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Carbamazepine.

Carbamazepine is an anticonvulsant medication used to manage epilepsy and trigeminal neuralgia (a pain disorder). It is sold under the brand names Tegretol and Equetro.

What is Carbamazepine?

Carbamazepine is an FDA-approved medication for managing epilepsy and trigeminal neuralgia. It works as an anticonvulsant and mood stabilizer by regulating abnormal electrical activity in the brain, which helps control seizures.

While it is not FDA-approved to treat bipolar disorder, scientific evidence supports that it helps manage the manic phases of bipolar disorder. It has acute antimanic effects, prevents manic relapses, and does not worsen the depression symptoms of bipolar disorder.

While designed to treat psychomotor and grand mal seizures, as well as trigeminal neuralgia, carbamazepine can also be effective in treating bipolar disorder.

More specifically, evidence indicates that it can be an effective treatment for the manic phases of bipolar disorder, which involve excessive euphoria, energy, irritability, and impulsivity.

Uses of Carbamazepine

Carbamazepine is used to treat the following conditions.

Epilepsy

Carbamazepine is highly effective in managing partial and generalized tonic-clonic seizures. It reduces the hyperactive nerve impulses that cause seizures.

Bipolar Disorder

As a mood stabilizer, carbamazepine may be prescribed to individuals with bipolar disorder to manage manic episode. It helps reduce the frequency and intensity of the manic phases of this condition while having no negative effects on the depressive phases.

Potential Side Effects of Carbamazepine

While carbamazepine is effective, it is not without potential side effects. Understanding these can help patients and caregivers monitor and manage their use effectively.

Common Side Effects

The following are the most common side effects of carbamazepine.

  • Drowsiness
  • Fatigue
  • Dizziness
  • Nausea
  • Headaches

Serious Side Effects

In addition to the more common side effects, carbamazepine may also have the following rarer but severe and sometimes fatal side effects:

  • Severe skin reactions. In rare cases, carbamazepine can cause life-threatening skin conditions like toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS). These reactions happen in 1 to 6 in 10,000 people among mostly Caucasian populations but are significantly more likely in people from some Asian countries.
  • Blood disorders. Rarely, carbamazepine can cause low white blood cell or platelet counts, which can increase infection risks or cause bruising.
  • Liver toxicity. Effects may range from slight elevations in liver enzymes to liver failure. In some cases, effects may persist after discontinuing the use of the carbamazepine.

Given these potentially serious side effects, regular blood tests and routine medical check-ups are important before taking carbamazepine.

Carbamazepine for Bipolar Disorder

Bipolar disorder is characterized by extreme mood swings, ranging from manic or hypomanic highs to depressive lows, with each phase lasting from days to weeks.

While not FDA-approved for bipolar disorder, carbamazepine is effective in treating its manic phases, which involve excessive euphoria, energy, irritability, and impulsivity.

Does Carbamazepine Interact With Other Drugs?

As with many other drugs, carbamazepine can interact with hundreds of different medications. More specifically, the categories of medications it is most likely to interact with include:

  • Some antidepressants
  • Medication to manage seizures, such as valproic acid and Phenytoin.
  • Warfarin (blood clot medication)
  • Atypical antipsychotics
  • Hormonal birth control
  • Benzodiazepines

Carbamazepine also interacts very poorly with regular consumption of grapefruit and grapefruit juice, as it increases the drug’s drug’s levels to potentially risky levels.

Consuming alcohol and carbamazepine simultaneously can also worsen some side effects.

Should Some People Not Take Carbamazepine?

Your healthcare provider may highly discourage or prohibit carbamazepine use if you are part of the following groups:

  • Individuals with bone marrow suppression or severe liver disease.
  • Pregnant or breastfeeding individuals.
  • Those taking any medication that has a negative interaction with carbamazepine, such as some antidepressants and seizure management medication.

Alternatives to Carbamazepine

For individuals who cannot tolerate carbamazepine, there are several alternatives available:

Other Mood Stabilizers

Mood stabilizers help manage manic or hypomanic (milder periods of mania) episodes. Alternatives to carbamazepine include:

  • Lithium. Often the first-line treatment for bipolar disorder.
  • Valproate. Effective for mixed or rapid-cycling episodes.
  • Lamotrigine. Especially useful in preventing depressive episodes.

Non-Mood Stabilizer Medications

Mood stabilizers are not the only medication healthcare providers may prescribe to people with bipolar disorder. Alternatives to mood stabilizers include:

  • Antipsychotics with mood stabilizer properties.
  • Antidepressants to manage depression. However, antidepressants may have side effects like causing manic or hypomanic episodes, and your provider will likely prescribe them along with mood stabilizers.
  • Antianxiety medication like benzodiazepines, but only on a short-term basis.

Non-Medication Options

In addition to medication, bipolar disorder can be treated with psychotherapy and lifestyle changes.

Psychotherapy options include cognitive-behavioral therapy (CBT), family-focused therapy, and interpersonal and social rhythm therapy. Lifestyle changes include regular exercise, a healthy diet, and adequate sleep.

When to Speak with a Doctor

It’s crucial to consult a healthcare professional if:

  • Side effects, such as persistent dizziness or nausea, become severe or unmanageable.
  • Symptoms worsen despite treatment, such as increased mood swings or seizures.
  • Signs of serious complications, like jaundice or unusual bruising, appear.

Your doctor can provide personalized guidance, adjusting your treatment plan to ensure the best possible outcomes.

Carbamazepine Is Highly Effective for Bipolar Mania

Carbamazepine is FDA-approved for managing epilepsy and trigeminal neuralgia, but it is also highly effective as an off-label medication for the manic phases of bipolar disorder. It helps reduce the severity and frequency of mania symptoms.

However, while it is effective for bipolar disorder, its use requires careful professional monitoring to manage potential side effects and interactions, which can be serious or even fatal in rare cases.

If you or a loved one is exploring treatment options for bipolar disorder, we encourage you to seek providers near your location with our Find a Provider feature. It will help you access comprehensive resources and support tailored to your needs.

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