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• Click "Print this page" on the left hand side to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.
• Download a handy QuILL (Quick Information Leaflet), a shorter, pictorial version of the PILL, designed for younger people. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

^{Updated 12.11}

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Carbamazepine has three main uses:

• It can be used to help prevent mood swings e.g. feeling 'high' or 'low', in people who suffer from a bipolar mood disorder (sometimes called manic-depression). There are a number of other drugs which are useful to help stabilise moods. It is more useful in bipolar mania and less so in bipolar depression
• It can be used to help control epilepsy (fits, seizures or blackouts).
• It may be used to help the symptoms of trigeminal neuralgia (a really painful condition of the face)

Carbamazepine is also sometimes used to help a number of other illnesses such as alcohol dependence, alcohol withdrawal, schizophrenia, and withdrawal from benzodiazepines.

^{Updated 10.11}

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The usual dose of carbamazepine depends on age, weight, any other medicines also being taken, blood levels and what it is being taken for. For the plain tablets, the usual dose is usually split up as two or three times a day to reduce side effects. The slow release (Retard) tablets can be taken once a day.

Epilepsy:

The usual starting dose in adults is 100-200mg once or twice a day. This can then be slowly increased to 800-1200mg a day. Some people may need 1600mg or even 2000mg a day.

The usual dose in children and the elderly should be lower.

For bipolar mania (stopping it coming back): The starting dose usually is 200mg twice a day. The usual dose is around 400-600mg a day, although some people may need up to 1600mg a day.  

Trigeminal neuralgia - the usual dose starts at 200-400mg a day up to 200mg 3-4 times a day. In severe cases some people may need higher doses than this.

For alcohol withdrawal: the usual dose usually starts at around 800mg a day (often 200mg four times a day). This is then reduced gradually over 5 days or so to 200mg a day. It is not usually needed for longer than 7-10 days.

^{Updated 10.11}

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Alcohol dependence - main options, main medicines and handy chart
• Alcohol withdrawal - main options, main medicines and handy chart
• Bipolar mood disorder - main options, main medicines and handy chart
• Bipolar depression - main options, main medicines and handy chart
• Bipolar mania - main options, main medicines and handy chart
• Epilepsy - main options, main medicines
• Schizophrenia - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

^{Updated 1.12}

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In epilepsy, epileptic seizures (fits or blackouts) happen when an abnormal electrical discharge, like a short circuit causing a spark, occurs in the brain. Carbamazepine makes these discharges less likely to happen. It is not known exactly how carbamazepine works in people with mood problems, but it does seem to help to stabilise the brains activity.

Carbamazepine works by "reduced kindling". To help understand this better you may find it helpful to read the answers to the following questions

• How do medicines work in the brain?

• What happens when transmitter activity is high?

• How does carbamazepine work in detail?

^2.11

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Take the dose of carbamazepine as directed on the medicine label. You should take it at regular times each day but can be taken with, between or after meals.

"Tegretol Chewtabs" can be taken with, between or after meals, followed by a little liquid e.g. a small glass of water.

If the instructions say to take it once a day this is usually best at bedtime as they may make you drowsy. They are not sleeping tablets though. If you are taking carbamazepine to help control fits or blackouts, it is particularly important that you take it regularly as directed by your doctor to make sure you are getting the best control. Missing a dose can cause your fits to return.

^{Updated 10.11}

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Tablets
Tablets should be swallowed with at least half a glass of water whilst sitting or standing so that they reach the stomach and do not stick in the throat.

"Tegretol Retard" tablets should be swallowed whole and not chewed. This tablet is made so that the carbamazepine is released over a longer period of time. This can help to reduce side-effects or reduce the number of times a day you need to take this medicine. If you cannot swallow them whole they can be broken, but do not crush chew or dissolve them as this will cause the drug to be released too soon.
"Tegretol Chewtabs" may be chewed or sucked.
Liquids:
Your pharmacist should give you a medicine spoon or oral syringe. Use it carefully to make sure that you measure the correct amount. Ask your pharmacist for a medicine spoon if you do not have one. Shake the bottle well before use as the drug can settle to the bottom and cause you to receive a lower dose at the start and too high a dose at the end of the bottle, which could be dangerous.

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This may depend on what you are taking carbamazepine for. Click the link below for the answer for that condition:

• Alcohol dependence
• Alcohol withdrawal
• Bipolar mood disorder
• Bipolar depression
• Bipolar mania or hypomania
• Epilepsy
• Schizophrenia

^{Updated 10.11}

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This will depend on what you are taking it for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Alcohol dependence
• Alcohol withdrawal
• Bipolar mood disorder
• Bipolar depression
• Bipolar mania or hypomania
• Epilepsy
• Schizophrenia

^{Updated 10.11}

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Carbamazepine is not addictive. If, however, you are taking it for epilepsy you should not stop taking it suddenly for the reasons explained below. It is probably also not a good idea to stop any mood stabliser suddenly in case it destabilises you.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Carbamazepine has none of these and so is not addictive. Any discontinuation effects are probably more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal".

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

^9.10

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Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet. If you are taking carbamazepine to help control fits or blackouts and you are ill and vomit soon after taking your tablets, you should take that dose again. Missing a dose can cause your fits to return. The amount in your blood may drop below the level needed to control your fits. Missing the occasional dose (e.g. once a week) isn't usually a big problem (unless you are taking it for seizures).

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by your bed etc.

^9.10

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Carbamazepine is a "preventative medicine". If you are taking carbamazepine to help control fits or blackouts never stop taking it suddenly or without advice from your doctor as this might mean an increase in your fits. If you are taking it to help prevent mood swings it is also unwise to stop taking your carbamazepine suddenly, even if you feel better. You should not suffer any withdrawal effects. For it to continue working carbamazepine must be taken every day. If you do stop taking it before you are advised to do so by your doctor your symptoms could return.

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The table below will show you some of the main side effects you might get from carbamazepine.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

^{Updated 12.11}

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Carbamazepine may make you feel a bit drowsy or sleepy at first. You should not drive (see below) or operate machinery until you know how it affects you. You should be careful as this may affect your reflexes or reaction times. It is not, however, a sleeping tablet, although if you take it at night it may help you get to sleep.

^{Updated 11.11}

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Carbamazepine does not usually cause any changes in weight. If, however, you do start to have problems with your weight, tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice on how to help manage this. You are less likely to gain weight with medicines like carbamazepine if you have some physical activity as well as dieting ^{(Gaspari and Guerreiro 2010)}

Click here for a few tips on how to help you feel less hungry and lose weight.

^{Updated 11.11}

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Carbamazepine and oxcarbazepine have not been reported to have a major adverse effect on these three stages. However, if this does seem to happen, you should discuss this with your doctor, as a change in dose may help minimise any problem. Your doctor may want to do a blood test to check on your testosterone levels, as carbamazepine and possibly oxcarbazepine can reduce them and this can reduce desire.

^{Updated 11.11}

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You should have no problem with most foods or drinks, other than alcohol (see separate question) and caffeine.

The liver has many enzymes that break down chemicals from foods, drinks and medicines. One of these enzymes is called CYP1A2 (sometimes P450-1A2). Caffeine is broken down by CYP1A2. Caffeine (e.g. in tea, coffee, colas, Dr Pepper, energy drinks etc) can also increase the speed at which CYP1A2 works. Carbamazepine increases the speed at which 1A2 works. This can lead to less effect from caffeine.

^{Updated 11.11}

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. asthma or a chest infection (as alcohol can make it harder to breathe), epilepsy
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

You should be careful about drinking alcohol while taking carbamazepine or oxcarbazepine as it may make you feel more sleepy. if this happens, you must take extra care if you are allowed to drive or operate machinery. You must seek advice on this.  

It is not safe to drive after drinking alcohol, with or without carbamazepine or oxcarbazepine. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

^{Updated 11.11}

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Carbamazepine has many interactions with other medicines, partly because it increases the speed at which the liver breaks down some medicines:

• Carbamazepine should not be taken with clozapine (because it might cause a blood problem) or St. John's wort.
• The effects of carbamazepine can sometimes be increased by calcium-channel blockers (e.g. diltiazem, verapamil) and some antibiotics e.g. doxycycline, erythromycin, fluconazole, isoniazid, and ciprofloxacin (Shahzadi 2011).
• The effect of carbamazepine can be decreased by phenobarbital, phenytoin or rifampicin
• Carbamazepine can sometimes decrease the effect of some antipsychotics (e.g. aripiprazole, clozapine, haloperidol, quetiapine, risperidone), antiretroviral (used for AIDS), ciclosporin, corticosteroids, nicoumalone, oral contraceptives, omeprazole, tricyclics (e.g. dosulepin, imipramine, lofepramine), valproate (e.g. Epilim, Depakote), warfarin, melatonin, lamotrigine, topiramate, bupropion, zolpidem or methadone.

This does not necessarily mean that some of these medicines can not be used together, just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

^{Updated 1.12}

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking.

However, carbamazepine and oxcarbazepine do not seem to be affected so there seem to be no extra problems if smoking with either of them. However, carbamazepine can reduce the effects of nicotine, which might lead you to smoke more, which isn't a good idea. 

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, there are no extra problems with smoking cannabis, other than the smoking itself (see above).

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with carbamazepine and cocaine, although this doesn't mean it's safe.Cocaine can increase the effects of carbamazepine or oxcarbazepine on the heart. This is not likely to be a big problem unless you have a heart problem.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with carbamazepine or oxcarbazepine and ecstasy, but this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with carbamazepine or oxcarbazepine, although you might feel more drowsy.

^{Updated 1.12}

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It is important that your Doctor knows if you are taking a contraceptive pill. This is because carbamazepine can make "The Pill" less effective. Your doctor may need to change you to a higher dose pill. Even with this change, the contraceptive pill may still not work well enough. You may want to think about other methods of contraception e.g. condom or coil. Ask your doctor or visit your local family planning clinic for advice.

^{Updated 11.11}

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In the UK, Levonelle one step® is available and is usually known as 'the morning-after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking carbamazepine (or if you have taken it in the last 4 weeks), your liver will be working quicker and so the usual dose may not work. You should see your Doctor as soon as possible as you will need a higher dose. Levonelle one step® has 1.5mg of levonorgestrel, and you will need 3mg of levonorgestrel to be safe. You should also take the dose as soon as possible, so don't delay.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

^6.11

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily carbamazepine doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

^{Updated 11.11}

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Carbamazepine is classed as "D". There is some evidence of problems e.g. a 1 in 30 (3.3%) chance of an abnormality (Jentink 2010), mainly spina bifida but the risk is still low, and lower than some similar medicines. If the mum has been taking carbamazepine in pregnancy, longer studies have shown that this should have no effect on the child's IQ (Banach 2010).

You will need to seek personal advice from an expert, as counselling and screening is recommended. Taking folic acid supplements throughout pregnancy (and possibly before) may reduce this risk. You will also need to consider the risk of relapse if you stop your carbamazepine. If you are taking this medicine for epilepsy, then you will need to also consider the risk of seizures as well. One study over the first few years of life was able to show that carbamazepine did not appear to have an effect on intelligence and speech abilities of children born to mothers who took carbamazepine throughout pregnancy.

^{Updated 11.11}

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.

• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.

• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter

• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit

• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half

• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that some carbamazepine gets into breast milk, but usually only enough to give the baby small amounts via the milk. The American Academy of Pediatrics has said that carbamazepine is "compatible" with breast feeding. However, there have been some cases of the baby not feeding well and being drowsy. So you should be careful and seek advice if your baby feeds poorly, is extra sleepy or you are on a high dose of carbamazepine. We would expect oxcarbazepine to be similar to carbamazepine but there is little information at the moment so is best avoided if possible. One large study showed that breast feeding while someone is taking carbamazepine has no harmful effects on the child's development over the next 3 years.

^6.11

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Carbamazepine and oxcarbazepine can make you drowsy or sleepy and cause blurred vision or double vision when you first start taking it. A study in 2010 ^(Kaussner) showed that people taking carbamazepine found it more difficult to keep to lanes, made more mistakes, and were sleepier, so you would need to take extra care. It is vital that you report any epilepsy or sudden disabling attacks of loss or partial loss of consciousness to the licensing authorities.

If you are taking any medicines (including epilepsy or bipolar disorder), the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)
• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

^{Updated 11.11}

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You may need to have a blood test (or even several) after starting carbamazepine or oxcarbazepine. You may then need a test every six months or so to make sure that the dose of carbamazepine or oxcarbazepine is enough but not too much for you. This is particularly important if you are taking oxcarbazepine or carbamazepine for fits or blackouts. You may also need a test if your dose or tablet is changed or other medicines you are taking are changed.

If you are of Han Chinese and Thai origin should might need to be tested for the "HLA-B*1502" gene. If you have this gene it means you have a higher chance of getting a bad skin reaction (the Stevens-Johnson syndrome) from carbamazepine.

^{Updated 10.11}

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