US Brand Names: Tegretol, Equetro, Carbatrol, Atretol, Convuline, Epito, Macrepan
See toward the bottom of the page for other brand names
Generic Name: carbamazepine USP
Other Forms: Vanilla-flavored syrup; chewable tablets; suppositories; extended-release tablets, most of which you don’t digest and it really is supposed to come out the other end undigested.
What is Tegretol / Tegretol XR / Equetro: Tegretol and Equetro same thing, anticonvulsants, such as enzyme-inducing antiepileptic
What FDA approved uses in & Tegretol Tegretol XR: For epilepsy – psychomotor, generalized tonic-clonic seizures and mixed forms. If you need to know:
Simple partial seizures – you’re still awake (more or less), with symptoms such as one or two limbs spazzing out or wacky visual or other sensory distortions. Think Alice in Wonderland, as Lewis Carroll must have had some serious temporal lobe issues. The fist link will take you to a better explanation. For a really detailed explanation of what a simple partial seizure is, click here.
Complex partial seziures – the people around you think you’re just acting out to get attention. In reality you have no control over what’s happening. Again, click there for the basics, click here for what neurologists think about this type of seizure.
Generalized tonic-clonic – the classic definition of a seizure, when you’re completely flopping all over the place like a fish out of water. For the neurologist’s view, click here.
Mixed pattern is where, like me, you get a little bit of everything. Although Tegretol doesn’t seem to help much with absence seizures and might even make atypical absence seizures worse for some people.
Tegretol is also approved for glossopharyngeal and trigeminal neuralgia. If you have either you know what they are, I don’t have a clue, other than excruciating pain around your head and face caused by wackiness with your trigeminal nerves.
Tegretol (carbamazepine USP) 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.
What is Equetro’s FDA Approved Use: extended-release carbamazebine by another brand name (i.e. Carbatrol) – 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.
Off-Label Uses: Diabetic neuropathy, augmenting treatment of schizophrenia, intermittent explosive disorder and other rage disorders, alcohol withdrawal syndrome, benzodiazepine withdrawal and PTSD.
Tegretol’s & Equetro’s pros and cons:
Pros: Having been around forever, the effects and side effects are well known. The only anticonvulsant approved for a mixed-bag of seizures. It has FDA approval to treat bipolar, in case you’re stuck with a government or insurance formulary.
Cons: The side effects suck donkey dong! You need to have regular blood tests. It’s especially sensitive to food, booze and alcohol. It’s not really all that good for bipolar disorder.
Tegretol’s & Equetro’s Typical Side Effects: Those common for anticonvulsants. Nausea is very common when starting Tegretol / Equetro. Like all meds that hit 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.
For tips on how to cope with these side effects, please see our side effects page.
These aren’t all the side effects you can get, just the most popular ones.
Tegretol’s & Equetro’s Not So Common Side Effects: Photosensitivity. While all anticonvulsants and antipsychotics make you more sensitive to sunlight, Tegretol / Equetro 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.
These may or may not happen to you don’t, so don’t be surprised one way or the other.
Tegretol’s & Equetro’s Freaky Rare Side Effects: Growing a lot more body hair and being able to get drunk off of water.
You aren’t going to get these. I promise.
For all side effects read the Tegretol PI sheet or the Equetro PI sheet as appropriate.
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 you’ll start to clear it out of your system faster.
There’s been some anecdotal evidence (i.e. reports from people in support groups) that various generic forms and the Carbatrol form of carbamazepine does not work as well as brand-name Tegretol in controlling bipolar symptoms. I have no reports about control of epileptic symptoms when switching from brand to a generic or alternate brand, but it wouldn’t surprise me if the same is true. This is probably an instance of brand vs. generic in action. Then again, the extended-release version Equerto recently received FDA approval to treat the manic and mixed symptoms of bipolar 1, so who the hell knows?
Tegretol’s & Equetro’s Dosage and How to Take Tegretol / Equetro: I’m just going to deal with adults and monotherapy. 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.
Days to Reach a Steady State: Usually a week, but there are far too many variables involved with enzyme-inducing drugs.
When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.
How Long Tegretol / Equetro Takes to Work: First you have to reach the therapeutic range of 4 to 10. But unlike the valproates or lithium the blood plasma level isn’t tested that often. Enzyme-inducing anti-epileptic drugs tend to work faster than their non-inducing counterparts by the very nature of the enzyme induction. But the odds are you’ll find the sweet spot somewhere between 400 and 1200mg a day, so whenever you get to that dosage, it’ll start working.
Tegretol’s & Equetro’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 anticonvulsants that’s subject to change.
How to Stop Taking Tegretol / Equetro: 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. For more information, please see the page on how to safely stop taking these crazy meds.
Like any anticonvulsant, if you’ve been taking Tegretol (carbamazepine USP) 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 grand mals, despite your never having had a seizure disorder before! The risk is worse if you’re taking a lithium variant, and/or any antidepressant, especially Wellbutrin (bupropion hydrochloride).
If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.
Comments: Be sure to read the sections on anticonvulsants and enzyme-inducing anti-epileptic drugs if you haven’t done so already.
Approved by the FDA in 1968, Tegretol (carbamazepine USP) is the manliest of the anticonvulsants. What? Tegretol (carbamazepine USP) works better if you take it with the occasional shot of booze or cigar, it absorbs well when taken with high fat meals, it just clobbers the efficacy of oral contraceptives and other estrogen supplements, and it really does a number on Lamictal (lamotrigine) – the diva of anticonvulsants. That’s manly in my book! No, really, occasional alcohol intake will increase Tegretol’s plasma levels in unpredictable ways, so it’s not really recommended. And if you smoke you’ll find that you probably won’t need as much Tegretol as a non-smoker. At first. But like all enzyme-inducing meds, you’ll have to eventually increase the dosage of the Tegretol. Or the nicotine if you like clearing the Tegretol out of your system sooner.
Tegretol (carbamazepine USP) 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. But don’t write it off just yet. The key is to look at how it performs in epilepsy. Like Topamax (topiramate) and Trileptal (oxcarbazepine), Tegretol is best used when applied to problems in the temporal lobes. You don’t have to be epileptic to have problems with your temporal lobes, as your bipolar disorder could be living there as well. So when tested on random bipolar people it would be the same as if tested on random epileptics, Tegretol wouldn’t be that effective when compared to lithium for bipolar or Dilantin (phenytoin) for epilepsy. But if you were to just take people with temporal lobe issues, then Tegretol (carbamazepine USP), like Topamax (topiramate) and Trileptal (oxcarbazepine), works very well indeed. Given all of its side effects and the blood work involved, though, Tegretol would probably be the last of the three I’d try.
Trileptal is, after all, just the new & improved Tegretol (carbamazepine USP). One extra oxygen atom that makes all the difference in the world for a lot of people.
For Kassiane Tegretol was the best thing ever for controlling her bipolar and epileptic symptoms. Until the aplastic anemia hit her with a vengeance, like being smitten by the hammer of an angry neuropharmaceutical diety.
Unlike other anticonvulsants used for pain relief, how Tegretol (carbamazepine USP) works for pain is more-or-less understood, as it stimulates the infraorbital nerve. I’m sure that is meaningful to someone reading this. Whereas how it works as an anticonvulsant/mood stabilizer is really not that well understood at all. While the means by which all anticonvulsants is truly guessed at, Novartis doesn’t even bother publishing a method of action beyond, “It appears to act by reducing polysynaptic responses and blocking the post-tetanic potentiation..” No neurotransmitters, no receptors, nothing. Dr. Stahl thinks that it works along potassium and/or sodium channels to enhance GABA. I’ll go along with that for three reasons:
Many people, including Mouse with the related med Trileptal (oxcarbazepine), report sodium or potassium related problems with Tegretol (carbamazepine USP) and Trileptal (oxcarbazepine). Meds that work along these channels can cause sodium or potassium issues elsewhere in the body.
Many of the other side effects are similar to other GABAergic meds such as Depakote (divalproex sodium) and Topamax (topiramate). So it would make sense that GABA is getting played around with. Of course these side effects can result because of other reasons, so this is just a bit of circumstantial evidence.
Dr. Stahl is just a pharmacological god as far as I’m concerned. While he most likely can make mistakes, I’ll put my money on this not being one.
Unless Trileptal (oxcarbazepine) has failed for you or just isn’t available where you live, it’s usually a better first choice if Tegretol (carbamazepine USP) 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 (oxcarbazepine) really is just as effective as Tegretol (carbamazepine USP) or not. Tegretol (carbamazepine USP) has tested as the superior med when it comes to neuropathic pain. But Tegretol (carbamazepine USP) is otherwise a fine med for temporal lobe issues.
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.
Other Brand Names: 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)
Carpaz (South Africa)
Degranol (South Africa)
Epileptol, Epileptol CR (Korea)
Eposal Retard (Colombia)
Foxalepsin, Foxalepsin Retard (Germany)
Mazetol (India; Malaysia)
Neugeron (Costa Rica; Dominican Republic; Guatemala; Honduras; Mexico; Nicaragua; Panama)
Neurotop (Austria; Hungary; Malaysia)
Neurotop Retard (Malaysia)
Nordotol (Denmark; Mexico)
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)