Carbamazepine is sold under the brand name "Tegretol".
Brand names also include Carbitrol, Epitol, and Equetro among others.
Carbamazepine is an antiepileptic medication that in the formulation of Equetro is approved for use in Bipolar Disorder, manic and mixed phases. It was the first antiepileptic used successfully for Bipolar Disorder and the only medication in addition to lithium for years with support for use in Bipolar Disorder. It has become less popular over the last years because of its unfavorable adverse event profile and because there are now so many good alternative medications.
Carbamazepine, like oxcarbazepine, appears to reduce the pathological release of glutamate by blocking the depolarization of a particular class of voltage dependent sodium channel.
Carbamazepine tends to be more effective for the manic and mixed than the depressed phases of Bipolar Disorder. It is therefore often combined with a mood elevating medication, e.g. lamotrigine or bupropion, to provide good support against both mania and depression. In more difficult to treat manias it may be combined with lithium, valproic acid, atypical antipsychotics, and other mood stabilizers.
Carbamazepine has been associated, like other antiepileptic medications, with Stevens-Johnson Syndrome, a potentially fatal rash. It can also cause an aplastic anemia and agranulocytosis (failure of key cell lines in the blood to develop that can also be fatal). In addition, it increases the rate at which many enzyme systems in the liver eliminate themselves and other medications, thus altering the levels of many medications, including birth control pills, and making it difficult in the first 6 months to establish a consistently effective blood level of carbamazepine. It can also cause the kidneys to fail to retain sodium properly, leading to large urine volumes and low sodium levels that in turn can cause fatigue, sedation, cognitive impairment, and, again, can possibly be fatal. Finally, carbamazepine can be fatal in overdose.
It is recommended as a first line option (as Equetro) for the treatment of Bipolar Disorder, manic phase, by the American Psychiatric Association treatment guidelines.
Other less serious side effects can include sedation, nausea, double vision, diarrhea and others.
Carbamazepine can also cause birth defects, possibly associated with interference with folic acid metabolism leading to neural tube defects in neonates. Dr. Hoopes recommends that all women of childbearing age treated with carbamazepine take a daily prenatal vitamin.
Carbamazepine should have regular blood work monitoring for electrolytes, blood count, and serum carbamazepine levels.
If you miss a dose of carbamazepine it is best not to “make up the dose” by adding the missed dose to the next dose. It is important, of course, to take this and other medications regularly as prescribed.
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