Tegretol (Carbamazepine)
Also sold as: Tegretol, Zen Retard, Carbatol, Mazetol, Zeptol
Pregnancy
Cat D
Lactation
Caution
Schedule
H
Forms
Tablet 100mg, 200mg, 400mg +3
Indications
- Partial (focal) seizures with or without secondary generalisation — first-line
- Tonic-clonic seizures
- Trigeminal neuralgia — first-line
- Glossopharyngeal neuralgia
- Bipolar disorder — mood stabilisation (especially mania)
- Neuropathic pain (adjunct)
- Alcohol withdrawal seizures
Adult Dosing
Epilepsy
Start 100-200 mg BD; increase by 200 mg/week to 400-1200 mg/day in divided doses
Controlled release preferred for better tolerability. Target trough level: 4-12 mg/L
Trigeminal neuralgia
Start 100 mg BD; increase to 200 mg QID (max 1200 mg/day)
Start low — older patients especially sensitive
Bipolar mania
400-1600 mg/day in divided doses
Monitor levels and CBC closely
Pediatric Dosing
Suspension (100mg/5mL) available for young children. TDM essential in paediatrics.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No specific adjustment — not renally eliminated. Monitor for toxicity |
Hepatic Adjustment
Avoid in significant hepatic impairment — hepatically metabolised. Can itself cause hepatotoxicity.
Pregnancy & Lactation
Pregnancy: Category D
TERATOGENIC: neural tube defects (spina bifida ~1%), cardiac defects, cleft palate. Supplement high-dose folic acid (5 mg/day). Levels fall during pregnancy — monitor TDM. If possible, switch to lamotrigine or levetiracetam before conception.
Lactation: Caution
Excreted in breast milk. Monitor infant for drowsiness, poor feeding. Compatible with breastfeeding with monitoring.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Oral contraceptives | Potent CYP3A4 inducer — significantly reduces OCP efficacy; use alternative contraception | Major |
| Warfarin | Reduces warfarin levels — INR falls; monitor and increase warfarin dose | Major |
| Valproate | Reduces carbamazepine levels; increases toxic metabolite (CBZ-10,11-epoxide) | Major |
| Erythromycin / Clarithromycin / Azithromycin | Significantly increases carbamazepine levels — toxicity (ataxia, diplopia) | Major |
| Fluoxetine / Fluvoxamine | Increase carbamazepine levels | Major |
| Lithium | Additive neurotoxicity | Moderate |
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Side Effects
Common
- Dizziness
- Diplopia (double vision)
- Ataxia
- Drowsiness
- Nausea
- Hyponatremia (SIADH — especially in elderly)
- Rash
Serious / Discontinue If
- Aplastic anaemia / Agranulocytosis (rare but potentially fatal — monitor CBC)
- Stevens-Johnson syndrome / TEN (especially in HLA-B*1502 allele carriers — Han Chinese, SE Asians)
- Hyponatraemia (can be severe in elderly)
- Hepatotoxicity
- Carbamazepine toxicity: nystagmus, ataxia, diplopia, coma
Contraindications
- AV block
- History of bone marrow depression
- Known HLA-B*1502 allele without prior CBZ tolerance (SJS risk)
- MAO inhibitor use within 14 days
- Acute intermittent porphyria
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Tegretol 200mg | Novartis | 10 tab ₹52 |
| Zen Retard 200mg CR | Sun Pharma | 10 tab ₹68 |
| Carbatol 200mg | Torrent | 10 tab ₹42 |
| Mazetol 200mg | Sun Pharma | 10 tab ₹38 |
Monitoring Required
- Serum carbamazepine level: therapeutic 4-12 mg/L (trough)
- CBC at baseline, then monthly × 3 months, then every 3-6 months
- LFTs (hepatotoxicity)
- Serum sodium (hyponatraemia, especially elderly)
- HLA-B*1502 genotyping before starting in Han Chinese, Thai, SE Asian patients (SJS risk)
Patient Counseling Points
- DO NOT stop suddenly — seizure risk
- Women on OCP: use additional contraception — CBZ reduces pill effectiveness
- Report: rash, mouth sores, unusual bruising, jaundice, double vision, severe drowsiness
- Grapefruit juice increases CBZ levels — avoid
- Macrolide antibiotics (erythromycin, clarithromycin) can cause toxicity — always tell prescribers you are on CBZ
- Avoid alcohol — increases CNS depression
Stop Googling drug references mid-consultation
EasyClinic auto-flags Tegretol interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Vikram Sinha, DM (Neurology), Senior Neurologist
Last reviewed: 2026-04-01
References
- BNF — Carbamazepine
- ILAE Epilepsy Treatment Guidelines
- EAN Trigeminal Neuralgia Guidelines
- IAP Epilepsy Guidelines 2024