Tegretol: Effective Seizure Control and Mood Stabilization
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Tegretol (carbamazepine) is a well-established anticonvulsant and mood-stabilizing medication primarily indicated for the management of epilepsy and bipolar disorder. As a dibenzazepine derivative, it functions by stabilizing hyperexcitable nerve membranes and inhibiting repetitive neuronal firing through use-dependent blockade of voltage-gated sodium channels. Its therapeutic efficacy, backed by decades of clinical use and research, makes it a cornerstone in neurology and psychiatry for controlling partial and generalized tonic-clonic seizures and for managing acute manic and mixed episodes. This product card provides a comprehensive, expert-level overview for healthcare professionals to support informed prescribing and patient counseling decisions.
Features
- Active ingredient: Carbamazepine
- Available formulations: Tablets (100 mg, 200 mg), chewable tablets (100 mg), extended-release tablets (100 mg, 200 mg, 400 mg), oral suspension (100 mg/5 mL)
- Mechanism of action: Use-dependent blockade of voltage-gated sodium channels
- Half-life: Initial: 25–65 hours; chronic dosing: 12–17 hours (due to autoinduction)
- Metabolism: Hepatic, primarily via CYP3A4, with active metabolite (carbamazepine-10,11-epoxide)
- Excretion: Primarily renal (72%), fecal (28%)
Benefits
- Provides effective reduction in frequency and severity of partial and generalized tonic-clonic seizures
- Offers proven efficacy in the acute treatment of manic and mixed episodes associated with bipolar I disorder
- Demonstrates utility in the management of trigeminal neuralgia and other neuropathic pain conditions
- Helps restore functional stability and improve quality of life in patients with epilepsy or mood disorders
- Available in multiple formulations to support individualized dosing and adherence
- Supported by extensive long-term safety and efficacy data across diverse patient populations
Common use
Tegretol is primarily prescribed for the treatment of epilepsy, including partial seizures with complex symptomatology (psychomotor, temporal lobe), generalized tonic-clonic seizures (grand mal), and mixed seizure patterns. It is also indicated for the acute treatment of manic and mixed episodes in bipolar I disorder. Off-label uses include the management of trigeminal neuralgia, diabetic neuropathy, postherpetic neuralgia, and certain psychiatric conditions. Its use is generally reserved for cases where first-line treatments are ineffective or poorly tolerated, and it requires careful titration and therapeutic drug monitoring to optimize efficacy and minimize adverse effects.
Dosage and direction
Dosage must be individualized based on clinical response, tolerance, and plasma concentration monitoring. For adults and children over 12 years old, initial dosing for epilepsy typically starts at 200 mg twice daily (tablets) or 4 teaspoonfuls (400 mg/day) of suspension, increased gradually by 200 mg/day at weekly intervals. Maintenance doses generally range from 800–1200 mg/day divided into 2–4 doses. For bipolar disorder, initial dose is 200 mg twice daily, adjusted to achieve a response, with usual range of 600–1600 mg/day. Extended-release formulations allow for twice-daily dosing. Always administer with meals to minimize gastrointestinal upset. Regular monitoring of serum levels (therapeutic range: 4–12 mcg/mL) is essential.
Precautions
Tegretol carries several important precautions. It may cause drowsiness, dizziness, or blurred vision—patients should avoid driving or operating machinery until response is known. Aplastic anemia and agranulocytosis have been reported; complete blood counts should be performed baseline and periodically. Liver function tests should be monitored due to risk of hepatitis. May cause SIADH and hyponatremia; monitor sodium levels, especially in elderly patients. Use with caution in patients with cardiac conduction abnormalities, hepatic or renal impairment, or increased intraocular pressure. Abrupt withdrawal may precipitate seizures or status epilepticus; discontinue gradually. Pregnancy Category D: may cause fetal harm; use only if potential benefit justifies risk.
Contraindications
Tegretol is contraindicated in patients with known hypersensitivity to carbamazepine or any tricyclic compound. Should not be used in patients with a history of bone marrow depression. Contraindicated with MAO inhibitors; must allow 14-day washout period. Avoid use in patients with atrioventricular block or other conduction abnormalities. Not recommended for patients with porphyria. Contraindicated in those with hepatic impairment significant enough to affect metabolism. Should not be administered concurrently with nefazodone or other potent CYP3A4 inhibitors that may significantly increase carbamazepine levels.
Possible side effect
Common adverse reactions (≥10%) include dizziness, drowsiness, unsteadiness, nausea, and vomiting. Frequent side effects (1–10%) include diplopia, blurred vision, headache, hyponatremia, rash, leukopenia, and elevated liver enzymes. Serious but rare (<1%) adverse effects include Stevens-Johnson syndrome, toxic epidermal necrolysis, aplastic anemia, agranulocytosis, hepatitis, pancreatitis, cardiac conduction disturbances, and SIADH. Most side effects are dose-related and may diminish with time or dosage adjustment. Any sign of blood dyscrasia, severe dermatological reaction, or hepatic dysfunction requires immediate medical attention.
Drug interaction
Tegretol has extensive drug interactions due to potent induction of CYP3A4 and other enzymes. It decreases levels of oral contraceptives, warfarin, doxycycline, theophylline, valproate, many antipsychotics, and numerous other medications. Concurrent use with strong CYP3A4 inhibitors (clarithromycin, fluconazole, verapamil, etc.) may significantly increase carbamazepine levels. May reduce efficacy of hormonal contraceptives; alternative contraception recommended. Interacts with other anticonvulsants: may decrease levels of lamotrigine, topiramate, tiagabine; valproate may increase carbamazepine epoxide levels. Use with alcohol or other CNS depressants may enhance sedation.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Patients should be advised to maintain a consistent dosing schedule and use pill organizers or reminders if forgetfulness is an issue. For extended-release formulations, the same guidance applies, though the prolonged absorption profile may provide some forgiveness for minor timing variations. Consistent timing is particularly important for seizure control.
Overdose
Carbamazepine overdose presents with symptoms including drowsiness, dizziness, nausea, vomiting, restlessness, agitation, confusion, tremor, involuntary movements, nystagmus, dilated pupils, tachycardia, hypotension or hypertension, respiratory depression, coma, and convulsions. Management includes gastric lavage if presented early, activated charcoal, and supportive care with monitoring of vital signs, ECG, and electrolytes. Multiple-dose activated charcoal may enhance elimination. Hemodialysis is not effective due to high protein binding. Forced diuresis is contraindicated. Specific antidote is unavailable; treatment is symptomatic and supportive. Plasma levels >40 mcg/mL may indicate severe poisoning.
Storage
Store at controlled room temperature (20–25°C or 68–77°F); excursions permitted to 15–30°C (59–86°F). Keep container tightly closed and protect from moisture. Oral suspension should be stored in tight, light-resistant containers and should not be frozen. Keep all medications out of reach of children and pets. Do not use beyond the expiration date printed on packaging. Do not transfer oral suspension to other containers as this may affect stability. Tablets should be kept in their original blister packs or bottles to maintain stability and prevent moisture exposure.
Disclaimer
This information is intended for healthcare professionals and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this product card. Dosage and indications may vary based on individual patient factors. Always verify current prescribing information before initiating therapy.
Reviews
Clinical studies and meta-analyses consistently demonstrate Tegretol’s efficacy in seizure control, with approximately 60-70% of patients achieving significant reduction in seizure frequency. In bipolar disorder, response rates for acute mania range from 50-70% in various trials. Many clinicians appreciate its well-characterized pharmacokinetics and the ability to monitor levels therapeutically. However, reviews often note the significant side effect profile and drug interaction potential as limitations. Long-term experience shows that while many patients tolerate it well, careful monitoring is essential. Patient reviews often mention initial side effects that frequently diminish over time, with many reporting good seizure control or mood stabilization after the titration period.