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US Brand Names: Tegretol, Equetro, Carbatrol, Atretol, Convuline, Epito, Macrepan

See toward the bottom of the page for other brand names

Generic Name: carbamazepine USP

Other Forms: Vanilla-flavored syrup; chewable tablets; suppositories; extended-release tablets, most of which you don't digest and it really is supposed to come out the other end undigested.

What is Tegretol / Tegretol XR / Equetro: Tegretol and Equetro are the same thing, an anticonvulsants, specifically an enzyme-inducing anticonvulsant.
Read up on these sections if you haven't done so already, because they cover a lot of information about multiple medications that I'm not going to repeat on many pages.  I'm just autistic that way about not repeating myself.

 

 

What are Tegretol's & Tegretol XR's FDA Approved Uses:  For epilepsy - complex partial, generalized tonic-clonic and mixed pattern seizures.  In case you need to know:

Simple partial seizures - you're still awake (more or less), with symptoms such as one or two limbs spazzing out or wacky visual or other sensory distortions.  Think Alice in Wonderland, as Lewis Carroll must have had some serious temporal lobe issues.  The fist link will take you to a better explanation.  For a really detailed explanation of what a simple partial seizure is, click here.

Complex partial seziures - the people around you think you're just acting out to get attention.  In reality you have no control over what's happening.  Again, click there for the basics, click here for what neurologists think about this type of seizure.

Generalized tonic-clonic - the classic definition of a seizure, when you're completely flopping all over the place like a fish out of water.  For the neurologist's view, click here. 

 Mixed pattern is where, like me,  you get a little bit of everything.   Although Tegretol doesn't seem to help much with absence seizures and might even make atypical absence seizures worse for some people.

Tegretol is also approved for glossopharyngeal and trigeminal neuralgia.  If you have either you know what they are, I don't have a clue, other than excruciating pain around your head and face caused by wackiness with your trigeminal nerves.

Tegretol (carbamazepine USP) is approved in Canada to be used in combination with other meds to treat bipolar disorder, or to be used if other meds don't work.  Note that it's not approved as a first-line treatment for bipolar disorder, and I've got a study here and another here back that up.  It's OK for bipolar disorder, just not great for bipolar.  Lithium tested better in the two studies, but more on that in the comments section.

What is Equetro's FDA Approved Use: extended-release carbamazebine by another brand name (i.e. Carbatrol) - is approved to treat acute manic and mixed episodes as part of Bipolar 1 by itself.  Shire just did its own clinical trials to get results that were good enough.

 

 

Off-Label Uses: Diabetic neuropathy, augmenting treatment of schizophrenia, intermittent explosive disorder and other rage disorders, alcohol withdrawal syndrome, benzodiazepine withdrawal and PTSD.

Tegretol's & Equetro's pros and cons: 

Pros: Having been around forever, the effects and side effects are well known.  The only anticonvulsant approved for a mixed-bag of seizures.  It has FDA approval to treat bipolar, in case you're stuck with a government or insurance formulary.

Cons: The side effects suck donkey dong!  You need to have regular blood tests.  It's especially sensitive to food, booze and alcohol.  It's not really all that good for bipolar disorder.

 

 

 

Tegretol's & Equetro's Typical Side Effects: Those common for anticonvulsants.  Nausea is very common when starting Tegretol / Equetro.  Like all meds that hit your temporal lobe, you'll feel tired, confused, uncoordinated, even somewhat drunk and disoriented.  You'll have problems with your memory, have a hard time thinking and things will just seem really strange.  For the most part these will pass, or at least they won't be so bad, within a couple of weeks.  Or a month.  And, of course, they'll come back when your dosage goes up.  But they usually won't be as bad or last as long the next time around.  Unless you're getting way more Tegretol than you should be.

For tips on how to cope with these side effects, please see our side effects page.
These aren't all the side effects you can get, just the most popular ones.

  

Tegretol's & Equetro's Not So Common Side Effects: Photosensitivity.  While all anticonvulsants and antipsychotics make you more sensitive to sunlight, Tegretol / Equetro is the worst when it comes to this side effect.  It figures that any med good for treating pain will turn around and give nasty headaches to anyone who doesn't have them to start with. 
These may or may not happen to you don't, so don't be surprised one way or the other.

  

Tegretol's & Equetro's Freaky Rare Side Effects: Growing a lot more body hair and being able to get drunk off of water.

 You aren't going to get these. I promise.

 

For all side effects read the Tegretol PI sheet  or the Equetro PI sheet as appropriate.

 

 

Interesting Stuff Your Doctor Probably Won't Tell You: If you're taking the XR version your doctor or pharmacist really should tell you that you're going to poop out the outer coating.  That's normal.  Whatever you do, don't cut the damn things up!!

Smoking initially increases Tegretol's plasma levels, so if you smoke you'll be better off starting at the lower dosages.  But since nicotine is also an enzyme inducing drug it will just require you to ultimately hit the maximum dosage of Tegretol you'll start to clear it out of your system faster.

There's been some anecdotal evidence (i.e. reports from people in support groups) that various generic forms and the Carbatrol form of carbamazepine does not work as well as brand-name Tegretol in controlling bipolar symptoms.  I have no reports about control of epileptic symptoms when switching from brand to a generic or alternate brand, but it wouldn't surprise me if the same is true.  This is probably an instance of brand vs. generic in action.  Then again, the extended-release version Equerto recently received FDA approval to treat the manic and mixed symptoms of bipolar 1, so who the hell knows?

  

 

Tegretol's & Equetro's Dosage and How to Take Tegretol / Equetro: I'm just going to deal with adults and monotherapy.  For epilepsy and bipolar disorder you start at 100-200mg a day and increase by 100-200mg a day, taking two or three doses a day (if you take the extended or immediate release) until the symptoms abate, you max out at 1200mg a day, a blood test tells you to quit, or you can't deal with the side effects.  The soonest you should increase your dosage is a week.

For neuralgia the immediate release form is recommended.  Starting at 200mg a day, divided into two 100mg doses.  Symptoms should be relieved somewhere between 200 and 800mg a day.

 

 Days to Reach a Steady State: Usually a week, but there are far too many variables involved with enzyme-inducing drugs.

When you're fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you'll have fewer valleys after this point. In theory anyway.

  

How Long Tegretol / Equetro Takes to Work: First you have to reach the therapeutic range of 4 to 10.  But unlike the valproates or lithium the blood plasma level isn't tested that often.  Enzyme-inducing anti-epileptic drugs tend to work faster than their non-inducing counterparts by the very nature of the enzyme induction.  But the odds are you'll find the sweet spot somewhere between 400 and 1200mg a day, so whenever you get to that dosage, it'll start working.

  

Tegretol's & Equetro's Half-Life & Average Time to Clear Out of Your System: Because it's an enzyme-inducing drug, the half-life is really hard to pin down.  It's somewhere in the neighborhood of 16-24 hours, but if you take other anticonvulsants that's subject to change.

How to Stop Taking Tegretol / Equetro: Your doctor should be recommending that you reduce your dosage by 100-200mg a day every five days, based on the 16-24 hour half-life, if not more slowly than that.  For more information, please see the page on how to safely stop taking these crazy meds. 

Like any anticonvulsant, if you've been taking Tegretol (carbamazepine USP) for more than a couple months and you're up to or above 400mg a day (give or take, depending on other meds you might be taking) you just can't stop cold turkey if you're not at the therapeutic dosage for another anticonvulsant that you know works for you, otherwise you risk partial-complex, absence seizures or even tonic-clonic grand mals, despite your never having had a seizure disorder before!  The risk is worse if you're taking a lithium variant, and/or any antidepressant, especially Wellbutrin (bupropion hydrochloride).

If you've worked your way up to a particular dosage, it's usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

 

 

 
Comments: Be sure to read the sections on anticonvulsants and enzyme-inducing anti-epileptic drugs if you haven't done so already.

Approved by the FDA in 1968, Tegretol (carbamazepine USP) is the manliest of the anticonvulsants.  What?  Tegretol (carbamazepine USP) works better if you take it with the occasional shot of booze or cigar, it absorbs well when taken with high fat meals, it just clobbers the efficacy of oral contraceptives and other estrogen supplements, and it really does a number on Lamictal (lamotrigine) - the diva of anticonvulsants.  That's manly in my book!  No, really, occasional alcohol intake will increase Tegretol's plasma levels in unpredictable ways, so it's not really recommended.  And if you smoke you'll find that you probably won't need as much Tegretol as a non-smoker.  At first.  But like all enzyme-inducing meds, you'll have to eventually increase the dosage of the Tegretol.  Or the nicotine if you like clearing the Tegretol out of your system sooner.

Tegretol (carbamazepine USP) has long been considered a first-line medication for bipolar disorder, but as you can see from the FDA approval, and from a few studies it's not really that great a med for bipolar.  But don't write it off just yet.  The key is to look at how it performs in epilepsy.  Like Topamax (topiramate) and Trileptal (oxcarbazepine), Tegretol is best used when applied to problems in the temporal lobes.  You don't have to be epileptic to have problems with your temporal lobes, as your bipolar disorder could be living there as well.  So when tested on random bipolar people it would be the same as if tested on random epileptics, Tegretol wouldn't be that effective when compared to lithium for bipolar or Dilantin (phenytoin) for epilepsy.  But if you were to just take people with temporal lobe issues, then Tegretol (carbamazepine USP), like Topamax (topiramate) and Trileptal (oxcarbazepine), works very well indeed.  Given all of its side effects and the blood work involved, though, Tegretol would probably be the last of the three I'd try. 

Trileptal is, after all, just the new & improved Tegretol (carbamazepine USP).  One extra oxygen atom that makes all the difference in the world for a lot of people.

For Kassiane Tegretol was the best thing ever for controlling her bipolar and epileptic symptoms.  Until the aplastic anemia hit her with a vengeance, like being smitten by the hammer of an angry neuropharmaceutical diety.

 

Unlike other anticonvulsants used for pain relief, how Tegretol (carbamazepine USP) works for pain is more-or-less understood, as it stimulates the infraorbital nerve.  I'm sure that is meaningful to someone reading this.  Whereas how it works as an anticonvulsant/mood stabilizer is really not that well understood at all.  While the means by which all anticonvulsants is truly guessed at, Novartis doesn't even bother publishing a method of action beyond, "It appears to act by reducing polysynaptic responses and blocking the post-tetanic potentiation.."  No neurotransmitters, no receptors, nothing.  Dr. Stahl thinks that it works along potassium and/or sodium channels to enhance GABA.  I'll go along with that for three reasons:

  1. Many people, including Mouse with the related med Trileptal (oxcarbazepine), report sodium or potassium related problems with Tegretol (carbamazepine USP) and Trileptal (oxcarbazepine).  Meds that work along these channels can cause sodium or potassium issues elsewhere in the body.

  2. Many of the other side effects are similar to other GABAergic meds such as Depakote (divalproex sodium) and Topamax (topiramate).  So it would make sense that GABA is getting played around with.  Of course these side effects can result because of other reasons, so this is just a bit of circumstantial evidence.

  3. Dr. Stahl is just a pharmacological god as far as I'm concerned.  While he most likely can make mistakes, I'll put my money on this not being one.

Unless Trileptal (oxcarbazepine) has failed for you or just isn't available where you live, it's usually a better first choice if Tegretol (carbamazepine USP) is indicated.  It has a lower side effect profile and generally a better response rate - mainly because the side effects suck less and people are more med compliant.  The jury is still out as to whether or not Trileptal (oxcarbazepine) really is just as effective as Tegretol (carbamazepine USP) or not.  Tegretol (carbamazepine USP) has tested as the superior med when it comes to neuropathic pain.    But Tegretol (carbamazepine USP) is otherwise a fine med for temporal lobe issues.

Like other anticonvulsants, Tegretol (carbamazepine USP) carries the rare but possible risk for aplastic anemia and agranulocytosis.  Unlike the others, the risk with Tegretol is great enough that regular blood tests are recommended.  So if you see lots of weird bruises that you can't explain, see your doctor immediately!  Better yet, make sure your doctor orders a regular blood count before hand.  And if your doctor doesn't, lots of places cater to hypochondriacs these days where you can walk in off the street and order a CBC (complete blood count) yourself for around $20.  It's worth doing once a month and bringing the numbers in to an M.D. you trust for interpretation.

Have questions about Tegretol?  Want to read about experiences other people have had with Tegretol? Check out our Trileptal & Tegretol Board.

 

Who makes Tegretol, Equetro & Carbatrol: Novartis (Tegretol) Shire (Equetro & Carbatrol) PurePac (one of many manufacturers of the generic version)

 

Sample US Cost of Tegretol: $62 for 100 200mg brand name Tegretol immediate release or XR tablets. $18 for 100 200mg generic carbamazepine tablets. 

As of 01/26/2004. Full retail for the uninsured. Go ahead and gloat, citizens of civilized countries and all of you with full medical coverage.

 

Sample Canadian Cost of Tegretol: $38 for 100 200mg brand name Tegretol immediate release or CR tablets.   $53 for 500 200mg generic immediate release carbamazepine capsules.

As of 05/16/2004. In US dollars, for re-importation to the US. Does not include any shipping charges. 

 

Remedy Find Rating for Epilepsy 

Remedy Find Rating for Headaches

Remedy Find Rating for Bipolar Disorder

 

Check for Drug-Drug Interactions

 

Full US Patient/Prescribing/Physician Tegretol Information Sheet

Full US Patient/Prescribing/Physician Equetro Information Sheet

Canadian Monograph from Internet Mental Health

UK SPC Sheet

New Zealand PI Sheet

South African Degranol PI Sheet

Australian Teril PI Sheet

Russian Carbadac PI Sheet

Please see the section on how to read these sheets. Don't freak out about every potential side effect. Look at the odds of something having happened during the clinical trials.

 

The Overlords of the 12 Zernox Galaxies have compelled me through messages in the Sunday Chronicle to beg you for your support.  Unfortunately I need money again, so if you can:

Visit the Support Page for how you can help if you don't have any money laying around.   This includes reviewing Crazy Meds for Amazon.com and/or

rating this site for Psych Central:

There's also our Mental Mall to snag some free software, purchase some books or t-shirts. 

Better yet, if you run a business and want to advertise on Crazy Meds, see our page on ad rates and policies.  I'm all about fiscal transparency, so follow the money for full disclosure of my pitiful finances.

 

 

 

 

Crazy Meds Home  Crazy Meds Talk  About Antidepressants   About SSRIs   About Anticonvulsants / Mood Stabilizers    About Atypical Antipsychotics   About Benzodiazepines   About Stimulants   Finding a Doctor    Sites with More Information     Support Group Sites    About Crazy Meds    Crazy Meds: The Blog

 

Tegretol in the News

Epilepsy in the News

Bipolar Disorder in the News

 

Take care of yourself, and keep taking your crazy meds!

Jerod

If you still have unanswered questions about this or other medications, including which one is, or combination of meds are the best for you, your best bet is to ask on Crazy Meds Talk.  Better yet, if you want to let the world know how they worked out for you and want to help out others in their quest for the correct meds, join the party.
If you 
want to discuss your issues, I suggest checking out one of the various support groups online.  
Otherwise, if you're letting me know about how much you like or hate the site, or  need to let me know about medication effects in private, then just drop a note to jerod23 at gmail dot com  Honestly, I usually don't have a lot of time to answer e-mail these days.  The snide autoresponse message that may or may not hit your mailbox is going to tell you the same thing.
Another problem is that you may not get a response even if I wanted to send you one.  You see, so many dickweeds with malicious intents and too much time on their hands have appropriated the crazymeds.org domain name to use for their spam, viruses and the like.  Subsequently some lazy-ass e-mail protection software authors just go by the domain name, and not the IP address.  So I've been blacklisted because of the actions of others.  Or the software just doesn't like the domain name because of the "crazy" and/or "meds."  Or your question about a particular medication will set off spam flags.  So the e-mail just wouldn't go through regardless.  Sorry.

 

Hey, did you find this page all by itself through Google or some other search engine? Great! But to really appreciate the entire site, you need to start here.

 

 

 

Other Brand Names: Apo-Carbamazepine (Canada; Malaysia)
Camapine (Taiwan; Thailand)
Carbadac (Benin; Burkina Faso; Ethiopia; Gambia; Ghana; Guinea; Ivory Coast; Kenya; Kuwait; Liberia; Libya Lebanon; Malawi; Mali; Mauritania; Mauritius; Morocco; Niger; Nigeria; Oman; Qatar; Republic of Yemen; Saudi Arabia; Senegal; Seychelles; Sierra Leone; South Africa; Sudan; Syria; Tanzania; Tunisia; Uganda; United Arab Emirates; Zambia; Zimbabwe)
Carbatol (India)
Carbazene (Thailand)
Carbazep (Mexico)
Carbazina (Mexico)
Carmaz (India)
Carpaz (South Africa)
Carzepin (Malaysia)
Carzepine (Thailand)
Clostedal (Mexico)
Degranol (South Africa)
Epileptol, Epileptol CR (Korea)
Eposal Retard (Colombia)
Espa-lepsin (Germany)
Foxalepsin, Foxalepsin Retard (Germany)
Hermolepsin (Sweden)
Karbamazepin (Sweden)
Kodapan (Japan)
Lexin (Japan)
Mazetol (India; Malaysia)
Neugeron (Costa Rica; Dominican Republic; Guatemala; Honduras; Mexico; Nicaragua; Panama)
Neurotol (Finland)
Neurotop (Austria; Hungary; Malaysia)
Neurotop Retard (Malaysia)
Nordotol (Denmark; Mexico)
Panitol (Thailand)
Sirtal (Germany)
Tardotol (Denmark)
Taver (Thailand)
Tegol (Taiwan)
Tegretal (Germany)
Telesmin (Japan)
Temporol (Bulgaria; South Africa)
Temporal Slow (Bahrain; Cyprus; Egypt; Hungary; Iran; Iraq; Israel; Jordan; Kuwait; Lebanon; Libya; Oman; Qatar; Republic of Yemen; Saudi Arabia; Syria; United Arab Emirates)
Teril (Australia; Hong Kong; Israel; New Zealand; Taiwan)
Timonil, Timonil Retard (Germany; Israel; Switzerland)

 

 

 

Dead tree references:

 

Essential Psychopharmacology Stephen M. Stahl, M.D., Ph. D. © 2000.   Published by  Cambridge University Press

 

Physicians' Desk Reference Edition 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. ©  2002. Published by Medical Economics Company.

 

 

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

 

 

The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.

 

Partial Seizure Disorders Mitzi Waltz © 2001. Published by O'Reilly & Associates.  Dedicated to me no less.

 

The Bipolar Disorder Survival Guide David J. Miklowitz, Ph.D. © 2002. Published by The Guilford Press.

 

 

Mosby's 2004 Drug Guide David Nissen PharmD, Editor.© 2004.  An imprint of Elsevier.  The edition we're using isn't listed on Amazon.

 

 

End of books used for this article.

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Created Monday, January 26, 2004

Last updated Saturday, May 15, 2010

 

Copyright © 2003 - 2006 Jerod Poore. All rights reserved.

 

Almost all of the material on this site is copyright © 2002, 2003, 2004, 2005 and 2006 Jerod Poore. Except, of course, the PI sheets, those are the property of the drug companies who developed the drugs the sheets are about.  And any documents that are written by other people which may be posted to this site will remain the property of the original authors.  You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder.  That's usually me, so just ask first.  That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that's OK to just do.  Go for it!  Please.  As long as you include this copyright notice and the following disclaimer, I'm cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won't necessarily happen to you. Nobody on this site is a doctor, therapist, or a pharmacist. We don't portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don't be a cyberchondriac, thinking you have every disease you see a website about, or that you'll get every side effect from every medication. Self-prescribing is just as dangerous.  All information on this site has been obtained through personal experience, the experiences of my friends, the experiences of people reported on online support groups, and from sources that are referenced throughout the site.  Know your sources!  As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it.  No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. All brand names of the drugs listed in this site are the trademarks of the companies listed after them in the pages about the drugs, even though those companies may or may not have been acquired by other companies who may or may not be listed in this site by the time you read this. Always read the PI sheet that comes with your medications and never ever throw them away.  If you didn't get a PI sheet, demand one.  Loudly.  Crazy Meds is not responsible for the content of sites we provide links to.  We like them, or they're paid advertisements, or they're something you should read to make an informed decision about a particular med.  Sometimes they're more than one of those things.  But what's on those sites is their business, not ours.  Very little information about visitors to this site is collected or saved. And from time to time I do look at search terms used to find it in an effort to make the information I present more relevant. Use only as directed. Void where prohibited.

 

"Everything is true, nothing is permitted." - Jerod Poore