side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

> Tegretol

US brand name: Tegretol
Generic name: carbamazepine

Other Forms:

  • Vanilla-flavored syrup
  • Chewable tablets
  • Suppositories
  • Extended-release tablets, most of which you don’t digest. The remnants really are supposed to come out the other end undigested.
  • Equetro - is Shire’s brand of carbamazepine that is a combination of immediate and extended release.

Class: Antiepileptic drug (AED)/Anticonvulsant (AC)

1.  Other US brand names & branded generic names1

Equetro, Carbatrol, Atretol, Convuline, Epito, Macrepan

2.  FDA Approved Uses of Tegretol (carbamazepine):

2.1  Epilepsy

Complex partial, generalized tonic-clonic and mixed pattern seizures. Monotherapy? Used with other meds? Sure, whatever. Unlike most anticonvulsants/antiepileptic drugs there’s nothing in the PI sheet about that. Since Tegretol has been on the US market since 1968 my money is on its being approved to take it by itself or with other meds to treat any type of epilepsy you got.

2.2  Trigeminal Neuralgia and Glossopharyngeal Neuralgia

Tegretol is also approved to treat trigeminal neuralgia. There are other treatments, but Tegretol is considered the best available. Glossopharyngeal neuralgia is included under the approval for trigeminal neuralgia, but the wording is vague:

Beneficial results have also been reported in glossopharyngeal neuralgia. Tegretol PI sheet

That looks like one of those quasi-approvals, where a condition is so bad that no one with any ethics is going to give anyone a placebo in a double-blind clinical trial, but there’s nothing else on the market to use as an active placebo.

2.3  Bipolar


Approved in Canada, but not the US, to be used in combination with other meds to treat bipolar disorder, or by itself if other meds don’t work. It’s not approved as a first-line treatment for bipolar disorder, even though other meds fare marginally better in the studies. Here’s one such study showing lithium just beating out Tegretol.


Shire’s combination of immediate- and extended-release carbamazapine is approved in the US to treat acute manic and mixed episodes as part of Bipolar 1 by itself. Other than its name, composition and approval, there’s not much difference between Tegretol and Equetrol.

3.  Tegretol’s Off-Label Uses

4.  Tegretol’s pros and cons

4.1  Pros

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

4.2  Cons

Some of the side effects truly suck donkey dong! You need to have regular blood tests. It’s especially sensitive to food, booze and alcohol. It’s great for mania, but otherwise not really all that good for bipolar disorder by itself.

5.  Tegretol’s Side Effects

5.1  Typical Side Effects

Those common for anticonvulsants. Nausea is very common when starting Tegretol. Like all meds that focus on 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.

5.2  Not So Common Side Effects

Photosensitivity. While all anticonvulsants and antipsychotics make you more sensitive to sunlight, Tegretol 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.

5.3  Freaky Rare Side Effects

Growing a lot more body hair and being able to get drunk off of water (frank water intoxication - AKA awesome rock’n’roll name).

6.  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 and reach it sooner, as you’ll start to clear it out of your system faster.
  • Occasionally drinking alcohol increases the plasma level of Tegretol, which is just weird. Booze + AEDs and what they are used to treat (bipolar disorder and epilepsy) is a pretty stupid idea though.
  • As an enzyme-inducing AED, Tegretol will sap your body of vitamin D, folic acid, and maybe even calcium. So ask your doctor about tests for vitamin D and calcium levels and supplements. You should probably take 400–1,000mcg of folic acid in any event, but no more than that, otherwise it might interfere with how well Tegretol works. That folic acid may help you feel a lot less lethargic.

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Medicated For Your Protection buttons

7.  Dosage and How to Take Tegretol

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.

8.  How Long Tegretol Takes to Work

Usually by the time you find the right dosage for you that’s somewhere between 400 and 1200mg a day. So that’s anywhere from one week to three months.

9.  Tegretol’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 meds that’s subject to change.

10.  Days to Reach a Steady State

Usually a week, but there are far too many variables involved with enzyme-inducing drugs.

11.  Shelf Life

  • Tablets: 3 years
  • Chewable tablets: 5 years
  • Suppositories: 3 years
  • Extended-release tablets: 3 years
  • Vanilla-flavored syrup: 3 years, per the New Zealand Data Sheet

12.  How to Stop Taking Tegretol

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.

Like any anticonvulsant, if you’ve been taking Tegretol 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 (AKA grand mal) seizures, despite your never having had a seizure disorder before! The risk is worse if you’re taking a lithium variant, and many other antidepressants, especially Wellbutrin.


I sarcastically refer to Tegretol as the manliest of the AEDs/ACs. Wait. What? For some strange quirk of pharmacokinetics you get more out of Tegretol if taken with high fat meals, the occasional shot of booze (again: never a good idea) or cigar. Tegretol totally clobbers the efficacy of oral contraceptives and other estrogen supplements, and it really does a number on Lamictal - the diva of anticonvulsants. That’s manly in my book!

Tegretol 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.

Unlike other anticonvulsants used for pain relief, how Tegretol works for pain is more-or-less understood, as it stimulates the infraorbital nerve. That, in turn, helps to lessen the pain involved in glossopharyngeal neuralgia and trigeminal neuralgia.

Unless Trileptal has failed for you or just isn’t available where you live, it’s usually a better first choice if Tegretol 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 really is just as effective as Tegretol or not. Tegretol is the superior med when it comes to neuropathic pain, so don’t bother trying anything else first if you’d rather cut off your head than live another day with whatever form of neuropathic pain you have.

Like other anticonvulsants, Tegretol (carbamazepine) 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.

14.  Overseas trade names and branded generic names1

  • 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)

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15.  Tegretol Ratings, Reviews, & Other Sites of Interest

Tegretol Ratings & Reviews Page.

15.1  Rate Tegretol

Give your overall impression of Tegretol on a scale of 0 to 5. Detailed ratings and reviews are available on the Tegretol Ratings & Reviews Page.

Get all critical about Tegretol

3.5 stars Rating 3.0 out of 5 from 33 criticisms.
Vote Distribution: 7 – 2 – 3 – 4 – 5 – 12

15.2  Rate this article

If you’re still feeling judgmental as well as just mental2, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Tegretol (carbamazepine) Synopsis

4.5 stars Rating 4.3 out of 5 from 16 value judgments.
Vote Distribution: 0 – 0 – 1 – 2 – 4 – 9

15.3  Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, check for drug-drug interactions

Tegretol’s Full US Prescribing Information / PI Sheet

UK SPC Sheet
New Zealand Data Sheet
New Zealand CMI leaflet
South African Degranol PI Sheet
Australian CMI leaflet
Russian Карбадак (Carbadac) PI Sheet’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.

15.4  Discussion board

If you have any questions not answered here, please see the Crazymeds Tegretol discussion board.

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16.  Bibliography

Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) 3rd edition Stephen M. Stahl

PDR: Physicians’ Desk Reference 2010 64th edition

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

Primer of Drug Action 12th edition by Robert M. Julien Ph.D., Claire D. Advokat, Joseph Comaty © 2011 Published by Worth Publishers.

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

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

Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 An imprint of Elsevier.

1 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions.

2 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

If you have any questions not answered here, please see the Crazymeds Tegretol discussion board. I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.

Last modified on Wednesday, 26 March, 2014 at 05:21:40 by SomeMedCriticPage Author: JerodPooreDate created Tuesday, 15 March, 2011 at 14:33:16

Tegretol by JerodPoore is copyright © 2011 JerodPoore

Tegretol, and all other drug names on this page and use throughout the site, are a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.

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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 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 something along the lines of following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or 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. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you 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. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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‘Everything is true, nothing is permitted.’ - Jerod Poore

1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]

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