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Carbamazepine / Carbatrol / Tegretol / Tegretol Retard / Tegretol XR

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TJW

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Tegretol (TEG-reh-tall) is a brand name used in the United States, Canada, the UK, and some other countries for a type of medicine called carbamazepine (CAR-buh-MAZ-uh-peen). Carbamazepine is also available in different forms by other names, including Tegretol-XR and Carbatrol.

Tegretol is manufactured by Novartis. The name or appearance may be different in various countries but usually the dose (measured in milligrams, abbreviated "mg") will be the same.

Tablets
200-mg (capsule-shaped, pink)
One side says "Tegretol" and the other side says "27" on each half. These should be swallowed whole, not chewed.

Chewable tablets
100-mg (round, white with red speckles)
One side says "Tegretol" and the other side says "52" on each half. These tablets are flavored and can be either swallowed whole or chewed.

Tegretol suspension (liquid)
100 mg per 5 mL (yellow-orange, citrus-vanilla flavored liquid).

Follow the doctor's directions. Call if you have any questions. Ask the doctor what to do if you forget a dose. The way the medicine is taken depends, of course, on what form the doctor has prescribed.

Most doctors recommend taking Tegretol with food to avoid an upset stomach. Because food affects the way medicine is used by the body, try to be consistent day in and day out. A person who usually takes it with meals should do that all the time.

To use the liquid suspension, shake the bottle just before pouring it into a measuring spoon or filling a dropper. Use the same standard-size medicine spoon or dropper each time to get an accurate dose. Do not mix this form of Tegretol with any other liquid or take it at the same time as another liquid medicine.

Don't drink grapefruit juice with Tegretol, because it can interfere with the body's use of the medication.

As the doctor increases the amount of Tegretol that you take, you may be given a different kind of tablet than the ones you've been taking. For example, you may start out using 100-mg tablets and then switch to 200-mg tablets. If this happens, be careful to use the correct number. Don't automatically continue to take the same number of tablets as before.

Store all types of Tegretol at room temperature (below 86°F, 30°C). Protect the tablets from moisture. Don't keep them in the bathroom, where it's damp. Keep the bottle of the liquid in a cupboard where it won't get too much light.

Take a forgotten dose right away. If it is almost time for the next dose, delay that dose for a few hours so you're not taking two doses close together. If you're not sure what to do, call the doctor's office for advice.

Do your best to follow the doctor's directions. The more often a medicine must be taken, the greater the chance of forgetting, and some people need to take Tegretol four times every day. This can be difficult. If you forget doses often, it may be a good idea to get a special pillbox or watch with an alarm to remind you.

Taking the right amount of seizure medicine on time every single day is the most important step in preventing seizures!

Carbamazepine is effective against partial seizures, secondarily generalized seizures, and tonic-clonic seizures. It is not effective against other generalized seizure types, such as absence seizures or myoclonic seizures.

Doctors have studied large numbers of patients to find out how well Tegretol controls seizures. They have reported that it completely controls partial seizures in about 70% of people just beginning their treatment, and that it completely controls tonic-clonic (grand mal) seizures in about 80%.

Most people who take Tegretol don't have too much trouble with side effects. That's one of the reasons it's used so much. The most common complaints (usually mild to moderate in severity) are:

dizziness
sleepiness
unsteadiness
upset stomach
blurred or double vision
headache
Sometimes the doctor can help with these side effects by changing the prescription:

reducing the overall amount of Tegretol
prescribing smaller doses, taken more often
changing the prescription from Tegretol to an extended-release form of carbamazepine, like Tegretol-XR or Carbatrol.
No one should stop taking Tegretol or change the amount they take without their doctor's guidance.

People who have just started taking Tegretol (or who have just started taking a larger amount) should be careful during activities that might be dangerous, until they know whether they are having any side effects.

Other side effects of Tegretol that are much less common include:

vomiting
a low level of sodium in the blood, which causes dizziness, tiredness, confusion, or increased seizures (more common in older people and those with heart disease)
pain in the abdomen
constipation
diarrhea (if this happens, it may help to limit your intake of lactose-containing foods, such as dairy products)
loss of appetite
Allergic reactions
About 5% to 10% of people who take Tegretol have a red rash within the first month of taking it. If this happens, tell the doctor or nurse, to be sure that it's not the beginning of a serious problem. During this time, it's a good idea to avoid too much sunlight, which may increase the risk of rash.

About half the time the rash will go away on its own and will not come back. Stopping the Tegretol for a day or two (with the doctor's OK) and then starting it again seems to help. Other people need to stop taking it permanently, and some use another medicine to treat the rash itself. The doctor can advise on which is the best strategy for each person.

Long-term side effects
Some doctors suspect that the bones of some people who take Tegretol for years may become thin and weak, though this effect has not yet been proven. It may happen because Tegretol can interfere with the way the body uses vitamin D. This vitamin is needed to help the bones absorb calcium. People who take Tegretol should be careful to get plenty of vitamin D and calcium every day. They also should exercise to keep their bones strong. Ask the doctor for advice on the proper doses of vitamin D and calcium. The doctor also can say whether a bone density test is advised.

Any time a doctor suggests a new prescription, be sure to talk about what other medicines are already in use. If two medications affect each other, the doctor may want to prescribe something else or change the amount to be taken.

Seizure medicines (including Tegretol) often affect each other. This is why people who start to take a second seizure medicine in combination (or stop taking a combination) may need a change in the dose of the first medicine.

How does Tegretol affect other medicines?
Tegretol makes birth control pills less effective, so the chances of becoming pregnant are greater. Women who use pills for birth control should talk to the doctor who prescribed them right away if they start taking Tegretol. The same is true for other forms of hormonal birth control, like Depo-Provera or implants. Barrier forms of birth control, such as condoms, IUDs, and diaphragms, are not affected by Tegretol.

Tegretol also affects the way the body handles many other seizure medicines. Some of these are:

Depakote (valproic acid)
Dilantin or Phenytek (phenytoin)
Klonopin (clonazepam)
Topamax (topiramate)
How do other medicines affect Tegretol?
Some medicines can cause Tegretol to build up in the blood. Having too much Tegretol in the blood makes people feel dizzy, unsteady, or sleepy.

Some of the medications and other substances that may raise Tegretol levels include:

Depakote and other valproate seizure medicines
some medicines for high blood pressure, including Cardizem (diltiazem) and verapamil
Prozac (fluoxetine)
certain antibiotics, including erythromycin
cimetidine (Tagamet, also available without a prescription)
Darvon and Darvocet
several anti-fungus medications, including Diflucan and Flagyl
grapefruit juice

On the other hand, some medicines reduce the amount of Tegretol in the blood. More seizures may occur unless a higher dosage of Tegretol is taken.

Medicines that may lower Tegretol levels include:

Dilantin or Phenytek (phenytoin)
Trileptal (oxcarbazepine)
Felbatol (felbamate)
phenobarbital
Mysoline (primidone)

Tegretol is useful in treating many kinds of seizures that occur in children. But other types that are also common can be made worse, so a correct diagnosis is very important.

Children's bodies break down Tegretol faster than adults' bodies do. This means that young children need to take a larger amount, relative to their weight, than adults. They also may need to take the medication more often. By the time children reach their early teens, however, their bodies absorb, digest, and excrete medicines more like adults do, so they may need to take less than before.

Because children absorb Tegretol so quickly, the levels of medication in their blood can fluctuate widely. As a result, children often have trouble with side effects like sleepiness, double vision, or dizziness a short time after taking a dose of Tegretol, when the level in the blood is highest. Using an extended-release form like Carbatrol or Tegretol-XR may reduce this problem.

Parents and doctors also need to watch for problems with children's thinking or behavior. These problems are uncommon, but if they occur they can interfere with the child's development and school performance.

Tegretol is listed in Pregnancy Category D. This means that there is a risk to the baby, but the benefits may outweigh the risk for some women. A warning appears in the package insert.

This warning sounds grim but in fact a large majority of women who use Tegretol during pregnancy have normal, healthy babies. Certain types of defects, including minor defects of the face or fingernails and developmental delay, are increased but they are still relatively uncommon. The risk of defects is higher for women who take more than one seizure medicine. Women with a family history of birth defects also have a higher risk.

All women who are capable of becoming pregnant should take 0.4 mg (400 mcg) of the vitamin called folic acid every day because it helps to prevent birth defects called neural tube defects, malformations of the brain or spinal cord. The most common of these is spina bifida, which affects about 1 in 200 babies of women who take Tegretol during the first 4 to 6 weeks of pregnancy. Women at high risk of having a baby with one of these defects (such as those who have had a previous baby with spina bifida) should take a much larger dose—4 mg (4000 mcg) per day—if they are considering pregnancy.

Women with epilepsy who are pregnant or thinking about becoming pregnant should talk to their doctor about the medications they are taking. Because taking more than one seizure medicine may increase the risk of birth defects, doctors sometimes gradually reduce the number or amount of seizure medicines taken by women planning for pregnancy. This is not done routinely, however. The risk of seizures increases when medications are withdrawn, and seizures-particularly complex partial seizures and tonic-clonic seizures-can injure the baby. Because having these types of seizures may harm the baby, it's important not to stop taking seizure medicines or reduce the amount without the doctor's OK.

If the mother is taking Tegretol, a breast-fed baby will get a tiny amount of it in the breast milk. It should not be harmful for a healthy, full-term baby.

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