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medication / mood stabilizers / carbamazepine

Mood stabilizers: carbamazepine


Because carbamazepine (Tegretol) can cause serious side effects, its use should only be considered if less dangerous drugs have had no effect.


The person who is prescribed carbamazepine  (Tegretol) should tell their doctor if:

  • She has problems:


   of liver


   bone marrow


   thyroid failure

   adrenal insufficiency

  • She has epilepsy

  • She has had thrombophlebitis (inflammation of a vein in which a blood clot forms)

  • She has a blood disease

  • She has glaucoma

  • She has diabetes

  • She is very sensitive to tricyclic antidepressants or MAOI antidepressants

  • She takes more than 2 drinks of alcohol a day

  • She takes other medications, with or without a prescription, including vitamins

  • She plans to undergo an operation under anesthesia in the following weeks


It is necessary to carry out an analysis:

  • urine

  • of the blood count


It is necessary to evaluate the operation:

  • liver

  • kidneys

  • thyroid


It is necessary to carry out the eye examination. The blood test is absolutely vital every  weeks for the first 3 months, then monthly for the next 2-3 years.  Other analyzes must be done regularly and diligently. The target concentration is 15 to 50 mcmol/L.


Physical health issues

  • Several kinds of epilepsy

  • Painful tics of the face, tongue and throat

  • Trigeminal neuralgia (facial nerve)

  • Neuropathic pain (cancer, diabetes)

  • Prevent migraine

  • Diabetes insipidus


Mental health problems

  • Bipolar disorder, manic or mixed phase

  • Prevention of relapses of bipolar disease

  • Aggressive or explosive behavior

  • People who present at least  4 phases of mania and depression per year

  • With an antipsychotic to treat schizophrenia

  • Schizoaffective disorder

  • borderline personality disorder

  • Alcohol withdrawal

Contraindications ​


Physical health issues

  • Bone marrow problem

  • Heart block (heart rhythm disorder)

  • liver disease

  • Urinary retention

  • Glaucoma

  • Thyroid or adrenal insufficiency

  • People hypersensitive to this product

  • People who react badly to tricyclic antidepressants or MAOIs



  • Often very sensitive to this substance  and they may react with confusion or agitation

  • Lower doses than adults

  • Monitor for worsening glaucoma, coronary artery disease, or prostate


Pregnancy and breast feeding

  • Should not be taken by pregnant women 

  • Abstain while breastfeeding



Safe for epilepsy

Mental health problems

  • Alcohol consumption

  • Person taking clozapine (Clozaril)

Drugs interactions ​


Carbamazepine (Tegretol) causes over 100 significant interactions. The pharmacist is in the best position to advise people and

their doctor. Here are the main drug interactions:


Psychiatric drugs

  • Reduces the effect of certain benzodiazepines (the 3 that end in -zolam)

  • Reduces the effect of certain antipsychotics. Among others: haloperidol (Haldol); risperidone (Risperdal); quetiapine (Seroquel)

  • MAOI antidepressants can make carbamazepine toxic: moclobemide (Manerix); phenelzine (Nardil); tranylcypromide (Parnate)

  • Lithium (Carbolith, Duralith, Lithane)  may increase side effects


Other drugs

  • Reduces the effect of birth control pills

  • Decreases the effect of oral anticoagulants

  • Certain drugs can make carbamazepine (Tegretol) toxic:

> Certain antibiotics  (erythromycin)

> Diltiazem and verapamil

> Several treatments for HIV

> Certain histamine inhibitors:  cimetidine (Tagamet)

> Certain medicines used to treat tuberculosis: isoniazid (Isotamine)



Combined with alcohol, it can lead to abnormal calm and a dangerous drop in blood pressure.

Side effects​

They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.



  • Dizziness (at first only, disappears after a few weeks)

  • May impair mental reaction skills

  • Headache

  • Blurred or double vision

  • Dry mouth

  • Hair loss



If coronary artery problems, refrain from excessively violent exercises



  • Pain in muscles and joints

  • Coordination disorders



  • Gastric irritation (at first only, disappears after a few weeks)

  • Constipation

  • Diarrhea

  • Nausea (at first only, disappears after a few weeks)

  • Weight gain



sexual impotence



  • Causes hypersensitivity to the sun

  • Significant increase in sweat

  • Rash (transient or fugitive rash)

It is urgent to consult your doctor if:



  • Pain or ulcers in the mouth

  • Fever

  • Sore throat



Swollen ankles



  • Rash (transient or fugitive rash) with fever

  • abnormally dark urine

  • Abnormal bruising or bleeding

  • Fatigue and weakness associated with nausea, vomiting,  confusion, the urge to urinate frequently, or a decrease in  the amount of urine


Other signs to look out for



  • Involuntary movements of the eyeball

  • Difficulty speaking

  • Ringing in the ears

  • Swollen glands

  • Yellow discoloration of the skin and eyes



  • Involuntary limb movements

  • Numbness of hands and feet



Slow-down  heart rate



  • Dark urine

  • Pale stools



Difficulty breathing

Monitoring and medical surveillance​

Actions one can take to avoid iatrogenic effects (which are caused by medicine)


  • Blood test

  • Liver examination

  • Weight monitoring

Withdrawal symptoms

Psychotropic drugs act in the brain just as they do in the rest of the body; and as we have seen, each person reacts differently. It's the same with weaning; the person's metabolism, the type of drug, the dose as well as the duration of the intake and its half-life, explain that the withdrawal effects are varied. We have listed the potential and main withdrawal symptoms of each class of psychotropic drugs. This list is incomplete, as not all withdrawal effects are listed; moreover, knowledge is rapidly evolving in this field. A person may have no withdrawal symptoms or experience one, a few, or even many. The medication reduction journey is specific to each person, just as each process is unique. For example, a person can take the same medicine twice at the same dose and the effects will be different. Gradual reduction, like removing 10  % of dose per week/month, reduces the frequency or intensity of withdrawal symptoms and the incidence of rapid relapses. It is very important to undertake this process with the collaboration of your doctor. The pharmacist also plays a key role and can provide guidance to monitor withdrawal effects for each medication. Most people who will have withdrawal symptoms will tolerate them without problems for the short duration of these symptoms.


Common and frequent withdrawal symptoms for all classes: anxiety, nervousness, restlessness, sleep problems, greater need to rest, sleep, irritability, fatigue.

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