Apo-Carbamazepine , Carbatrol, Epitol, Equetro, Mazepine , PMS-Carbamazepine , Tegretol, Tegretol XR, Teril
Classifications: central nervous system agent; anticonvulsant; tricyclic
Pregnancy Category: D


100 mg chewable tablets; 200 mg tablets; 100 mg, 200 mg, 400 mg sustained-release tablets; 100 mg, 200 mg, 300 mg sustained-release capsules; 100 mg/5 mL suspension


Structurally related to tricyclic antidepressants (TCAs) but lacks antidepressant properties. Anticonvulsant actions appear qualitatively similar to those of phenytoin. Like phenytoin, provides relief in trigeminal neuralgia by reducing synaptic transmission within trigeminal nucleus. Also has sedative, anticholinergic, antidepressant, and muscle relaxant (by inhibition of neuromuscular transmission) effects and slight analgesic actions.

Therapeutic Effects

Effective anticonvulsant for a range of seizure disorders and as an adjuvant reduces depressive signs and symptoms and stabilizes mood. It is effective for pain and other symptoms associated with neurologic disorders.


Alone or concomitantly with other anticonvulsants in treatment of grand mal and psychomotor or temporal lobe epilepsy and mixed seizures in patients who have not responded satisfactorily to other agents. Also used for symptomatic treatment of trigeminal (tic douloureux) and glossopharyngeal neuralgias and for pain and paroxysmal symptoms associated with multiple sclerosis and other neurologic disorders.

Unlabeled Uses

Certain psychiatric disorders including prophylaxis and treatment of manic-depressive illness, treatment of schizoaffective illness, resistant schizophrenia, dyscontrol syndrome; for management of alcohol withdrawal, rage outbursts, and for antidiuretic effect in diabetes insipidus.


Hypersensitivity to carbamazepine and to TCAs; history of myelosuppression or hematologic reaction to other drugs; increased IOP; SLE; cardiac, hepatic, or renal disease; coronary artery disease; hypertension; pregnancy (category D), lactation. Safe use in children <6 mo not established.

Cautious Use

The older adult; history of cardiac disease.

Route & Dosage

Adult: PO 200 mg b.i.d., gradually increased to 800–1200 mg/d in 3–4 divided doses. Tegretol XR dosed b.i.d.
Child: PO <6 y: 10–20 mg/kg/d, may gradually increase weekly, recommended max 35 mg/kg/d in 3–4 divided doses; 6–12 y: 100 mg b.i.d., gradually increased to 400–800 mg/d in 3–4 divided doses (max: 1 g/d); <6 y: 20–30 mg/kg/d in 3–4 divided doses

Trigeminal Neuralgia
Adult: PO 100 mg b.i.d., gradually increased by 100 mg increments q12h until relief; usual dose 200–800 mg/d in 3–4 divided doses (max: 1.2 g/d). Tegretol XR dosed b.i.d.



Adverse Effects (1%)

Body as a Whole: Myalgia, arthralgia, leg cramps, carbamazepine-induced SLE. CV: Edema, syncope, arrhythmias, heart block. GI: Nausea, vomiting, anorexia, abdominal pain, diarrhea, constipation, dry mouth and pharynx, abnormal liver function tests, hepatitis, cholestatic and hepatocellular jaundice, pancreatitis. Endocrine: Hypothyroidism, SIADH. Hematologic: Aplastic anemia, leukopenia (transient), leukocytosis, agranulocytosis, eosinophilia, thrombocytopenia. CNS: Dizziness, vertigo, drowsiness, disturbances of coordination, ataxia, confusion, headache, fatigue, listlessness, speech difficulty, development of minor motor seizures, hyperreflexia, akathisia, involuntary movements, tremors, visual hallucinations, activation of latent psychosis, aggression; agitation, respiratory depression. Skin: Skin rashes, urticaria, petechiae, erythema multiforme, Stevens-Johnson syndrome, photosensitivity reactions, altered skin pigmentation, exfoliative dermatitis, alopecia. Special Senses: Abnormal hearing acuity, scotomas, conjunctivitis, blurred vision, transient diplopia, oculomotor disturbances, oscillopsia, nystagmus. Urogenital: Urinary frequency or retention, oliguria, impotence.

Diagnostic Test Interference

False-negative pregnancy test results with tests involving human chorionic gonadotropin.


Drug: Serum concentrations of other anticonvulsants may decrease because of increased metabolism; verapamil, erythromycin, ketoconazole, nefazadone may increase carbamazepine levels; decreases hypoprothrombinemic effects of oral anticoagulants; increases metabolism of estrogens, thus decreasing effectiveness of oral contraceptives. Herbal: Ginkgo may decrease anticonvulsant effectiveness.


Absorption: Slowly absorbed from GI tract. Peak: 2–8 h. Distribution: Widely distributed; high concentrations in CSF; crosses placenta; distributed into breast milk. Metabolism: Metabolized in liver; can induce liver microsomal enzymes. Elimination: Excreted in urine and feces. Half-Life: 14–16 h (decreases with long-term use).

Nursing Implications

Assessment & Drug Effects

Patient & Family Education

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug