Carbamazepine XR
TEGRETOL-XR
Pronunciation: kar-ba-MAZ-e-peen
“Tiger tail (in the) Car maze”
Shredder inDucer
What it isExtended-release sodium-channel-blocking antiepileptic; seizures and trigeminal neuralgia.
Why this oneBID dosing with flatter peaks than IR reduces peak-related dizziness and diplopia; shell may appear in stool, and Carbatrol ER capsules are the sprinklable sibling.
What limits itSerious HLA-associated rash and marrow failure are boxed risks; autoinduction, drug interactions, and hyponatremia complicate use.
FDA-approved for
- seizures (1996)
- trigeminal neuralgia (1996)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Epilepsy (partial/complex, generalized tonic-clonic, mixed seizures) | >12 yr and adults | 200 mg BID (400 mg/day) | Increase 200 mg/day weekly; maintenance usually 800–1200 mg/day | 1000 mg/day (12–15 yr); 1200 mg/day (>15 yr); 1600 mg/day (adults, rare) |
| Epilepsy | Children 6–12 yr | 100 mg BID (200 mg/day) | Increase 100 mg/day weekly; maintenance usually 400–800 mg/day | 1000 mg/day |
| Epilepsy | Children <6 yr | 10–20 mg/kg/day divided BID–TID (tablet/suspension) | Increase weekly; maintenance usually <35 mg/kg/day | 35 mg/kg/day |
| Trigeminal neuralgia | Adults | 100 mg BID (200 mg/day) | Increase up to 200 mg/day; maintenance 400–800 mg/day | 1200 mg/day |
Titration Increase at weekly intervals (epilepsy); trigeminal neuralgia by up to 200 mg/day.
Renal Prescribe only after critical benefit-to-risk appraisal in patients with renal damage.
Hepatic Prescribe only after critical benefit-to-risk appraisal in hepatic damage; hepatic effects up to hepatic failure reported.
Instructions
- Swallow extended-release tablets whole; do not crush or chew
- Take with meals
- Do not administer suspension simultaneously with other liquid medications
- Obtain baseline hematologic testing; screen HLA-B*1502 in at-risk ancestry
- Do not discontinue abruptly (seizure risk)
Available strengths
- ER tab 100, 200, 400 mg
- tab 100, 200 mg
- ER cap 100, 200, 300 mg
- chew tab 100, 200 mg
- susp 100 mg/5 mL
Contraindications
- History of previous bone marrow depression
- Sensitivity to tricyclic compounds (e.g., amitriptyline, imipramine)
- Concomitant MAOI use (discontinue MAOI ≥14 days before)
- Coadministration with nefazodone
Cautions
- Serious dermatologic reactions (SJS/TEN)
- Aplastic anemia/agranulocytosis
- Hyponatremia/SIADH
- Hepatic effects/failure
- Cardiac conduction disturbances/AV block
- Avoid in hepatic porphyria
- Suicidal behavior/ideation
Adverse reactions
- Dizziness
- Drowsiness
- Unsteadiness/ataxia
- Nausea
- Vomiting
- Serious skin reactions (SJS/TEN)
- Blood dyscrasias
Pregnancy Can cause fetal harm (spina bifida, craniofacial/cardiovascular defects, developmental delay).
Lactation Undefined.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 100 mg | ER tab | 4 q-wk | $0.81 | offered |
| 200 mg | ER tab | 4 q-wk | $1.60 | offered |
| 400 mg | ER tab | 4 q-wk | $2.61 | offered |
Other forms: Carbamazepine (TEGRETOL) · Carbamazepine ER capsules (CARBATROL) · Carbamazepine ER (Equetro)
⚠ BOXED WARNINGS
- Serious dermatologic reactions and HLA-B*1502 allele
- Aplastic anemia and agranulocytosis
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilitySerious rash, aplastic anemia/agranulocytosis, hyponatremia and extensive enzyme induction.
Active metabolites
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