Carbamazepine (Tegretol®)

This article provides a comprehensive overview of carbamazepine, including the conditions it’s used for, possible side effects, precautions, and drug interactions.

Key Takeaways:

• Carbamazepine is an anti-seizure medication that helps treat several forms of seizures, as well as bipolar disorder, nerve pain, and other conditions. It works by controlling excessive electrical activity in the brain and nervous system.
• Common side effects include drowsiness, dizziness, and nausea, among others. Some people may experience rare but severe side effects, such as rare skin reactions, liver toxicity, or decreased white blood cell count.
• Many medications and other substances may interact with carbamazepine, including a variety of mental health medications, antibiotics, and oral contraceptives. Your doctor will determine if carbamazepine is safe and effective for you.

Understanding Carbamazepine

Carbamazepine is a medication in the category of anticonvulsants (which are now more accurately termed “antiseizure medications”). It was initially approved as an antiepileptic drug in Great Britain and Switzerland as far back as 1963, and was initially approved in the United States for epilepsy in 1968. ^[1]

Due to the unique effects it has in the brain, carbamazepine has been used not only for seizures, but also for bipolar disorder, trigeminal neuralgia, and other conditions. It is only available as a prescription. ^[2]

How it Works

Generally, carbamazepine works by slowing down excessive activity in the brain and nervous system. It helps prevent the build-up of excessive electrical signals from building up in the brain, while also reducing the release of glutamate. Together, these effects help reduce the intensity and frequency of seizures. ^{[2] [3]}

The effects on glutamate are also a possible beneficial mechanism for bipolar disorder, although the way it works for this disorder isn’t fully understood.

Lastly, carbamazepine may help individuals with nerve pain by slowing down pain signals that are sent to the brain.

Brand Names

Tegretol® is the most common brand name for carbamazepine. Tegretol® is available as immediate-release and extended-release tablets and an oral suspension. ^[4]

Other brand names of carbamazepine include: ^[4]

*

• Carbatrol®
• Extended-release capsules
• Equetro®
• Extended-release capsules
• Epitol®
• Tablets
• Teril®
• Tablets

Conditions Carbamazepine is Used For

There are several carbamazepine uses, which include approved and off-label uses. In the United States, carbamazepine is FDA-approved to treat the following conditions: ^[2]

• Epilepsy
• Trigeminal neuralgia (this is a condition that causes facial nerve pain)
• Acute manic and mixed episodes in Bipolar I disorder

Within epilepsy, carbamazepine can help treat several forms of seizures, including partial seizures with complex symptoms, generalized tonic seizures, and mixed seizures. ^[2]

Regarding carbamazepine for bipolar disorder, it helps control symptoms of both manic and mixed episodes. Manic episodes involve a variety of “overexcitable” symptoms, such as euphoria, frenzied or irritated mood, and reckless behaviors. Mixed episodes involve symptoms of both manic episodes and depressive episodes (e.g., low mood, lack of pleasure, trouble thinking). ^{[2] [4]}

In addition to these approved uses, carbamazepine is sometimes prescribed off-label for various conditions, including: ^{[1] [2]}

• Certain forms of schizophrenia
• Restless legs syndrome
• Agitation and aggression within dementia
• General nerve pain
• Fibromyalgia
• Maintenance therapy for bipolar disorder
• Adjuvant treatment for alcohol withdrawal syndrome
• Benzodiazepine withdrawal
• Psychosis within Alzheimer’s

Carbamazepine Side Effects

There are many possible side effects of carbamazepine. Some of these may diminish or resolve as your body adjusts to the medication, while others may not go away completely or at all, even with continued use. Staying in contact with your doctor is essential to minimize the risk of any carbamazepine side effects.

The most common side effects of carbamazepine are: ^{[2] [3] [4] [5]}

• Dizziness
• Drowsiness
• Nausea
• Vomiting
• Ataxia (poor muscle control that affects walking, balance, and general movement)
• Headache
• Dry mouth
• Constipation
• Double or blurry vision

Other relatively common side effects that may occur with carbamazepine are: ^{[2] [3]}

• Difficulty speaking
• Abnormal thought processes
• Uncontrollable shaking of a part of the body
• Weight gain

Dangerous and Rare Side Effects

Carbazepine may cause dangerous or potentially life-threatening side effects in some individuals. While rare, these side effects should be reported immediately to your doctor or whoever prescribed the medication.

Carbamazepine may cause a variety of severe skin reactions, such as Stevens-Johnson syndrome. This can cause flu-like symptoms, along with a red or purple rash that spreads to other areas of the body and forms blisters. Other possible skin reactions include toxic epidermal necrolysis and maculopapular eruptions. Also, individuals of Asian descent should be screened for HLA-B\*1502 before starting carbamazepine, because carrying this gene can result in a deadly skin reaction.

^[2]

Other possible severe carbamazepine side effects include: ^{[2] [3] [5]}

• Agranulocytosis: Decreased white blood cell count
• Aplastic anemia: Deficiency of all types of blood cells due to a lack of bone marrow development
• Liver toxicity
• Kidney toxicity
• Central nervous system (CNS) depression
• Suicidal ideation
• Low sodium levels in the blood
• Worsened heart failure
• Heart dysfunction
• Allergic reactions (swelling of the eyes, lips, face; trouble breathing or swallowing)

The above lists may not contain all possible side effects. Talk to your doctor about any side effects or unusual reactions you notice when taking carbamazepine. Side effects are more likely to occur when you first start taking carbamazepine or when the dosage is changed.

Precautions

Several precautions with carbamazepine are important to understand. Carbamazepine is contraindicated for individuals with a known allergy or hypersensitivity to it, as well as a known allergy to tricyclic antidepressants. Carbamazepine is also contraindicated for individuals with bone marrow depression. ^{[1] [2]}

Due to the potential interactions with monoamine oxidase inhibitors (MAOIs), MAOIs need to be discontinued for at least 14 days before starting carbamazepine. ^[2]

Certain individuals are more likely to experience side effects, especially those with the following conditions or symptoms: ^{[2] [4]}

• Glaucoma
• Irregular heartbeat
• Other heart problems
• Kidney, thyroid, or liver disease
• Depression
• Suicidal thoughts or actions
• Other mental health problems

Always tell your doctor about any medical conditions you have to ensure safe and appropriate treatment.

Considerations and Risks

Carbamazepine may increase the risk of delirium in elderly individuals. Older adults may require a lower dose and more careful monitoring. ^[4]

There is an increased risk of birth defects when using carbamazepine. Use during pregnancy requires a careful weighing of the risks and benefits. ^[2]

Carbamazepine is very likely to decrease the effectiveness of hormonal contraceptives. Therefore, other forms of birth control should be used if you’re taking carbamazepine. ^[4]

Carbamazepine may cause drowsiness or dizziness. This may impact your ability to drive, operate machinery, or perform other mental or physical tasks. It may also increase the risk of falls and injuries. Don’t take carbamazepine in these situations until you know how it affects you, and after your doctor approves it. ^[4]

Carbamazepine Interactions

Carbamazepine may interact with a variety of medications, drugs, and other substances. Listed below are common classes of medications (with some examples) that may negatively interact with carbamazepine: ^{[3] [4] [6]}

• Other anti-seizure medications (e.g., phenytoin, valproic acid, lamotrigine)
• Selective-serotonin reuptake inhibitors (e.g., escitalopram)
• MAOIs (e.g. selegiline, moclobemide)
• A variety of serotonin-based antidepressants (e.g., nefazodone, trazodone)
• Barbiturates (e.g., phenobarbital)
• Antifungal medications (e.g., ketoconazole)
• Antibiotics (e.g., ciprofloxacin, erythromycin)
• Medications for heartburn or reflux (e.g., cimetidine, omeprazole)
• Certain heart medications (e.g., diltiazem, verapamil)
• Warfarin and other blood-thinning medications
• Oral contraceptives
• Certain antiviral medications (e.g., ritonavir)
• Immunosuppressants, specifically those used after organ transplants (e.g. tacrolimus, cyclosporine)
• St. John’s Wort
• Certain painkillers (e.g., acetaminophen, ibuprofen)

In addition, alcohol may worsen drowsiness or other side effects of carbamazepine. Do not drink alcohol while using this medication.

Carbamazepine may also interact with grapefruit or grapefruit juice.

This list does not contain all possible drug interactions. Tell your doctor everything you currently take or have taken, including prescription and over-the-counter medicines, herbs, vitamins, and supplements.

Carbamazepine Dosage

Carbamazepine is available as tablets (200 mg), an oral suspension (100mg/5 mL), extended-release tablets (100, 200, and 400 mg), and extended-release capsules (100, 200, and 300 mg). All forms are taken orally. ^[5]

In general, daily doses range from 200 to 1,600 mg. Patients typically start with a low dose of 100 to 200 mg, 1 to 4 times per day. This is then gradually increased over several weeks until the optimal dose is achieved. ^{[3] [5]}

Listed below are common carbamazepine dosages for the approved indications: ^[3]

• Seizures: 800 to 1,200 mg
• Trigeminal neuralgia (and other nerve pain): 600 to 800 mg
• Bipolar disorder: 400 to 600 mg

The total daily dose may be taken once daily or split in up to 4 divided doses. Your doctor will determine the most appropriate dosage and protocol for you.

What to Do in the Event of An Overdose

If you overdose on carbamazepine, contact your poison control center or your doctor. If the situation is difficult or life-threatening, contact 911 or your local emergency number right away.

There are many possible symptoms of overdose, including: ^[4]

• Restlessness
• Muscle twitching
• Abnormal movements
• Shaking
• Unsteadiness
• Drowsiness
• Dizziness
• Vision changes
• Irregular or slowed breathing
• Rapid or pounding heartbeat
• Nausea
• Vomiting
• Trouble urinating

Severe overdoses can lead to seizures, coma, or significant breathing problems.

Carbamazepine FAQs

Listed below are frequently asked questions about the use of carbamazepine. Talk to your doctor if you have any other questions or concerns regarding carbamazepine.

Does carbamazepine cause weight gain?

Some people may experience weight gain after taking carbamazepine. This side effect does not happen in everyone.

Is carbamazepine safe in pregnancy?

There is an increased risk of birth defects if carbamazepine is taken during pregnancy. It is only used during pregnancy if the benefits strongly outweigh the risks.

What happens if you stop taking carbamazepine suddenly?

Suddenly stopping carbamazepine is unsafe and increases the risk of side effects, such as seizures.

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

David MilesPharmD

David is a seasoned Pharmacist, natural medicines expert, medical reviewer, and pastor.

Activity History - Medically reviewed on April 9, 2026 and last checked on March 19, 2026