- Does Tegretol (carbamazepine) cause side effects?
- What are the important side effects of Tegretol (carbamazepine)?
- Tegretol (carbamazepine) side effects list for healthcare professionals
- Does Tegretol (carbamazepine) cause addictionn or withdrawal symptoms?
- What drugs interact with Tegretol (carbamazepine)?
Does Tegretol (carbamazepine) cause side effects?
Recurrent seizures (epilepsy) are divided into two main categories according to how much of the brain is involved, either partial or generalized epilepsy (which includes petit mal, grand mal, and myoclonic epilepsy). Seizures are called "simple" if there is no loss of consciousness and "complex" if there is.
Tegretol works as an anticonvulsant for partial and grand mal seizures by reducing or blocking certain responses by nerves in the brain. It also is used for treating trigeminal neuralgia. One dosage form, Equetro, has been approved for treating bipolar disorder.
Common side effects of Tegretol include
Serious side effects of Tegretol include
- dangerously low red and white blood cell counts,
- severe skin reactions,
- serious liver abnormalities (such as hepatitis, resulting in jaundice),
- low sodium levels,
- thyroid abnormalities, and
- an increased risk of suicidal thinking and behavior.
Drug interactions of Tegretol include phenobarbital, phenytoin, or primidone, because lower levels of Tegretol are seen when administered with these drugs. Warfarin, phenytoin, theophylline, and valproic acid are more rapidly eliminated with Tegretol, while Tegretol levels are elevated when taken with erythromycin, cimetidine, propoxyphene, and calcium channel blockers.
What are the important side effects of Tegretol (carbamazepine)?
Serious side effects include dangerously low red and white blood cell counts. Severe skin reactions can occur as well as serious liver abnormalities, such as hepatitis, resulting in jaundice. Low sodium levels and thyroid abnormalities have been described.
Minor more common side effects include
Rarely, patients with Asian ancestry may develop severe skin reactions to carbamazepine (Stevens-Johnson syndrome and toxic epidermal necrolysis). These patients can be identified by genetic testing, and such testing is recommended for all patients who are Asian before starting therapy.
Antiepileptic medications have been associated with an increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need.
Patients who are started on therapy should be closely observed for
- clinical worsening,
- suicidal thoughts, or
- unusual changes in behavior.
Tegretol (carbamazepine) side effects list for healthcare professionals
If adverse reactions are of such severity that the drug must be discontinued, the physician must be aware that abrupt discontinuation of any anticonvulsant drug in a responsive epileptic patient may lead to seizures or even status epilepticus with its life-threatening hazards.
The most frequently observed adverse reactions, particularly during the initial phases of therapy, are
- nausea, and
To minimize the possibility of such reactions, therapy should be initiated at the lowest dosage recommended.
The following additional adverse reactions have been reported:
- Aplastic anemia,
- bone marrow depression,
- acute intermittent porphyria,
- variegate porphyria,
- porphyria cutanea tarda.
- Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS),
- Acute Generalized Exanthematous Pustulosis (AGEP),
- pruritic and erythematous rashes,
- photosensitivity reactions,
- alterations in skin pigmentation,
- exfoliative dermatitis,
- erythema multiforme and nodosum,
- aggravation of disseminated lupus erythematosus,
- onychomadesis and hirsutism.
In certain cases, discontinuation of therapy may be necessary.
- Congestive heart failure,
- aggravation of hypertension,
- syncope and collapse,
- aggravation of coronary artery disease,
- arrhythmias and AV block,
- thromboembolism (e.g., pulmonary embolism), and
- adenopathy or lymphadenopathy.
- Abnormalities in liver function tests,
- cholestatic and hepatocellular jaundice,
- very rare cases of hepatic failure.
- Urinary frequency,
- acute urinary retention,
- oliguria with elevated blood pressure,
- renal failure, and
Testicular atrophy occurred in rats receiving Tegretol orally from 4 to 52 weeks at dosage levels of 50 to 400 mg/kg/day. Additionally, rats receiving Tegretol in the diet for 2 years at dosage levels of 25, 75, and 250 mg/kg/day had a dose-related incidence of testicular atrophy and aspermatogenesis.
- disturbances of coordination,
- blurred vision,
- visual hallucinations,
- transient diplopia,
- oculomotor disturbances,
- speech disturbances,
- abnormal involuntary movements,
- peripheral neuritis and paresthesias,
- depression with agitation,
- neuroleptic malignant syndrome.
There have been reports of associated paralysis and other symptoms of cerebral arterial insufficiency, but the exact relationship of these reactions to the drug has not been established.
Isolated cases of neuroleptic malignant syndrome have been reported both with and without concomitant use of psychotropic drugs.
- gastric distress and abdominal pain,
- anorexia, and
- dryness of the mouth and
- glossitis and
Although a direct causal relationship has not been established, many phenothiazines and related drugs have been shown to cause eye changes.
- Aching joints and muscles, and
- leg cramps.
Decreased levels of plasma calcium have been reported. Osteoporosis has been reported.
Isolated cases of a lupus erythematosus-like syndrome have been reported. There have been occasional reports of elevated levels of cholesterola>, HDL cholesterol, and triglycerides in patients taking anticonvulsants.
A case of aseptic meningitis, accompanied by myoclonus and peripheral eosinophilia, has been reported in a patient taking carbamazepine in combination with other medications. The patient was successfully dechallenged, and the meningitis reappeared upon rechallenge with carbamazepine.
Does Tegretol (carbamazepine) cause addictionn or withdrawal symptoms?
Drug Abuse And Dependence
No evidence of abuse potential has been associated with Tegretol, nor is there evidence of psychological or physical dependence in humans.
What drugs interact with Tegretol (carbamazepine)?
There has been a report of a patient who passed an orange rubbery precipitate in his stool the day after ingesting Tegretol suspension immediately followed by Thorazine solution. Subsequent testing has shown that mixing Tegretol suspension and chlorpromazine solution (both generic and brand name) as well as Tegretol suspension and liquid Mellaril, resulted in the occurrence of this precipitate.
Because the extent to which this occurs with other liquid medications is not known, Tegretol suspension should not be administered simultaneously with other liquid medicinal agents or diluents. Clinically meaningful drug interactions have occurred with concomitant medications and include (but are not limited to) the following:
Agents That May Affect Tegretol Plasma Levels
- When carbamazepine is given with drugs that can increase or decrease carbamazepine levels, close monitoring of carbamazepine levels is indicated and dosage adjustment may be required.
Agents That Increase Carbamazepine Levels
- CYP3A4 inhibitors inhibit Tegretol metabolism and can thus increase plasma carbamazepine levels.
- Drugs that have been shown, or would be expected, to increase plasma carbamazepine levels include aprepitant, cimetidine, ciprofloxacin, danazol, diltiazem, macrolides, erythromycin, troleandomycin, clarithromycin, fluoxetine, fluvoxamine, trazodone, olanzapine, loratadine, terfenadine, omeprazole, oxybutynin, dantrolene, isoniazid, niacinamide, nicotinamide, ibuprofen, propoxyphene, azoles (e.g., ketaconazole, itraconazole, fluconazole, voriconazole), acetazolamide, verapamil, ticlopidine, grapefruit juice, and protease inhibitors.
- Human microsomal epoxide hydrolase has been identified as the enzyme responsible for the formation of the 10,11-transdiol derivative from carbamazepine-10,11 epoxide.
- Coadministration of inhibitors of human microsomal epoxide hydrolase may result in increased carbamazepine-10,11 epoxide plasma concentrations.
- Accordingly, the dosage of Tegretol should be adjusted and/or the plasma levels monitored when used concomitantly with loxapine, quetiapine, or valproic acid.
Agents That Decrease Carbamazepine Levels
- CYP3A4 inducers can increase the rate of Tegretol metabolism. Drugs that have been shown, or that would be expected, to decrease plasma carbamazepine levels include cisplatin, doxorubicin HCl, felbamate, fosphenytoin, rifampin, phenobarbital, phenytoin, primidone, methsuximide, theophylline, aminophylline.
Effect Of Tegretol On Plasma Levels Of Concomitant Agents
Decreased Levels of Concomitant Medications
Tegretol is a potent inducer of hepatic 3A4 and is also known to be an inducer of CYP1A2, 2B6, 2C9/19 and may therefore reduce plasma concentrations of co-medications mainly metabolized by CYP 1A2, 2B6, 2C9/19 and 3A4, through induction of their metabolism.
When used concomitantly with Tegretol, monitoring of concentrations or dosage adjustment of these agents may be necessary:
- When carbamazepine is added to aripiprazole, the aripiprazole dose should be doubled. Additional dose increases should be based on clinical evaluation. If carbamazepine is later withdrawn, the aripiprazole dose should be reduced.
- When carbamazepine is used with tacrolimus, monitoring of tacrolimus blood concentrations and appropriate dosage adjustments are recommended.
- The use of concomitant strong CYP3A4 inducers such as carbamazepine should be avoided with temsirolimus. If patients must be coadministered carbamazepine with temsirolimus, an adjustment of temsirolimus dosage should be considered.
- The use of carbamazepine with lapatinib should generally be avoided. If carbamazepine is started in a patient already taking lapatinib, the dose of lapatinib should be gradually titrated up. If carbamazepine is discontinued, the lapatinib dose should be reduced.
- Concomitant use of carbamazepine with nefazodone results in plasma concentrations of nefazodone and its active metabolite insufficient to achieve a therapeutic effect. Coadministration of carbamazepine with nefazodone is contraindicated.
- Monitor concentrations of valproate when Tegretol is introduced or withdrawn in patients using valproic acid.
In addition, Tegretol causes, or would be expected to cause, decreased levels of the following drugs, for which monitoring of concentrations or dosage adjustment may be necessary:
- corticosteroids (e.g., prednisolone, dexamethasone),
- dihydropyridine calcium channel blockers (e.g., felodipine),
- oral and other hormonal contraceptives,
- protease inhibitors,
- tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline),
Other Drug Interactions
Cyclophosphamide is an inactive prodrug and is converted to its active metabolite in part by CYP3A. The rate of metabolism and the leukopenic activity of cyclophosphamide are reportedly increased by chronic coadministration of CYP3A4 inducers. There is a potential for increased cyclophosphamide toxicity when coadministered with carbamazepine.
- Concomitant administration of carbamazepine and lithium may increase the risk of neurotoxic side effects.
- Concomitant use of carbamazepine and isoniazid has been reported to increase isoniazid-induced hepatotoxicity.
- Alterations of thyroid function have been reported in combination therapy with other anticonvulsant medications.
- Concomitant use of Tegretol with hormonal contraceptive products (e.g., oral, and levonorgestrel subdermal implant contraceptives) may render the contraceptives less effective because the plasma concentrations of the hormones may be decreased. Breakthrough bleeding and unintended pregnancies have been reported. Alternative or back-up methods of contraception should be considered.
- Resistance to the neuromuscular blocking action of the nondepolarizing neuromuscular blocking agents pancuronium, vecuronium, rocuronium and cisatracurium has occurred in patients chronically administered carbamazepine. Whether or not carbamazepine has the same effect on other non- depolarizing agents is unknown. Patients should be monitored closely for more rapid recovery from neuromuscular blockade than expected, and infusion rate requirements may be higher.
Multimedia: Slideshows, Images & Quizzes
What Is Epilepsy? Symptoms, Causes, and Treatments
Learn about epilepsy symptoms and treatment for this seizure condition. Discover the definition of epilepsy, how epilepsy is...
Epilepsy & Seizures Quiz: What Causes Seizures?
Do you know the difference between seizures and epilepsy? What are the types of seizures? Take the Epilepsy & Seizures Quiz to...
Related Disease Conditions
Types of Traumatic Brain Injury (TBI) Medications
Traumatic brain injury and related conditions, may require diuretics, anticonvulsants, sedatives, antidepressants, muscle relaxers, pain relievers, and stimulants to treat deficits in cognitive functions such as attention, memory, learning and language.
Migraines and Seizures (Symptoms, Auras, Medication)
Migraines are a type of headache and seizures are the main symptom of epilepsy. Migraine headaches and seizures are two different neurological problems that have similar signs, symptoms, and auras, for example, sensitivity to light (photophobia) and sound, irritability, nausea, and vomiting. Symptoms unique to migraine and migraine auras are water retention, problems sleeping, appetite changes, and talkativeness. Symptoms unique to seizure and seizures auras are depression, a feeling of heaviness, a feeling that a seizure is approaching, and depression. Many of the symptoms of migraine and seizures are the same, however, seizures do not cause migraines; however, people who have seizures are twice as likely to have migraines and vice-versa. People who have migraines are twice as likely to have seizures, and people with seizures are twice as likely to have migraines; however, one condition does not cause the other.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Seizures Symptoms and Types
Seizures are divided into two categories: generalized and partial. Generalized seizures are produced by electrical impulses from throughout the brain, while partial seizures are produced by electrical impulses in a small part of the brain. Seizure symptoms include unconsciousness, convulsions, and muscle rigidity.
What Causes Myoclonic Seizures in Babies?
Epileptic syndromes that cause myoclonic seizures usually begin in early childhood, and last throughout life, though milder forms may improve with adulthood. Doose syndrome (myoclonic-atonic epilepsy), Dravet syndrome (severe myoclonic epilepsy of infancy [SMEI]) and Lennox-Gastaut syndrome are all childhood epilepsy syndromes that may cause seizures in babies and toddlers.
Seizure vs. Seizure Disorders: What's the Difference?
Seizures and seizure disorders are not the same medical problems. A seizure happens when the electrical activity in the brain is uncontrolled. There are about 40 different types of seizure disorders, in which epilepsy is one. Symptoms depend on the type of disorder, but can include loss of consciousness, uncontrolled twitching or shaking of one side, or the entire body.
Can the Vagus Nerve Cause Seizures?
The vagus nerve is an important pathway to the brain in addition to helping to control seizures. Stimulation of the vagus nerve leads to the discharge of electrical energy into a wide area of the brain, disturbing the abnormal brain activity that causes seizures. The vagus nerve is used to treat seizures that do not respond to medications.
Febrile seizures, or convulsions caused by fever, can be frightening in small children or infants. However, in general, febrile seizures are harmless. Febrile seizure is not epilepsy. It is estimated that one in every 25 children will have at least one febrile seizure. It is important to know what to do to help your child if he/she has a febrile seizure. Some of the features of a febrile seizure include losing consciousness, shaking, moving limbs on both sides of the body, and lasts 1-2 minutes. Less commonly, a febrile seizure may only affect one side of the body.
Epilepsy and Seizures: How to Treat?
A seizure is a sudden, uncontrolled electrical disturbance in the brain. Epilepsy is a neurological disorder where brain activities are abnormal, causing more than one or recurrent episodes of seizures. Most cases of seizures can be managed conservatively with medication and supportive treatments.
What Are the Main Causes and Symptoms of Epilepsy?
What is epilepsy and what causes it? Learn the signs and symptoms of epilepsy, what causes it, how doctors diagnose it, and what you can do to treat it.
What Are the Different Types of Seizures?
A seizure is a sudden change in the brain's normal electrical activity. During a seizure, brain cells fire uncontrollably than their normal rate, temporarily affecting the way a person behaves, moves, thinks, or feels. Recurrent seizures are called epilepsy. Seizures are usually categorized into three types depending on their onset.
Treatment & Diagnosis
- Epilepsy and Seizures FAQs
- What Are the Different Types of Epilepsy?
- Why Remove Half A Brain?
- Seizure Symptoms: How to Assist the Victim
- Seizures: When the Computer Goes Haywire
- Senator Ted Kennedy: Seizure, Brain Cancer, and Death
- Brain Cancer Symptoms: Headaches and Seizures
- Does Lupus Cause Seizures?
- What Is a Jacksonian Seizure?
Medications & Supplements
- carbamazepine - oral, Tegretol
- carbamazepine suspension - oral, Tegretol
- carbamazepine chewable tablet - oral, Tegretol
- carbamazepine extended-release - oral, Carbatrol, Tegretol XR
- CARBAMAZEPINE EXTENDED RELEASE TABLETS-ORAL, Tegretol XR
- carbamazepine, Tegretol, Tegretol XR , Equetro, Carbatrol, Epitol, Teril
- Carnexiv (carbamazepine) Injection
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Professional side effects, drug interactions, and addiction sections courtesy of the U.S. Food and Drug Administration.