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1 May 2026Oral drugsSource update: October 2024

Carbamazepine = CBZ oral

Carbamazepine guidance for epilepsy, neuropathic pain, and bipolar recurrence prevention, with gradual titration and close monitoring.

Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.

Therapeutic action

  • Antiseizure (antiepileptic).
  • Mood stabilizer.

Indications

Due to the numerous and potentially severe adverse effects of CBZ, patients should be kept under close surveillance.

  • Epilepsy: generalised tonic-clonic seizures and focal partial seizures.
  • Neuropathic pain, alone or combined with amitriptyline.
  • Prevention of recurrence of bipolar disorder.

Forms and strengths

  • 200 mg tablet.
  • 100 mg/5 ml oral solution to be administered using a measuring device.

Dose

Start with a low dose then increase gradually based on patient response and tolerance.

Epilepsy

  • Child 1 month to 11 years: start with 5 mg/kg once daily or 2.5 mg/kg 2 times daily; increase the daily dose by 2.5 to 5 mg/kg every 3 to 7 days, up to 5 mg/kg 2 or 3 times daily if necessary, maximum 20 mg/kg daily.
  • Child 12 years and over: start with 100 to 200 mg once daily or 50 to 100 mg 2 times daily; increase the daily dose by 100 to 200 mg every week, up to 200 to 400 mg 2 or 3 times daily if necessary, maximum 1800 mg daily.
  • Adult: start with 100 to 200 mg once daily or 50 to 100 mg 2 times daily; increase the daily dose by 100 to 200 mg every week, up to 400 mg 2 or 3 times daily if necessary, maximum 2 g daily.

Neuropathic pain

  • Adult: start with 200 mg once daily at bedtime for one week, then 200 mg 2 times daily for one week, then 200 mg 3 times daily.

Prevention of recurrence of bipolar disorder

  • Adult: start with 100 mg 2 times daily; increase the daily dose by increments of 200 mg every week, up to 200 mg 2 or 3 times daily if necessary, maximum 1200 mg daily.

Duration

  • Epilepsy and prevention of recurrence of bipolar disorder: as long as required. Do not stop treatment abruptly, even if changing to another medication.
  • Neuropathic pain: continue several months after pain relief is obtained, then attempt to stop treatment.

Contra-indications, adverse effects, precautions

  • Do not administer to patients with atrioventricular block or a history of bone marrow depression.
  • Administer with caution to patients with glaucoma, urinary retention, hepatic or renal impairment, heart failure, blood disorders, and older patients.
  • May cause headache, dizziness, confusional state and agitation in older patients, drowsiness, gastrointestinal and visual disturbances, vitamin D deficiency, osteoporosis, leucopenia, and rash.
  • Rarely, may cause agranulocytosis, anaemia, bone marrow depression, severe cutaneous hypersensitivity reactions, pancreatitis, hepatitis, or cardiac conduction defect. In these cases, stop treatment. Early symptoms such as fever, rash, mouth ulcers, and bleeding require immediate medical attention.
  • If possible, perform at least full blood count, liver enzymes, and serum sodium levels at baseline then regularly during treatment.
  • Avoid or monitor combinations with rifampicin and mefloquine because they reduce the effect of CBZ.
  • Erythromycin, isoniazid, fluoxetine, omeprazole, protease inhibitors, fluconazole, and valproic acid may increase CBZ toxicity.
  • Drugs containing alcohol, benzodiazepines, opioid analgesics, antipsychotics, first-generation antihistamines, antidepressants, and other antiseizure medications may increase sedation.
  • CBZ may reduce the effect of many drugs including diazepam, midazolam, oral anticoagulants, corticosteroids, tricyclic antidepressants, antipsychotics, protease inhibitors, rifampicin, itraconazole, doxycycline, and tramadol.
  • Implants and oral contraceptives are less effective: use injectable medroxyprogesterone or an intrauterine device.
  • Avoid alcohol during treatment.
  • Pregnancy: avoid for epilepsy and bipolar disorder because of the risk of neural tube defects and other malformations. If it is the only option in epilepsy, use the lowest effective dose and give folic acid 5 mg daily during the first trimester, starting as early as possible.
  • Breast-feeding: administer with caution and monitor the child for drowsiness, poor feeding, and transient hepatic impairment.

Source

MSF Essential drugs practical guidelines (January 2026)

This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.

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