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carbamazepine

Mood stabilizer • Brands: TEGRETOL

Last reviewed: 2025-12-28

General information

Class: Mood stabilizer
Common US brands: TEGRETOL
Typical dose range: Typical start is 200 mg BID; increase by 200 mg/day every 3–5 days to 800–1,200 mg/day (max 1,600 mg).
Therapeutic drug monitoring recommended; reference range 4–12 µg/mL.
Last reviewed: 2025-12-28

Dosing & forms

Forms/strengths: Immediate-release tablets/chewables 100–200 mg, oral suspension 100 mg/5 mL, extended-release tablets/capsules 100–400 mg.
Frequency: Typical start is 200 mg BID; increase by 200 mg/day every 3–5 days to 800–1,200 mg/day (max 1,600 mg).
Typical range: Typical start is 200 mg BID; increase by 200 mg/day every 3–5 days to 800–1,200 mg/day (max 1,600 mg).
Therapeutic range: 4–12 µg/mL

Mechanism (brief)

Voltage‑gated sodium channel blocker; reduces high‑frequency neuronal firing.

Metabolism & Half‑life

Metabolism: CYP3A4 (autoinduction), epoxide metabolite
Half‑life: Steady-state mean 15 h

Therapeutic Drug Monitoring (TDM)

Recommended: Yes

Reference range: 4–12 µg/mL

View labelExact

Monitoring highlights

Baseline: CBC (including WBC/ANC), LFTs, sodium; HLA-B*1502 testing in at-risk ancestry.
Ongoing: periodic CBC, LFTs, and sodium; monitoring for rash and hyponatremia/SIADH.
Serum levels: trough monitoring can be helpful in select cases; autoinduction and strong CYP induction create many drug interactions.
Recheck serum level after 3–4 weeks on a stable dose to account for autoinduction, and again after adding or stopping strong CYP3A4 inhibitors/inducers.
Medication reconciliation at each visit (oral contraceptives, warfarin or other anticoagulants, antipsychotics) because enzyme induction can lower exposure and change clinical response.
Contraception interactions and rash/fever warning signs are typically reviewed.

Sources

TEGRETOL (carbamazepine) prescribing information — DailyMed (2025)
The CANMAT and ISBD Guidelines for the Management of Patients With Bipolar Disorder: 2021 Update — Bipolar Disorders (2021)
Bipolar disorder: assessment and management (NICE guideline CG185) — National Institute for Health and Care Excellence (2020)
Extended-release carbamazepine capsules in the treatment of acute mania — American Journal of Psychiatry (2004)
Clinical pharmacokinetics of carbamazepine — Clinical Pharmacokinetics (1978)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)