Tegretol Tapering Guide
carbamazepine
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.
100mg, 200mg tablets; 100mg/5mL suspension; 100mg, 200mg, 400mg ER
Tablets: 200mg; Chewable tablets: 100mg; Suspension: 100mg/5mL; ER tablets: 100mg, 200mg, 400mg; ER capsules: 100mg, 200mg, 300mg
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.
Hyperbolic Tapering Guidance
Carbamazepine's enzyme induction means many concurrent drugs will need dose review during the taper as their metabolism slows.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Withdrawal Timeline
3-7 days after stopping
1-2 weeks
4-8 weeks
Mood instability can persist months without alternative coverage
Common Withdrawal Symptoms
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.
Pharmacokinetics
ADME Profile
Hepatic via CYP3A4 (major). Potent inducer of CYP3A4, CYP1A2, CYP2C9, UGT — induces own metabolism over the first weeks.
~76%
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Other Drug Profiles
Sources & References
Tegretol (carbamazepine) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
- Goodwin GM, Haddad PM, Ferrier IN, et al. 2016 — Discontinuation of mood stabilizers: practical considerations and review (Journal of Psychopharmacology)
- Geddes JR, Burgess S, Hawton K, et al. 2004 — Discontinuation of lithium augmentation in elderly patients (American Journal of Psychiatry)
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- International Society for Bipolar Disorders (ISBD) — Specialty society guidance for bipolar maintenance pharmacotherapy
- Deprescribing.org — Clinician-facing deprescribing algorithms
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — mood stabilizer tapering forum — Community archive of mood-stabilizer discontinuation experiences
- Mad in America — mood stabilizer coverage — Independent journalism on lithium, lamotrigine, and valproate
- Inner Compass Initiative — Withdrawal Project — Peer-led psychiatric drug withdrawal resources
- RxISK — adverse drug reaction reporting — Independent database of mood-stabilizer adverse-effect reports
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.