Carbamazepine (Tegretol)

Carbamazepine (brand name Tegretol) is an anticonvulsant medication also used for nerve-related pain and certain movement disorders. In neuro-ophthalmology, it's effective for superior oblique myokymia.

How It Works

Carbamazepine stabilizes nerve membranes by blocking sodium channels, reducing abnormal nerve firing. This helps control conditions caused by hyperexcitable nerves.

Common Uses

• Superior oblique myokymia
• Trigeminal neuralgia
• Epilepsy
• Bipolar disorder

Dosing

• Start low (100-200mg daily)
• Increase gradually
• Typical therapeutic dose: 200-400mg twice daily
• Extended-release formulation available

Side Effects

Common

• Dizziness
• Drowsiness
• Nausea
• Unsteadiness

Serious (Require Monitoring)

• Blood count changes (aplastic anemia, agranulocytosis—rare but serious)
• Liver problems
• Severe skin reactions (especially in certain genetic backgrounds)
• Low sodium

Important Monitoring

Before Starting

• Check CBC and liver function
• Consider HLA-B*1502 genetic testing (for certain populations—risk of severe skin reactions)
• Review drug interactions

Drug Interactions

Carbamazepine has many drug interactions. It can reduce effectiveness of:

• Birth control pills
• Warfarin
• Many other medications

Always inform doctors of all medications you take.

Frequently Asked Questions

Why do I need blood tests?

Carbamazepine can rarely cause dangerous drops in blood cell counts or liver problems. Regular monitoring catches these early.

Can I drink alcohol?

Alcohol can worsen side effects like drowsiness and dizziness. Use caution or avoid alcohol.

What if I need surgery?

Inform your surgical team—carbamazepine affects how other medications work.