Carbamazepine has been on the market for over 50 years. Here’s what you need to know.

Anticonvulsants Prescription medicines Medication safety Medicine Elementary

The bottom line

Carbamazepine is used for seizures, trigeminal neuralgia, and bipolar disorder. Side effects include drowsiness, dizziness, headache, fatigue, ataxia, blurry vision, nausea, vomiting, and dry mouth. More serious side effects include severe rashes, blood problems, liver, and kidney toxicity. Carbamazepine interacts with many other medications, as well as with grapefruit and grapefruit juice.

Prevention Tips

Store carbamazepine up, away, and out of reach of children.
Take as prescribed.
Do not take more than prescribed or more often than prescribed.
Shake liquid suspension well before each use.
Do not double your doses if you miss a dose.
Store at room temperature, away from heat and moisture. Do not put in direct sunlight.
Discuss possibility of drug interactions with your doctor or pharmacist.
Avoid grapefruit juice and grapefruit.
Contact your doctor immediately if you develop a rash, unusual bruising, sore throat, fever, yellowing of skin or eyes, dark urine.
Contact your doctor if you have confusion or fatigue which may mean that your sodium levels are low.
Do not stop this medication suddenly since this may cause your seizures to return.

This Really Happened

A 16-year-old girl on carbamazepine for generalized seizures ingested 20 grams of her medication in a suicide attempt. She was found 14 hours later in a coma responding to pain only. The serum carbamazepine level was elevated. Her stomach was pumped at 16 hours after ingestion. At 23 hours she was mostly unresponsive but became combative when aroused. At 36 hours she was alert with abnormal eye movements (nystagmus) and unsteady walking (ataxia). She was asymptomatic 54 hours after the overdose.

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What carbamazepine prescribed for?

Carbamazepine is prescribed for partial and tonic-clonic seizures, trigeminal neuralgia (facial nerve pain), and acute manic or mixed episodes in bipolar disorder. Off-label uses include other psychiatric conditions, alcohol withdrawal, restless leg syndrome, and diabetic neuropathy.

How does carbamazepine work?

Carbamazepine blocks sodium channels which decrease the brain activity that causes seizures. It also controls calcium channels and reduces the excitatory transmitter glutamate. It increases dopamine turnover and increases the inhibitory transmitter GABA. For trigeminal neuralgia, it prevents transmission of pain signals by stabilizing nerve membranes.

What are the side effects of carbamazepine?

Side effects include drowsiness, dizziness, headache, fatigue, wobbly walking, blurry vision, nausea, vomiting, and dry mouth. Other effects include fluid retention, weight gain, and rashes. Serious side effects include severe skin reactions, blood problems (aplastic anemia, agranulocytosis), low sodium levels, and liver or kidney toxicity. It can also cause rigidity-hyperthermia syndrome (neuroleptic malignant syndrome, serotonin syndrome) in combination with other drugs. Carbamazepine can also cause depression with suicidal thoughts.

Is carbamazepine a controlled substance?

No, carbamazepine is not a controlled substance. It is available by prescription only. Its brand name is Tegretol, which is available as immediate-release tablets, chewable tablets, extended-release tablets and capsules, and oral suspension. Generic formulations are also available.

What should I avoid while taking carbamazepine?

You should avoid alcohol and other central nervous system depressants because of the increased risk of drowsiness and dizziness. Also avoid driving or doing anything dangerous until you determine how this medication affects your coordination. Carbamazepine interacts with many other medications due to effects on liver metabolism, so talk to your doctor or pharmacist about drug interactions. Avoid grapefruit or grapefruit juice since they can increase the level of carbamazepine in your body. You should also avoid stopping carbamazepine abruptly since this may cause seizures to return.

What should I do if someone accidentally takes carbamazepine or takes too much carbamazepine?

If someone accidentally takes a dose of someone else’s carbamazepine or takes a double dose of their own carbamazepine, severe toxicity is unlikely, although there is increased risk of drowsiness and dizziness. Seek medical advice, especially if symptoms are present. Overdoses of carbamazepine can cause more serious toxicity including movement disorders, dilated pupils, involuntary eye movements, myoclonus (jerky muscle movements) increase or decrease heart rate, abnormal EKG, fever, seizures, coma, and respiratory arrest. Immediate medical attention is needed.

If someone swallows carbamazepine or if you have a question about using carbamazepine safely, use the webPOISONCONTROL^® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.