Mood stabilizer / anticonvulsant

Carbamazepine

Tegretol, Tegretol XR, Carbatrol, Equetro
FDA-Approved Indications
  • Bipolar I disorder: acute manic and mixed episodes (Equetro)
  • Epilepsy: partial seizures, generalized tonic-clonic seizures, mixed seizure patterns
  • Trigeminal neuralgia
Common Off-Label Uses
  • Bipolar maintenance therapy
  • Neuropathic pain
  • Alcohol withdrawal
  • Impulse control disorders
  • Schizoaffective disorder (adjunctive)

Side Effects Worth Knowing

Dizziness and Ataxia

Common during initiation and dose increases. Related to CNS sodium channel effects. Usually improves with dose adjustment or slower titration. More common in elderly patients.

Diplopia and Blurred Vision

Dose-related visual disturbances. Often a sign that the dose is at or above the upper tolerable range. May require dose reduction.

Nausea and GI Disturbance

Common during initiation. Extended-release formulations may reduce GI side effects. Taking with food can help.

Hyponatremia (SIADH)

Carbamazepine can cause SIADH with clinically significant hyponatremia. Risk increases with age and co-administration of other medications that affect sodium. Monitor sodium levels, particularly in elderly patients and those on diuretics or SSRIs.

Hematologic Effects

Benign leukopenia occurs in up to 10% of patients and is usually transient. Rare but serious: aplastic anemia and agranulocytosis. Baseline CBC with differential recommended; repeat if patient develops fever, sore throat, or signs of infection.

Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis

Rare but potentially fatal. Risk is strongly associated with HLA-B1502 allele (prevalent in Southeast Asian, South Asian populations). FDA requires HLA-B1502 testing before initiation in patients of Asian descent. Risk is highest in the first 1-2 months of treatment. Any new rash during this period requires immediate evaluation.

Hepatotoxicity

Rare hepatic injury. Baseline and periodic liver function tests recommended. Discontinue if significant elevations occur.

References & Further Reading

This page synthesizes information from standard clinical references. Consult primary sources for all prescribing decisions.

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For learning and board prep — not a prescribing reference. Dosing and safety information change. Always verify against current FDA labeling and your institution’s protocols before prescribing.