Carbamazepine
TEGRETOL
Pronunciation: kar-ba-MAZ-e-peen
“Tiger tail (in the) Car maze”
Shredder inDucer
What it isSodium-channel-blocking antiepileptic; focal seizures and trigeminal neuralgia. Bipolar mania is approved for the ER capsule EQUETRO.
Why this oneRemains the reference first-line treatment for trigeminal neuralgia, unlike most other mood stabilizers.
What limits itStrong enzyme induction and autoinduction destabilize combinations and dosing; screen relevant ancestry for HLA-B*1502 and monitor sodium and blood counts.
Pearls
- Avoid in pregnancy: malformations and neonatal vitamin K–deficient bleeding.
- Humid storage causes tablet concretion and therapeutic failure.
- Only Equetro (ER) is FDA-approved for bipolar mania.
- Usual serum level 4–12 mcg/mL; ER causes fewer CNS effects.
Carbamazepine prescription history
Animated chart of estimated U.S. prescriptions per year, Antiseizure meds (1869–2026). Carbamazepine enters in 1968 (estimated).
FDA-approved for
- seizures (1968)
- trigeminal neuralgia (1974)
- bipolar I mania and mixed episodes, as EQUETRO (2004)
Off-label
- neuropathic pain
- alcohol withdrawal
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilitySerious rash, aplastic anemia/agranulocytosis, hyponatremia and extensive enzyme induction.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Epilepsy | Adults & children >12 yr | 200 mg BID (400 mg/day) | 800–1200 mg/day | 1000 mg/day (12–15 yr); 1200 mg/day (>15 yr) |
| Epilepsy | Children 6–12 yr | 100 mg BID (200 mg/day) | 400–800 mg/day | 1000 mg/day |
| Epilepsy | Children <6 yr | 10–20 mg/kg/day | <35 mg/kg/day | 35 mg/kg/day |
| Trigeminal neuralgia | Adults | 100 mg BID (200 mg/day) | 400–800 mg/day | 1200 mg/day |
Titration Epilepsy: increase at weekly intervals; trigeminal neuralgia: increase up to 200 mg/day using 100 mg every 12 h
Renal Undefined
Hepatic Undefined
Do not exceed 35 mg/kg/day in children <6 yr
Instructions
- Take with meals
- Extended-release tablets: swallow whole, do not crush or chew
- Do not give suspension simultaneously with other liquid medications/diluents
- Reduce dose gradually; do not discontinue abruptly in epilepsy
Available strengths
- tab 100, 200 mg
- ER cap 100, 200, 300 mg
- ER tab 100, 200, 400 mg
- chew tab 100, 200 mg
- susp 100 mg/5 mL
Contraindications
- History of bone marrow depression
- Known sensitivity to tricyclic compounds (e.g., amitriptyline, imipramine, nortriptyline)
- MAOIs (concurrently or within 14 days)
- Coadministration with nefazodone (subtherapeutic nefazodone levels)
Cautions
- Serious dermatologic reactions (SJS/TEN; HLA-B*1502)
- Aplastic anemia/agranulocytosis, thrombocytopenia, leukopenia
- Hyponatremia/SIADH
- Hepatotoxicity
- Cardiac conduction disturbances (AV block)
- Suicidal ideation/behavior (AED class)
Adverse reactions
- Dizziness
- Drowsiness
- Unsteadiness/ataxia
- Nausea/vomiting
- Aplastic anemia/agranulocytosis (serious)
- SJS/TEN (serious)
- Hepatitis (serious)
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 100 mg | tab | 60 BID | not offered | |
| 200 mg | tab | 60 BID | $7.16 | offered |
Other forms: Carbamazepine ER capsules (CARBATROL) · Carbamazepine ER (Equetro) · Carbamazepine XR (TEGRETOL-XR)
Generic entry1986
Active metabolites
Open Carbamazepine in the interactive console ↗
Memory aids: interaction avatars
Open Carbamazepine in the interactive console ↗
Self-check
- Which HLA allele is screened in relevant ancestry before carbamazepine?
HLA-B*1502. - Which laboratory measures need monitoring with carbamazepine?
Sodium and blood counts.