Tegretol® (carbamazepine)
Brand
names:
Tegretol®
Tegretol®-XR
Carbatrol®,
Equetro®
Epitol®
Generic
name: carbamazepine (kar ba MAZ e peen)
Medication
class: anticonvulsant, mood stabilizer
What
is Tegretol® and what does it treat?
Carbamazepine is
a medication that works in the brain to treat bipolar disorder (also
known as manic depression). It is approved for the treatment of epilepsy or seizure disorders as well as acute mania and mixed
episodes associated with bipolar disorder. Bipolar disorder involves
episodes of mania and/or depression.
Symptoms
of depression include:
-
Depressed
mood – feeling sad, empty, or tearful
-
Feeling
worthless, guilty, hopeless, or helpless
-
Loss
of interest or pleasure in normal activities
-
Sleep
and eat more or less than usual (for most people it is less)
-
Low
energy, trouble concentrating, or thoughts of death (suicidal
thinking)
-
Psychomotor
agitation (‘nervous energy’)
-
Psychomotor
retardation (feeling like you are moving in slow motion)
Symptoms
of mania include:
-
Feeling
irritable or ‘high”
-
Having
increased self esteem
-
Feeling
like you don’t need to sleep
-
Feeling
the need to continue to talk
-
Feeling
like your thoughts are too quick (racing thoughts)
-
Feeling
distracted
-
Getting
involved in activities that are risky or could have bad consequences
(e.g. excessive spending)
What
is the most important information I should know about Tegretol®?
Bipolar
disorder requires long-term treatment. Do not stop taking
carbamazepine, even when you feel better.
Only
your healthcare provider can determine the length of carbamazepine treatment that is right for you.
Missing
doses of carbamazepine may increase your risk for a relapse in your mood symptoms.
Do
not stop taking carbamazepine or change your dose without talking to with your healthcare provider
first.
For carbamazepine to work properly, it should be taken every day as ordered by your
healthcare provider.
Periodically,
your healthcare provider may ask you to provide a blood sample to
make sure the appropriate level of medication is in your body and to
assess for side effects, such as changes in blood cell counts.
Are
there specific concerns about Tegretol® and pregnancy?
If
you are planning on becoming pregnant, notify your healthcare
provider so that he/she can best manage your medications. People
living with bipolar disorder who wish to become pregnant face
important decisions. It is important to discuss the risks and
benefits of treatment with your doctor and caregivers.
Carbamazepine
has been associated with and increased risk of defects of the head
and face, fingernails, and developmental delay. There may be precautions to decrease the risk of these effects.
Discontinuing mood stabilizer medications during pregnancy has been
associated with a significant increase in symptom relapse.
The
American Academy of Pediatrics committee on medications in
breastfeeding lists carbamazepine as “compatible” with
breast-feeding.
What
should I discuss with my healthcare provider before taking Tegretol®?
-
Symptoms
of your condition that bother you the most
-
If
you have thoughts of suicide or harming yourself
-
Medications
you have taken in the past for your condition, whether they were
effective or caused any adverse effects
-
If
you experience side effects from your medications, discuss them with
your provider. Some side effects may pass with time, but others may
require changes in the medication.
-
Any
other psychiatric or medical problems you have
-
All
other medications you are currently taking (including over the
counter products, herbal and nutritional supplements) and any
medication allergies you have
-
Other
non-medication treatment you are receiving, such as talk therapy or
substance abuse treatment. Your provider can explain how these
different treatments work with the medication.
-
If
you are pregnant, plan to become pregnant, or are breast-feeding
-
If
you drink alcohol or use illegal drugs
How
should I take Tegretol®?
Carbamazepine
is usually taken 2-4 times per day with or without food.
The
dose usually ranges from 200-1600
mg/day. Only
your healthcare provider can determine the correct dose for you.
Carbamazepine
suspension: Measure with a dosing spoon or oral syringe, which you
can get from your pharmacy.
Extended-release
capsules: Swallow whole or sprinkle onto food, such as applesauce or
pudding and eat immediately. Do not chew the sprinkle capsule or
contents.
Use
a calendar, pillbox, alarm clock, or cell phone alert to help you
remember to take your medication. You may also ask a family member a
friend to remind you or check in with you to be sure you are taking
your medication.
What
happens if I miss a dose of Tegretol®?
If
you miss a dose of carbamazepine,
take it as soon as you remember, unless it is closer to the time of
your next dose. Discuss this with your healthcare provider. Do not
double your dose or take
more than what is prescribed.
What
should I avoid while taking Tegretol®?
Avoid
drinking alcohol or using illegal drugs while you are taking
carbamazepine. They may decrease the benefits (e.g. worsen your
symptoms) and increase adverse effects effects
(e.g., sedation) of the medication.
What
happens if I overdose with Tegretol®?
If
an overdose occurs call your doctor or 911. You may need urgent
medical care. You may also contact the poison control center at
1-800-222-1222.
A
specific treatment to reverse the effects of carbamazepine does
not exist.
What
are possible side effects of Tegretol®?
Common
Side Effects
Rare
Side Effects
Carbamazepine
can cause a decrease in the body’s sodium level, especially at
higher doses. Some signs of low sodium include nausea, drowsiness,
and confusion.
Serious
Side Effects
Studies
have found that individuals who take anticonvulsant medications
including carbamazepine have
suicidal thoughts or behaviors up to 2 times more often than
individuals who take placebo (inactive medication). These thoughts
or behaviors occurred in approximately 1 in 550 patients taking the
anticonvulsant class of medications.
Mild
rash occurs in about 10-15% in those who take carbamazepine. In rare
cases (<1%) a severe, spreading rash with blistering of the skin
in patches over the entire body along with fever, headache and cough
can occur (Stevens-Johnson Syndrome). Although this is rare with
carbamazepine, discontinuation of this medication is necessary.
Carbamazepine
may lower blood counts. Your doctor will occasionally order blood
work to monitor for this side effect.
Contact
your healthcare provider immediately if you develop a skin reaction,
fever, swelling, or shortness of breath.
Are
there any risks for taking Tegretol® for long periods of
time?
To
date, there are no known problems associated with long term use of
carbamazepine. It is a safe and effective medication when used as
directed.
What
other medications may interact with Tegretol®?
Carbamazepine
may decrease the effectiveness of several other medications by
increasing their breakdown and elimination from the body. The effectiveness of carbamazepine may be reduced by other
medications as well. People who are taking carbamazepine should
consult their doctor before taking or discontinuing the following:
-
Oral
contraceptives (birth control pills)
-
Antipsychotics:
Latuda® (lurasidone), Abilify® (aripiprazole), Geodon® (ziprasidone), Clozaril® (clozapine)
-
Anticonvulsants:
Dilantin® (phenytoin), Depakote® (valproic acid), Luminal® (phenobarbital), Lamictal® (lamotrigine), Sabril® (vigabatrin)
-
Calcium
Channel Blockers: Norvasc® (amlodipine); Calan®,
Covera-HS®,
Isoptin SR® (verapamil); Cardizem®,
Tiazac® (diltiazem), Plendil® (felodipine), Procardia®,
Adalat® (nifedipine)
-
Benzodiazepines:
Xanax® (alprazolam),
Halcion® (triazolam), Valium® (diazepam)
-
Antibiotics:
Biaxin® (clarithromycin), Ery-Tab® (erythromycin), Ketek® (telithromycin)
-
Cholesterol
lowering agents: Lipitor®(atorvastatin),
Mevacor® (lovastatin), Zocor® (simvastatin)
-
HIV
Medications: Crixivan® (indinavir), Norvir® (ritonavir); Fortovase®,
Invirase®,
(saquinavir), Kaletra® (lopinovir/ritonavir), Rescriptor® (delavirdine)
-
Anticoagulants
(blood thinners: e.g., warfarin, aspirin, clopidogrel)
-
Tricyclic
antidepressants: Elavil® (amitriptyline); Asendin® (amoxapine); Anafranil® (clomipramine); Norpramin®,
Pertofrane® (desipramine); Sinequan® (doxepin); Tofranil® (imipramine); Pamelor®,
Aventyl® (nortriptyline); Vivactil® (protriptyline); Surmontil® (trimipramine)
-
Other:
Adenocard® (adenosine), Buspar® (buspirone), Camptosar® (irinotecan), Desyrel® (trazodone), Viagra® (sildenafil), Tagamet® (Cimetidine), corticosteroids, Luvox® (fluvoxamine)
-
Monoamine
oxidase (MAO) inhibitors: Marplan® (isocarboxazid), Nardil® (phenelzine), Eldepryl® (selegiline), Parnate® (tranylcypromine)
How
long does it take for Tegretol® to work?
It
is very important to tell your doctor how you feel things are going
during the first few weeks after you
start taking carbamazepine. It will probably take several weeks to
see big enough changes in your symptoms to decide if carbamazepine is
the right medication for you.
Mood
stabilizer treatment is generally needed lifelong for persons with
bipolar disorder. Your doctor can best discuss the duration of
treatment you need based on your symptoms and illness.
Provided
by
College
of Psychiatric and Neurologic Pharmacists
(January
2013)
Summary
of FDA Black Box Warnings
Decreased
Blood Cell Counts
Carbamazepine
may lower your blood counts (e.g. white blood cell which fight off
infection). Your doctor will occasionally order blood work to
monitor for changes in your blood counts. Notify your doctor if you
experience fever, sore throat, infections and easy bruising.
Screen
for the genotype HAL-B*1502 allele in Asian patients
Patients
with a positive result are more likely to have serious side effects
and should not take carbamazepine.
