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.

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

1.  FDA Approved Uses of Tegretol:

For 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.

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.

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.

Tegretol 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.

Equetro, which is just extended-release carbamazepine manufactured by Shire instead of Novartis, 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.

2.  Tegretol’s Off-Label Uses

• Diabetic neuropathy
• Augmenting the treatment of schizophrenia & schizoaffective psychoses
• Intermittent explosive disorder and other rage disorders (sorta kinda effective)
• Alcohol withdrawal syndrome (along with lorazepam)
• Benzodiazepine withdrawal
• PTSD

3.  Tegretol’s pros and cons

3.1  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.

3.2  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.

4.  Tegretol’s Side Effects

4.1  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.

4.2  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.

4.3  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).

5.  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.

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6.  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.

7.  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.

8.  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.

9.  Days to Reach a Steady State

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

10.  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.

11.  Comments

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 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.

12.  Other US brand names & branded generic names¹

Equetro, Carbatrol, Atretol, Convuline, Epito, Macrepan

13.  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)

14.  Discussion board

Crazy Meds’ Tegretol discussion board

15.  Your Comments About and Experiences with Tegretol

Tell us what you think about Tegretol

Hi

I have been on tegretol now for over eight months 2 tablets a day 100mg x 2 for three seizures over the last twenty seven years one just eight months ago. All test were negative and I have not been diagnosed an epileptic.I must say I think i have got every side effect going and still have them and i am still on this drug, pains in my joints, nauseous, weight loss, stomach pains and looking like shit, I am told by my friends that I look like a walking corpse,only in the past month looking this way. I have told my doctor I want off, I am working on reducing amounts down to one and half pills a day at present and on a supplement also nexim included which is quiet harmless. It will take me three months to come off the drug and staying on nexim also for a further month. PS I am getting my bloods checked on a regular basis.

Also I have done a lot of research on this drug and it should be used with medical advice and also come off with doctors advice and do so correctly do not just go cold turkey with tegretol as it can only make matter worse ie it will cause seizures.

Regards

Michael Cork Ireland.

what is meant by saying that tegratol does a number on lamictal? does tegratol decrease? or increase? lamictal. like when it is reported that tegratol decreases the effect of topomax somewhat.

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Enter your own Comments & Experiences with Tegretol here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

18.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Tegretol Full US Prescribing Information / PI Sheet
UK SPC Sheet
UK PIL
New Zealand Data Sheet
New Zealand CMI leaflet
South African Degranol PI Sheet
Australian CMI leaflet
Russian Карбадак (Carbadac) PI Sheet

Check for drug-drug interactions

19.  Bibliography

Essential Psychopharmacology 2nd Edition 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.

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.

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.

Date created 15 Mar 2011 - 14:33 Page Author: JerodPoore Last edited by: JerodPoore

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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 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 Crazy Meds. 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 the forerunner to 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]