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TEGretol-XR
Tegretol-XR (generic name: carbamazepine) is an extended-release formulation of carbamazepine, an anticonvulsant medication used to treat seizures, nerve pain, and bipolar disorder. It works by decreasing abnormal electrical activity in the brain, making it effective for treating certain types of seizures (such as partial seizures) and trigeminal neuralgia, a condition that causes severe facial pain. It is also used in the treatment of manic episodes in bipolar disorder.
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Frequently Asked Questions
How long does it take for Tegretol-XR to start working?
For seizure control, it may take a few weeks to reach full effectiveness. For bipolar disorder, it can take several weeks to achieve mood stabilization.
Can I stop taking Tegretol-XR abruptly?
No, you should not stop taking Tegretol-XR suddenly, as this can increase the risk of seizures or worsen mood instability. Always taper the dose under the guidance of your healthcare provider.
Can I drink alcohol while taking Tegretol-XR?
It is best to avoid alcohol while taking Tegretol-XR, as it can increase the risk of side effects such as drowsiness and dizziness.
What should I do if I miss a dose?
If you miss a dose of Tegretol-XR, take it as soon as you remember. If it is close to the next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Does Tegretol-XR affect birth control?
Yes, Tegretol-XR can decrease the effectiveness of oral contraceptives. Consider using a non-hormonal backup method of contraception while on this medication.
Comprehensive Drug Guide
How Does TEGretol-XR Work?
Carbamazepine works by stabilizing hyperactive neurons and preventing them from firing excessively, which helps reduce seizures and nerve pain. It blocks sodium channels in the brain and nerves, preventing the repetitive firing of electrical signals that lead to seizures, pain, or mood instability in bipolar disorder.
Common Dosages
- 100 mg
- 200 mg
- 400 mg
Typical Dosing
- For epilepsy: Initial dosing usually starts at 200 mg twice daily, with the dose gradually increased based on individual response and tolerability. Maintenance doses generally range from 800 mg to 1,200 mg per day, divided into twice-daily doses.
- For trigeminal neuralgia: The initial dose is typically 100 mg twice daily, gradually increased to an effective dose of 400 mg to 800 mg per day, divided into twice-daily doses.
- For bipolar disorder: Dosing is individualized, typically starting at 200 mg twice daily with gradual titration to a therapeutic dose.
Typical Dosing
FDA Approved Indications
- Partial seizures and generalized tonic-clonic seizures in epilepsy.
- Trigeminal neuralgia (a condition causing severe facial pain).
- Bipolar disorder, specifically for the treatment of acute manic or mixed episodes.
Who Shouldn't Take TEGretol-XR?
- Hypersensitivity to carbamazepine, tricyclic antidepressants, or any component of the formulation.
- Bone marrow depression.
- A history of serious blood disorders (e.g., aplastic anemia or agranulocytosis).
- MAOI (monoamine oxidase inhibitor) use: Avoid using Tegretol-XR within 14 days of MAOI therapy.
- HLA-B*1502 genetic variant in patients of Asian descent due to an increased risk of severe skin reactions.
Advice From The Pharmacist
- Take with food: Tegretol-XR should be taken with food to reduce stomach upset.
- Swallow whole: Do not crush or chew the extended-release tablets, as this will interfere with the extended-release mechanism.
- Monitor blood levels: Your doctor may order regular blood tests to monitor carbamazepine levels, as well as kidney and liver function, especially when starting or adjusting the dose.
- Avoid alcohol: Alcohol can increase the side effects of Tegretol-XR, including drowsiness and dizziness.
- Missed dose: If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Side Effects of TEGretol-XR
Common Side Effects
- Drowsiness
- Dizziness
- Nausea or vomiting
- Constipation
- Dry mouth
- Blurred vision
- Unsteady movements
Uncommon/Severe Side Effects
- Aplastic anemia or agranulocytosis: Symptoms include unusual bleeding or bruising, fatigue, and frequent infections.
- Severe skin reactions: Tegretol-XR has been associated with Stevens-Johnson syndrome and toxic epidermal necrolysis in certain populations, particularly those with the HLA-B*1502 gene.
- Hyponatremia (low sodium levels): Symptoms include headache, confusion, weakness, and seizures.
- Liver problems: Yellowing of the skin or eyes, dark urine, and abdominal pain.
Risks and Warnings of TEGretol-XR
- Serious blood disorders: Tegretol-XR can cause serious blood conditions such as aplastic anemia and agranulocytosis. Regular monitoring of blood cell counts is necessary.
- Severe skin reactions: Individuals of Asian ancestry should be screened for the HLA-B*1502 allele, as they are at a higher risk of developing severe skin reactions.
- Liver toxicity: Tegretol-XR may cause hepatotoxicity (liver damage), and liver function tests should be monitored periodically.
- Hyponatremia: Carbamazepine can lower sodium levels in the blood, leading to hyponatremia, especially in elderly patients or those on diuretics.
Interactions with TEGretol-XR
Common Drug Interactions
- CYP450 enzyme interactions: Tegretol-XR is metabolized by CYP3A4, and its levels can be affected by other medications that induce or inhibit this enzyme. Phenytoin, phenobarbital, and rifampin can lower carbamazepine levels, while azole antifungals (e.g., ketoconazole) and macrolide antibiotics (e.g., erythromycin) can increase its levels.
- Oral contraceptives: Tegretol-XR can reduce the effectiveness of birth control pills due to its enzyme-inducing properties.
- Warfarin: Tegretol-XR can decrease the effectiveness of warfarin, a blood thinner.
- MAOIs: Avoid use of Tegretol-XR with monoamine oxidase inhibitors (MAOIs), as this can lead to serious interactions.
Alternatives to TEGretol-XR
- Trileptal (Oxcarbazepine): Another anticonvulsant and mood stabilizer used to treat seizures and bipolar disorder with fewer side effects related to sodium levels.
- Lamictal (Lamotrigine): Used for epilepsy and bipolar disorder, with fewer risks of blood disorders but a risk of severe skin reactions.
- Depakote (Divalproex sodium): An anticonvulsant used for epilepsy, bipolar disorder, and migraine prevention.
- Keppra (Levetiracetam): An anticonvulsant used for a variety of seizure types with fewer drug interactions.
