF of at least 15 to protect your lips.
- Do not use a sunlamp or tanning bed or booth.
If you have a severe reaction from the sun, check with your doctor.
Before having any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some pregnancy tests may be affected by this medicine.
Do not stop taking this medicine without first checking with your doctor. Your doctor may want you or your child to gradually reduce the amount you are using before stopping it completely. This may help prevent worsening of seizures and reduce the possibility of withdrawal symptoms.
Birth control pills containing estrogen may not work properly if you take them while you are taking carbamazepine. Unplanned pregnancies may occur. Use a different or additional means of birth control while you are taking carbamazepine. If you have any questions about this, check with your doctor.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are Reasons I Shouldn't Take Tegretol?
You should not take Tegretol if you have a known allergy or sensitivity to carbamazepine or any of its ingredients or to a class of drugs called tricyclic antidepressants.
You should also not take Tegretol if you take a medication used to treat depression called Serzone (nefazodone).
In addition, talk to your healthcare provider if you are taking a monoamine oxidase (MAO) inhibitor. You will need to stop taking your MAO inhibitor at least two weeks before starting Tegretol.
Finally, patients with a history of bone marrow depression, certain types of heart rhythm problems (called AV block), or a rare condition called acute intermittent porphyria should not take Tegretol.
What Other Medications Interact With Tegretol?
Several medications may interact with Tegretol. If you are taking a medicine that interacts with Tegretol, your healthcare provider may need to adjust your dose, choose a different medicine, and/or order special tests for monitoring purposes.
This is not a complete list, but some common medications that may increase the blood levels of Tegretol in your body include:
Of note, grapefruit juice has a similar effect. Avoid drinking this kind of juice while taking Tegretol.
Some medications that can decrease the blood levels of Tegretol in your body include:
Tegretol may also alter the blood concentrations of other medications.
Examples of these medications include:
Before starting Tegretol, tell your healthcare team about all the medications you are taking, including prescription and over-the-counter drugs, herbal products, supplements, vitamins, and recreational drugs.
What Medications Are Similar?
Besides Tegretol, there are many other anti-seizure medications that your healthcare provider may consider prescribing.
The drug that most closely resembles Tegretol in its structure, how it works, and its side effect profile is Trileptal (oxcarbazepine). The Food and Drug Administration (FDA) approved Trileptal to treat partial seizures. Trileptal is sometimes used off-label to treat trigeminal neuralgia.
Tegretol and Trileptal control seizures by blocking "gates" called sodium channels in nerve cells. This blockage reduces waves of abnormal electrical activity from occurring in the brain.
Other anti-seizure drugs that work primarily by interacting with sodium channels include:
Sorting through which anti-seizure medication (or combination, in some cases) is safest and most effective for you can be a trial-and-error process. Your prescriber will consider your specific condition and the drug's potential for side effects and interactions with other substances.
How Can I Stay Healthy While Taking Tegretol?
Your best bet for staying healthy is to take your Tegretol regularly and as instructed by your prescriber. Your brain needs a constant and steady stream of medication to prevent seizures.
When you miss Tegretol doses, the levels of the drug in your bloodstream rise and fall erratically, which puts you at risk of having a seizure. Missed doses also increase your chances of experiencing unpleasant side effects.
During your appointments, whether virtual or in-person, remember to be open with your health provider—they care about you and are there to help optimize your health.
Last but not least, please reach out to loved ones or a support group for a shoulder to lean on or a listening ear. Epilepsy can be a heavy, life-altering diagnosis. You deserve emotional support as you move forward in feeling your best, despite your disease.
Medical Disclaimer
Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
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