How should I taper off Tegretol (carbamazepine)?

Slow taper over weeks. Watch for return of induced enzyme drug interactions as carbamazepine clears. Carbamazepine's enzyme induction means many concurrent drugs will need dose review during the taper as their metabolism slows.

How long does Tegretol withdrawal last?

Tegretol withdrawal typically begins 3-7 days after stopping, peaks around 1-2 weeks, and resolves within 4-8 weeks. Mood instability can persist months without alternative coverage

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Tegretol Tapering Guide

carbamazepine

Mood StabilizerFDA 1968

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Boxed Warning

Serious dermatologic reactions (Stevens-Johnson syndrome / TEN) — especially in HLA-B*1502 positive individuals. Aplastic anemia and agranulocytosis.

Overview

Carbamazepine is an anticonvulsant used for bipolar (especially mania), epilepsy, and trigeminal neuralgia. Notable for autoinduction of its own metabolism and a black-box warning for serious skin reactions in HLA-B*1502-positive individuals.

Common Doses

100mg, 200mg tablets; 100mg/5mL suspension; 100mg, 200mg, 400mg ER

Formulations

Tablets: 200mg; Chewable tablets: 100mg; Suspension: 100mg/5mL; ER tablets: 100mg, 200mg, 400mg; ER capsules: 100mg, 200mg, 300mg

Pregnancy

Category D

Mechanism of Action

Voltage-gated sodium channel blocker; decreases neuronal excitability.

Taper Notes

Slow taper over weeks. Watch for return of induced enzyme drug interactions as carbamazepine clears.

Maudsley Deprescribing Guidance

Carbamazepine's enzyme induction means many concurrent drugs will need dose review during the taper as their metabolism slows.

Withdrawal Timeline

⏱Onset

3-7 days after stopping

📈Peak Severity

1-2 weeks

📉Resolution

4-8 weeks

⚠️Protracted Risk

Mood instability can persist months without alternative coverage

Common Withdrawal Symptoms

rebound seizures (in seizure patients)mood instabilityanxietyinsomniaGI upset

Interactions & Safety

Drug Interactions

CYP3A4 substrates (oral contraceptives, warfarin, many psychotropics) — markedly reduced
CYP3A4 inhibitors (erythromycin, fluconazole, grapefruit) — increase carbamazepine levels
Lamotrigine — carbamazepine reduces lamotrigine levels

Contraindications

Bone marrow depression
Recent MAOI use
HLA-B*1502 positive without genotype confirmation in at-risk populations

Toxicity

Stevens-Johnson syndrome / TEN (especially HLA-B*1502 in Asian populations), aplastic anemia, agranulocytosis, hyponatremia (SIADH), hepatotoxicity, dizziness, ataxia, diplopia.

External References

Pharmacokinetics

ADME Profile

Metabolism

Hepatic via CYP3A4 (major). Potent inducer of CYP3A4, CYP1A2, CYP2C9, UGT — induces own metabolism over the first weeks.

Protein Binding

~76%

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