Carbamazepine
TEGRETOL
What it isSodium-channel-blocking antiepileptic; focal seizures, trigeminal neuralgia, and bipolar mania.
Why this oneIt remains 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.
FDA-approved for
- seizures (1968)
- trigeminal neuralgia (1974)
- bipolar mania (2004)
Off-label
- neuropathic pain
- alcohol withdrawal
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
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
⚠ BOXED WARNINGS
- Serious dermatologic reactions and HLA-B*1502 allele
- Aplastic anemia and agranulocytosis
Cost, est. cash$5–$150/month
Generic entry1986
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilitySerious rash, aplastic anemia/agranulocytosis, hyponatremia and extensive enzyme induction.
Mechanism of action: Carbamazepine ballicule
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