Carbamazepine | Side Effects, Dosage, Uses & More

Generic Name:

carbamazepine, Oral tablet

All Brands

  • Tegretol
SECTION 1 of 5

Highlights for carbamazepine

Oral tablet
1

Carbamazepine is an oral drug that’s used to treat bipolar disorder, epilepsy, and trigeminal neuralgia.

2

This drug may cause severe skin reactions known as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Your risk may be higher if you have Asian ancestry with a genetic risk factor.

3

Carbamazepine may decrease the number of blood cells that your body makes. In rare cases, this can cause serious or life-threatening health problems.

4

This drug may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.

5

Carbamazepine is a category D pregnancy drug.

IMPORTANT INFORMATION

FDA warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Severe skin reaction warning. This drug may cause life-threatening allergic reactions called Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These may cause severe damage to your skin and internal organs. Your risk may be higher if you have an Asian ancestry with a genetic risk factor. If you’re Asian, your doctor may test you for this genetic factor. You can still develop these conditions without the genetic risk factor. Call your doctor right away if you have any of these symptoms:

  • skin rash
  • hives
  • swelling of your tongue, lips, or face
  • blisters on your skin or the mucous membranes of your mouth, nose, eyes, or genitals

Low blood cell count warning. This drug may decrease the number of blood cells your body makes. In rare cases, this can cause serious or life-threatening health problems. Tell your doctor if you’ve ever had low blood cells, especially if it was caused by another drug. Call your doctor right away if you have any of these symptoms:

  • sore throat, fever, or other infections that come and go or don’t go away
  • bruising more easily than normal
  • red or purple spots on your body
  • bleeding from your gums or nosebleeds
  • intense fatigue or weakness

Risk of suicide

This drug may cause suicidal thoughts or actions in a small number of people, about 1 in 500. Call your doctor right away if you have any of these symptoms:

  • thoughts about suicide or dying
  • attempts to commit suicide
  • new or worse depression
  • new or worse anxiety
  • feeling agitated or restless
  • panic attacks
  • trouble sleeping
  • new or worse irritability
  • acting aggressive or violent or being angry
  • acting on dangerous impulses
  • an extreme increase in activity or talking
  • other unusual behavior or mood changes

Heart problems

This drug may cause an irregular heart rate. Symptoms include:

  • fast, slow, or pounding heart rate
  • shortness of breath
  • feeling lightheaded
  • fainting

Liver problems

This drug may raise your risk of live problems. Symptoms include:

  • yellowing of your skin or the whites of your eyes
  • dark-colored urine
  • pain on the right side of your stomach
  • bruising more easily than normal
  • loss of appetite
  • nausea or vomiting

Drug features

This drug is a prescription drug. It is available in these forms: oral tablet, oral chewable tablet, oral suspension, oral extended-release tablet, and oral extended-release capsule.

This drug is available in its generic form. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

This drug may be used as part of a combination therapy. This means you need to take it with other drugs.

Why it's used

This drug belongs to a class of drugs called anticonvulsants. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions.

More Details

How it works

It is not completely known how this drug treats bipolar disorder, epilepsy, or trigeminal nerve pain. It is known to block sodium currents in your brain and body. This helps to reduce abnormal electrical activity between your nerve cells.

Why it's used

This drug belongs to a class of drugs called anticonvulsants. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions. 

This drug is used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes (symptoms of mania and depression that happen at the same time) in people with bipolar disorder. 

This drug is also used to control certain types of seizures in people with epilepsy, and to treat trigeminal neuralgia, a condition that causes facial nerve pain.

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SECTION 2 of 5

carbamazepine Side Effects

Oral tablet

Most Common Side Effects

The most common side effects that occur with carbamazepine include:

  • stomach problems, including:

    • nausea
    • vomiting
  • problems with walking and coordination

  • dizziness

  • drowsiness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening or if you think you’re experiencing a medical emergency, call 9-1-1.

  •  Severe skin reaction. Symptoms include:

    • skin rash
    • hives
    • swelling of your tongue, lips, or face
    • blisters on your skin or the mucous membranes of your mouth, nose, eyes, or genitals
  • Low blood cell counts. Symptoms include:

    • sore throat, fever, or other infections that come and go or don’t go away
    • bruising more easily than normal
    • red or purple spots on your body
    • bleeding from your gums or nosebleeds
    • intense fatigue or weakness
  • Heart problems. Symptoms include:

    • fast, slow, or pounding heart rate
    • shortness of breath
    • feeling lightheaded
    • fainting
  •  Liver problems. Symptoms include:

    • yellowing of your skin or the whites of your eyes
    • dark-colored urine
    • pain on the right side of your stomach
    • bruising more easily than normal
    • loss of appetite
    • nausea or vomiting
  • Suicidal thoughts. Symptoms include:

    • thoughts about suicide or dying
    • attempts to commit suicide
    • new or worse depression
    • new or worse anxiety
    • feeling agitated or restless
    • panic attacks
    • trouble sleeping
    • new or worse irritability
    • acting aggressive or violent or being angry
    • acting on dangerous impulses
    • an extreme increase in activity or talking
    • other unusual behavior or mood changes
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug may cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

carbamazepine May Interact with Other Medications

Oral tablet

Carbamazepine can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Food interactions

Grapefruit juice blocks the enzyme that breaks down carbamazepine. Drinking grapefruit juice while taking this drug can cause higher levels of the drug in your body. This raises your risk of side effects.

Alcohol interaction

Drinking alcohol while taking carbamazepine can increase your risk of drowsiness.

Medications that might interact with this drug

Heart drugs
  • diltiazem
  • verapamil

These drugs will increase the level of carbamazepine in your body and cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking these drugs together.

Fungal infection drugs
  • ketoconazole
  • itraconazole
  • fluconazole
  • voriconazole

These drugs will increase the level of carbamazepine in your body and cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking these drugs together.

Antibiotics
  • clarithromycin
  • erythromycin
  • telithromycin
  • chloramphenicol
  • rifampin
  • rifabutin
  • rifapentine

These drugs will increase the level of carbamazepine in your body and cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking these drugs together.

HIV drugs
  • ritonavir
  • indinavir
  • nelfinavir
  • saquinavir
  • cobicistat
  • efavirenz
  • nevirapine

These drugs will increase the level of carbamazepine in your body and cause side effects. Your doctor may monitor your blood levels of carbamazepine if you’re taking these drugs together.

Anti-seizure drugs
  • phenytoin
  • fosphenytoin
  • phenobarbital
  • primidone

These drugs will decrease the level of carbamazepine in your body. This means that it won’t work as well to treat your condition. Your doctor may  monitor your blood levels of carbamazepine if you’re taking these drugs together.

  • phenytoin
  • divalproex
  • phenobarbital

Taking carbamazepine with these other medications that treat seizures may affect how your thyroid hormone works.

Herbal products
  • St. John’s wort

These drugs will decrease the level of carbamazepine in your body. This means that it won’t work as well to treat your condition. Your doctor may  monitor your blood levels of carbamazepine if you’re taking these drugs together.

Anti-rejection drugs
  • tacrolimus

Taking these drugs together will decrease the levels of tacromilus in your body. Your doctor may monitor your blood levels of tacromilus and change your dosage of that drug.

Bipolar disorder drugs
  • lithium

Taking these drugs together may increase your risk of side effects.

Tuberculosis drugs
  • isoniazid

Taking these drugs together may increase your risk of liver damage.

Blood pressure medications
  • hydrochlorothiazide
  • furosemide 

Taking these drugs together may lower the sodium level of your blood.

Hormonal birth control drugs

Carbamazepine may make hormonal birth control less effective. You may need to use alternative or back-up methods of contraception.

Respiratory drugs
  • theophylline

Taking this drug with carbamazepine will make it less effective. This is because carbamazepine makes the body process this drug more quickly, which decreases the amount of the drug in your blood.

Muscle relaxers
  • pancuronium
  • vecuronium
  • rocuronium
  • cisatracurium 

Taking these drugs with carbamazepine can lower the effect of these medications. Your doctor may adjust the dose of these drugs.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with liver disease

This drug is not recommended for use with acute (severe) liver disease as it may make the condition worse. If you have stable liver disease, your doctor will monitor and adjust your dose. If your liver disease suddenly gets worse, call your doctor to discuss your dose and use of this drug.

People with heart disease

If you have any damage to your heart or an abnormal heart rhythm, this drug may make it worse.

Pregnant women

This drug is a category D pregnancy drug. That means two things: 

  1. Studies show a risk of adverse effects to the fetus when the mother takes the drug.
  2. The benefits of taking the drug during pregnancy may outweigh the potential risks in certain cases.

Tell your doctor if you’re pregnant or plan to become pregnant. This drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Women who are breast-feeding

This drug passes into breastmilk. It may cause serious effects in a child who is breastfed.

You and your doctor may need to decide if you’ll take this drug or breastfeed.

For seniors

Older adults may process this drug more slowly. Because of this, your doctor should monitor you more closely while you’re taking this drug.

For children

The safety and effectiveness of this drug for bipolar disorder and trigeminal neuralgia hasn’t been established in people younger than 18 years.

Allergies

This drug may cause a severe allergic reaction. Symptoms include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives or rash
  • blistering or peeling skin

Don’t take this drug again if you’ve ever had an allergic reaction to it before. Taking it a second time after an allergic reaction could be fatal.

SECTION 4 of 5

How to Take carbamazepine (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Bipolar disorder

Brand: Equetro

Form: oral capsule (extended release)
Strengths: 100 mg, 200 mg, 300 mg
Adult dosage (ages 18 years and older)
  • First dose: 200 mg taken by mouth 2 times per day
  • Dose changes: Your doctor may increase your dose by 200 mg per day.
Child dosage (ages 0-17 years)

None given. The safety and effectiveness of carbamazepine hasn’t been established in people younger than 18 years.

Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Epilepsy

Brand: Tegretol/Tegretol XR

Form: Oral tablet
Strengths: 100 mg (chewable), 200 mg
Form: Oral tablet (extended release)
Strengths: 100 mg, 200 mg, 400 mg
Form: Oral suspension
Strengths: 100 mg/5 mL

Brand: Carbatrol

Form: Oral tablet (extended release)
Strengths: 100 mg, 200 mg, 300 mg

Brand: Epitol

Form: Oral tablet
Strengths: 200 mg
Adult dosage (ages 18 years and older)
  • First dose:
    • Tablets, extended-release tablets, and capsules: 200 mg taken by mouth 2 times per day
    • Oral suspension: 5 mL taken by mouth 4 times per day (400 mg total per day)
  • Usual dose: 800–1200 mg per day
  • Dose changes: Each week, your doctor may increase your daily dose by 200 mg.
  • Maximum dose: 1600 mg per day
Child dosage (ages 12-17 years)
  • First dose:
    • Tablets and extended-release tablets and capsules: 200 mg taken by mouth 2 times per day
    • Oral suspension: 5 mL taken by mouth 4 times per day (400 mg per day)
  • Usual dose: 800–1,200 mg per day
  • Dose changes: Each week, your doctor may increase your daily dose by 200 mg.
  • Maximum dose:
    • ages 12–15 years: 1,000 mg per day
    • 15 years and older: 1,200 mg per day
Child dosage (ages 6-12 years)
  • First dose:
    • Tablets and extended- release tablets and capsules: 100 mg taken by mouth 2 times per day
    • Oral solution: 2.5 mL taken by mouth 4 timers per day (200 mg per day)
  • Usual dose: 400–800 mg per day
  • Dose changes: Each week, your doctor may increase your daily dose by 200 mg.Maximum dose: 1,000 mg per day
Child dosage (ages 0-5 years)
  • First dose:
    • Tablets: 10–20 mg/kg per day. The dosage should be divided and taken by mouth 2–3 times each day.
    • Oral solution: 10–20 mg/kg per day. The dosage should be divided and taken by mouth 4 times per day.
  • Dose changes: Your doctor may increase your dose weekly.
  • Maximum dose: 35 mg/kg per day
Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Trigeminal nerve pain

Brand: Tegretol/Tegretol XR

Form: Oral tablet
Strengths: 100 mg (chewable), 200 mg
Form: Oral tablet (extended release)
Strengths: 100 mg, 200 mg, 400 mg
Form: Oral suspension
Strengths: 100 mg/5 mL

Brand: Carbatrol

Form: Oral tablet (extended release)
Strengths: 100 mg, 200 mg, 300 mg

Brand: Epitol

Form: Oral tablet
Strengths: 200 mg
Adult dosage (ages 18 years and older)
  • First dose:
    • Tablets and extended release tablets: 100 mg taken by mouth 2 times per day
    • Extended-release capsules: 200 mg taken by mouth once per day
    • Oral solution: 2.5 mL taken by mouth 4 times per day
  • Usual dose: 400–800 mg per day
  • Dose changes:
    • Tablets and extended-release tablets: Your doctor may increase your dose by 100 mg every 12 hours.
    • Extended-release capsules: Every 12 hours, your doctor may increase your dose by 200 mg per day.
    • Oral solution: Your doctor may increase your dose by 2.5 mL (50 mg) 4 times per day.
  • Maximum dose: 1,200 mg per day
Child dosage (ages 0-17 years)

None given. The safety and effectiveness of carbamazepine hasn’t been established in people younger than 18 years.

Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug comes with serious risks if you don’t take it as prescribed.

If you skip or miss doses

You may not see a full benefit of this drug for the treatment of your condition. If you double up your dose or take it too close to your next scheduled time, you may have a higher risk of serious side effects.

If you take too much

You may see an increased risk of side effects associated with this medication. If you think you have taken too much of this drug, go to the nearest emergency room.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then only take one dose at your scheduled time.

Never try to catch up by taking two doses at once. This could cause toxic side effects.

If you don’t take it at all

Your bipolar disorder or epilespy won’t be treated. If you’re taking this drug for trigeminal neuralgia, your facial pain may get worse.

How to tell if the drug is working

Bipolar disorder: You may be able to tell if this drug is working if your symptoms of bipolar disorder get better.

Epilepsy: You may be able to tell if this drug is working if you have fewer seizures.

Trigeminal neuralgia: You may be able to tell if this drug is working if your facial pain gets better.

This drug is a long-term drug treatment.

Taking this drug with food depends on its form

The tablets, oral suspension, and extended-release tablets should be taken with meals.

The extended-release capsules can be taken with or without meals.

Follow these guidelines for consuming the tablet

  • The extended-release tablets shouldn’t be crushed or chewed.
  • The extended-release capsules may be opened and the beads inside the capsule can be sprinkled over food, such as a teaspoon of applesauce. Then swallow the dose all at once. You should use this method if you cannot swallow the capsule whole. You shouldn’t crush or chew the contents of the capsule.
  • The 100-mg immediate-release tablet can be chewed.
  • The 200-mg immediate-release tablet can be crushed, but should not be chewed.

This drug must be stored at the right temperature

Tablets and oral suspension:

  • Don’t store this drug above 86°F (30°C).
  • Keep this drug away from light.
  • Keep it away from high temperature
  • Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

Extended-release tablets and extended-release capsules:

  • Store this drug at 77°F (25°C). It’s OK to store it briefly between 59°F (15°C) and 86°F (30°C).
  • Keep this drug away from light.
  • Keep it away from high temperature.
  • Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry your medication with you in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt this medication.
  • You may need to show airport staff your pharmacy’s label to clearly identify the medication. Keep the original prescription label with you when traveling.
  • Don’t leave this medicine in the car, especially when the temperature is hot or freezing.

Clinical monitoring

Before starting and during your treatment with this drug, your doctor may check the following:

  • blood tests, such as:
    • genetic tests
    • blood cell counts
    • liver function tests
    • blood levels of carbamazepine
    • kidney function tests
    • electrolyte tests
  • eye exams
  • thyroid function tests
  • heart rhythm monitoring
  • monitoring for changes in your behavior

Not every pharmacy stocks every form of this drug

When filling your prescription, be sure to call ahead.

Hidden costs

You may need to pay for monitoring tests, such as:

  • blood tests
  • eye exams
  • thyroid function tests
  • heart rhythm monitoring

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

What does the pill look like?

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SECTION 5 of 5

How Much Does carbamazepine Cost?

Oral tablet

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Lowest price for carbamazepine

Rite-Aid $9.99
CVS Pharmacy $15.16
Walgreens $18.09
These prices represent the lowest priced national pharmacies for carbamazepine on GoodRx. They may be lower than your insurance.

Enter your zip code to find the best deal near you.

These prices represent the lowest priced national pharmacies for carbamazepine on GoodRx. They may be lower than your insurance.

Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on August 7, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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