Carbamazepine

Pronunciation: kar-ba-MAZ-eh-peen.

Generic name
carbamazepine
Drug class
Anticonvulsant (antiepileptic drug) -- an iminostilbene derivative
Form
Tablet, chewable tablet, extended/controlled-release (CR) tablet (100 mg, 200 mg, 400 mg), and oral suspension/liquid (100 mg/5 mL)
Route
Oral
Legal status
Prescription-only

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Tegretol (5) · Full directory

What carbamazepine is and how it works

Carbamazepine is a long-established anticonvulsant (antiepileptic) medicine. It is used to control certain types of seizures, to relieve the severe facial pain of trigeminal neuralgia, and, in some countries, to help prevent episodes of mania in bipolar disorder when lithium has not worked well. (1) (2)

Carbamazepine carries an important, FDA-designated boxed warning covering two separate serious risks: a rare but serious skin reaction (Stevens-Johnson syndrome or toxic epidermal necrolysis) that is much more likely in people who carry a specific gene variant, HLA-B*1502, far more common in people of Han Chinese, Thai, and other broad Asian ancestries -- genetic testing before starting is recommended for people from these backgrounds; and a real, rare risk of serious blood disorders (aplastic anaemia and agranulocytosis), which is why a full blood count is needed before you start and periodically afterward. Because carbamazepine also has many drug interactions and can reduce the effectiveness of hormonal contraception, tell your clinician and pharmacist about every other medicine you take.

Mechanism of action: how carbamazepine works

Carbamazepine is an iminostilbene-derivative anticonvulsant that blocks voltage-gated sodium channels, stabilising hyperexcited neuronal membranes and reducing repetitive neuronal firing; this mechanism also underlies its efficacy in trigeminal neuralgia pain and bipolar-disorder mood stabilisation. Carbamazepine is a potent inducer of hepatic CYP3A4 and other enzymes, the basis for its extensive, clinically significant drug-interaction profile, including reduced efficacy of hormonal contraceptives and many co-administered medicines. (1) (2)

What carbamazepine is used for

Epilepsy -- partial and generalised tonic-clonic seizures

Used to control partial (focal) seizures, including those with complex symptoms, generalised tonic-clonic (grand mal) seizures, and mixed seizure patterns, in adults and children. It is not effective for absence seizures and may worsen atypical absence seizures. (1) (2)

Trigeminal neuralgia

Used to relieve the severe, sudden facial pain of trigeminal neuralgia; may also help glossopharyngeal neuralgia. (1)

Prevention of manic-depressive (bipolar) episodes

Used in some countries to help prevent episodes of manic-depressive psychosis (bipolar disorder) in people who have not responded well to lithium. (2)

Before taking carbamazepine

Do not take / not appropriate for

  • Do not take carbamazepine if you have a known hypersensitivity to carbamazepine or to structurally related medicines (such as tricyclic antidepressants). (all countries) (1) (2)
  • Do not take carbamazepine if you have a history of bone marrow depression (suppressed blood cell production). (all countries) (1) (2)
  • Do not take carbamazepine together with, or within 14 days of stopping, a monoamine oxidase inhibitor (MAOI). (all countries) (1) (2)
  • Do not take carbamazepine if you have atrioventricular (AV) heart block or a history of hepatic porphyria. (United Kingdom, European Union) (2)

Tell your clinician about

  • Your family background/ancestry, particularly Han Chinese, Thai, or other broad Asian ancestry -- your clinician may recommend genetic (HLA-B*1502) testing before you start, because of a much higher risk of serious skin reactions in people who carry this gene variant.
  • Any past allergic reaction to carbamazepine or a related medicine.
  • Any history of blood disorders, since a full blood count is needed before starting and periodically during treatment because of the real risk of aplastic anaemia and agranulocytosis.
  • Any history of liver problems, heart rhythm problems, or glaucoma.
  • Any history of depression, mood changes, or suicidal thoughts.
  • If you use hormonal contraception -- carbamazepine can make it significantly less effective, and highly effective (non-hormonal or additional) contraception is needed during treatment and for at least 2 weeks after stopping.
  • Whether you are pregnant, planning pregnancy, or breastfeeding.
  • All other medicines you take, since carbamazepine has many significant drug interactions.
(1) (2)

How to take carbamazepine

  • Take carbamazepine with food/meals, exactly as prescribed.
  • Extended/controlled-release tablets must be swallowed whole and never crushed or chewed.
  • Do not stop taking carbamazepine suddenly without medical advice -- it generally needs to be withdrawn gradually to reduce the risk of seizures returning or worsening.
  • Any dose change should be made by your clinician, not on your own.
(1) (2)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

If you miss a dose, contact your prescriber or pharmacist for specific guidance -- do not take a double dose to make up for a missed one without checking first, since maintaining steady blood levels matters for seizure control.

Overdose

Seek emergency medical attention immediately if too much carbamazepine has been taken, or if you notice severe drowsiness, irregular heartbeat, uncontrolled movements, seizures, or loss of consciousness. There is no specific antidote; treatment is supportive, and may include gastric decontamination measures where appropriate under emergency medical supervision. (2)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Dizziness, drowsiness, and unsteadiness (ataxia).

What to notice: Dizziness, drowsiness, and unsteadiness (ataxia).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Nausea and vomiting.

What to notice: Nausea and vomiting.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Headache and double vision (diplopia).

What to notice: Headache and double vision (diplopia).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Dry mouth and fatigue.

What to notice: Dry mouth and fatigue.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Mild, usually harmless reduction in white blood cell count (leucopenia).

What to notice: Mild, usually harmless reduction in white blood cell count (leucopenia).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Serious warnings

Signs of a serious skin reaction (Stevens-Johnson syndrome or toxic epidermal necrolysis) — emergency

Symptoms: A spreading rash, blistering or peeling skin, mouth/eye/genital sores, or fever alongside a new rash.

Action: Seek emergency medical help immediately and do not take another dose. This risk is meaningfully higher in people carrying the HLA-B*1502 gene variant, far more common in people of Han Chinese, Thai, and other broad Asian ancestries -- genetic testing before starting is recommended for people from these backgrounds. Over 90% of these reactions happen within the first few months of treatment. (1) (2)

Signs of a serious blood disorder (aplastic anaemia or agranulocytosis) — high caution

Symptoms: Fever, sore throat or mouth ulcers that will not heal, unusual bruising or bleeding, or persistent tiredness.

Action: Contact your clinician urgently for a blood count -- carbamazepine carries a real, FDA boxed-warning risk of serious blood disorders (aplastic anaemia and agranulocytosis), about 5-8 times more likely than in the general population. A baseline blood count is needed before starting, with periodic checks during treatment. (1) (2)

Signs of a serious allergic reaction or DRESS syndrome — emergency

Symptoms: Swelling of the face, lips, tongue, or throat; difficulty breathing; widespread rash with fever and swollen glands.

Action: Seek emergency medical help immediately. Anaphylaxis, angioedema, and DRESS (a serious multi-organ hypersensitivity reaction) have been reported. (1) (2)

Signs of liver problems — high caution

Symptoms: Yellowing of the skin or eyes (jaundice), dark urine, persistent nausea, or unusual tiredness.

Action: Contact your clinician promptly -- liver function tests are recommended before starting and periodically during treatment; rare but serious liver problems, including liver failure, have been reported. (1) (2)

Signs of low blood sodium (hyponatraemia) — high caution

Symptoms: Nausea, headache, confusion, drowsiness, or (rarely) seizures.

Action: Contact your clinician for a blood sodium check, especially if you are elderly or take other medicines that can lower sodium (such as certain diuretics). (1) (2)

New or worsening mood changes, or thoughts of suicide or self-harm — high caution

Symptoms: New or worsening depression, anxiety, agitation, or thoughts of self-harm.

Action: Contact your clinician promptly, or seek emergency help if there is any immediate risk. Antiepileptic medicines as a class, including carbamazepine, carry a small increased risk of suicidal thoughts or behaviour. (1) (2)

Interactions

  • Significantly reduces the effectiveness of hormonal contraceptives (the pill, patch, ring, and similar methods) -- discuss additional or alternative non-hormonal contraception with your clinician. (1) (2)
  • Carbamazepine is a potent inducer of liver enzymes (CYP3A4) and can reduce the effectiveness of warfarin, corticosteroids, and many other medicines. (1)
  • Certain antibiotics (macrolides such as erythromycin/clarithromycin), antifungals (azoles), and heart medicines (diltiazem, verapamil) can raise carbamazepine levels, increasing side effects. (1)
  • Grapefruit juice can raise carbamazepine blood levels. (1)
  • Must not be combined with monoamine oxidase inhibitors (MAOIs). (1) (2)
  • Nefazodone should not be combined with carbamazepine. (1)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

Carbamazepine can cause fetal harm, with an increased risk of major congenital malformations including neural tube defects (such as spina bifida), cleft palate, and heart defects. Untreated seizures also carry real risks to both mother and baby, so treatment should not be stopped abruptly -- discuss the safest plan, folic acid supplementation, and monitoring with your specialist. In New Zealand, a specific regulator safety alert also highlights increased risk of smaller-than-expected head size and body size in babies exposed during pregnancy. (1) (2) (3) (4) (5) (6)

Breastfeeding

Carbamazepine passes into breast milk in small amounts. Discuss with your clinician, and watch the baby for drowsiness, poor feeding, or poor weight gain if breastfeeding. (1) (2) (3) (4) (5) (6)

Children

Used in children for epilepsy, with weight-based or age-banded dosing set by the prescriber; not effective for absence seizures. (1) (2) (3) (4) (5) (6)

Elderly

No routine dose adjustment based on age alone is described, but elderly patients may be more sensitive to side effects (including confusion, agitation, and hyponatraemia) and to drug interactions -- lower starting doses and closer monitoring are often used. (1) (2) (3) (4) (5) (6)

Hepatic_impairment

Use with caution; liver function should be checked before starting and periodically during treatment. (1) (2) (3) (4) (5) (6)

Renal_impairment

No specific dose adjustment is described in the sources reviewed, though general caution and monitoring are advised. (1) (2) (3) (4) (5) (6)

Source_ids

US-DAILYMED-CARBAMAZEPINE-2026,UK-EMC-TEGRETOL-2026,NZ-MEDSAFE-TEGRETOL-2026 (1) (2) (3) (4) (5) (6)

Monitoring

Before starting

  • Baseline full blood count (because of the aplastic anaemia/agranulocytosis risk)
  • Consideration of HLA-B*1502 genetic testing in patients of Han Chinese, Thai, or other higher-risk ancestry
  • Baseline liver function tests
  • Baseline serum sodium in higher-risk patients
  • Review of any past hypersensitivity reaction to carbamazepine or related medicines

During treatment

  • Periodic full blood counts to monitor for aplastic anaemia or agranulocytosis.
  • Periodic liver function tests.
  • Prompt skin/mucosal assessment if any new rash develops.
  • Serum sodium checks in higher-risk patients (elderly, those on sodium-lowering medicines).
  • Ongoing monitoring for mood changes or suicidal thoughts, especially early in treatment.
  • Carbamazepine blood-level monitoring to help guide dosing and check for interactions.
(1) (2)

Storage

Store at room temperature, protected from moisture, out of reach of children, following the specific product's packaging instructions.

Study the drug class: Antiepileptics · Mood stabilisers

Professional information

Clinician-facing context only, sourced from the current US FDA and UK SmPC labels; verify against the current full label before prescribing.

United States / United Kingdom / European Union / Canada / Australia / New Zealand

Indication: Epilepsy, adults and children over 12 years

Dose summary: Initial 200 mg twice daily (400 mg/day), titrated by up to 200 mg/day weekly to a usual maintenance range of 800-1200 mg/day (max 1000-1200 mg/day depending on age; rare cases up to 1600 mg/day in adults).

Renal context: No specific dose adjustment described in the sources reviewed; general caution advised. (1) (2)

United States / United Kingdom / European Union / Canada / Australia / New Zealand

Indication: Trigeminal neuralgia

Dose summary: Initial 100-200 mg twice daily, titrated up to a maximum of 1200 mg/day; typical maintenance 400-800 mg/day.

Renal context: Not separately established in the sources reviewed. (1) (2)

Mechanism of action

Hepatic guidance

Use with caution in hepatic impairment; baseline and periodic liver function tests are recommended given the real risk of hepatotoxicity, including rare hepatic failure.

Overdose note

No specific antidote; manage with supportive care, gastric decontamination measures where appropriate, and monitoring of cardiac, neurological, and haematological status. (1) (2)

Frequently asked questions

Is carbamazepine available in the US, UK, Europe, Canada, Australia, and New Zealand?

Yes. It is authorised in all of these regions, marketed as Tegretol (and, in the US, mainly as generic carbamazepine) plus extensive generic availability. (1) (2) (3) (4) (5) (6)

Does carbamazepine have a boxed warning?

Yes -- carbamazepine carries a real FDA boxed warning covering two separate serious risks: rare but serious skin reactions (Stevens-Johnson syndrome/toxic epidermal necrolysis), much more likely in people who carry a specific gene variant, HLA-B*1502, more common in people of Han Chinese, Thai, and other broad Asian ancestries; and a real, rare risk of serious blood disorders (aplastic anaemia and agranulocytosis), about 5-8 times more likely than in the general population. (1) (2)

Why might my clinician recommend a genetic test before I start carbamazepine?

If you are of Han Chinese, Thai, or certain other Asian ancestries, your clinician may recommend testing for the HLA-B*1502 gene variant, which is carried much more often in these populations and is linked to a higher risk of serious skin reactions (Stevens-Johnson syndrome/toxic epidermal necrolysis) with carbamazepine. (1) (2)

Why do I need blood tests before and during carbamazepine treatment?

Carbamazepine carries a real, boxed-warning risk of serious blood disorders (aplastic anaemia and agranulocytosis), so a full blood count is needed before starting and periodically afterward to catch any problem early. (1) (2)

What is the mechanism of action of carbamazepine?

Carbamazepine is an iminostilbene-derivative anticonvulsant that blocks voltage-gated sodium channels, stabilising hyperexcited neuronal membranes and reducing repetitive neuronal firing; this mechanism also underlies its efficacy in trigeminal neuralgia pain and bipolar-disorder mood stabilisation. Carbamazepine is a potent inducer of hepatic CYP3A4 and other enzymes, the basis for its extensive, clinically significant drug-interaction profile, including reduced efficacy of hormonal contraceptives and many co-administered medicines. (1) (2)

What is the generic name of Carbamazepine?

The generic name is carbamazepine. (1) (2)

What class of drug is carbamazepine?

Carbamazepine is classed as: Anticonvulsant (antiepileptic drug) -- an iminostilbene derivative. (1) (2)

References

  1. CARBAMAZEPINE Extended-Release Tablets, USP -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information (extended-release tablets, generic carbamazepine) · United States · accessed 2026-07-30 · source 1
  2. Tegretol 200mg Tablets -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom -- Novartis Pharmaceuticals UK Ltd · United Kingdom · accessed 2026-07-30 · source 2
  3. Carbamazepine -- list of nationally authorised medicinal products (PSUSA/00000539/202012)European Medicines Agency (EMA) -- PSUSA (periodic safety update report single assessment), list of nationally authorised medicinal products · European Union · accessed 2026-07-30 · source 3
  4. PrTEGRETOL (carbamazepine) and pms-CARBAMAZEPINE CR -- Health Canada product monographsHealth Canada -- approved product monograph (Novartis Pharmaceuticals Canada Inc / pms generic) · Canada · accessed 2026-07-30 · source 4
  5. TEGRETOL (carbamazepine) tablets and liquid -- ARTG entries 11062/41848/41846/59160Therapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-30 · source 5
  6. TEGRETOL (carbamazepine) New Zealand Data Sheet, Consumer Medicine Information, and pregnancy safety alertMedsafe (New Zealand regulator) · New Zealand · accessed 2026-07-30 · source 6

Brand names by country

Single-ingredient carbamazepine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Tegretol100 mg, 200 mg, 400 mg, 100 mg/5mL · novartis pharmaceuticals corporation
  • Carbatrol200 mg, 300 mg, 100 mg · takeda pharmaceuticals america, inc.
  • EQUETRO300 mg, 100 mg, 200 mg · validus pharmaceuticals llc
  • Carbamazepin200 mg · upsher-smith laboratories, llc

United Kingdom

  • Tegretol (2)MHRA licensed emc smpc confirmed · 100 mg, 200 mg, 400 mg tablets, 200 mg/400 mg prolonged-release tablets, 100 mg/5 mL liquid · Novartis Pharmaceuticals UK Ltd

Canada

  • TEGRETOL CHEWTABS
  • TEGRETOL CR
  • CARBAMAZEPINE CR
  • TEGRETOL - SUS
  • MAZEPINE
  • TEGRETOL
  • PMS-CARBAMAZEPINE-CR
  • TARO-CARBAMAZEPINE CR
  • DOM-CARBAMAZEPINE CR
  • SANDOZ-CARBAMAZEPINE CR

Australia

  • Tegretol (5)TGA ARTG registered confirmed · 100 mg, 200 mg tablets, 20 mg/mL liquid · Novartis Pharmaceuticals Australia Pty Ltd

New Zealand

  • Tegretol (6)Medsafe data sheet and CMI confirmed · 200 mg, 400 mg tablets, Tegretol CR 200 mg/400 mg, 100 mg/5 mL liquid · Novartis New Zealand Limited
View brands in additional countries.

European Union

Various (e.g. Essential Pharma 125mg Suppositories; Carba retard 150 mg Desitin Retardtabletten) (3)

This page provides general reference information about carbamazepine and is not a substitute for advice from the prescriber managing your treatment. All dosing and treatment decisions, including any decision to change or stop treatment, should be made with your prescriber.

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