Bipolar Disorder Treatment Medications Potential Side Effects and Risks of Tegretol By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on May 18, 2023 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Jose Luis Pelaez Inc / Getty Images Table of Contents View All Table of Contents Common Side Effects Severe Skin Rash Bone Marrow Problems Other Health Concerns What to Tell Your Doctor What is the most important information I should know about Tegretol? Tegretol may cause a severe and potentially fatal skin rash. Call your doctor if you experience blisters on the skin, swelling of the mouth or face, or hives.Bone marrow problems, liver dysfunction, kidney problems, and heart issues can also occur; monitoring and testing is important before and during treatment. Tegretol (carbamazepine) is an anticonvulsant sometimes prescribed as a mood stabilizer in bipolar disorder. Bipolar disorder is a mental health condition that involves extreme shifts in mood, thoughts, and behavior. People with bipolar disorder experience mania or hypomania and periods of depression. Symptoms of mania can include elevated mood, grandiose behavior, impulsivity, and racing thoughts, while depression can involve symptoms such as fatigue, low mood, and loss of interest. Tegretol can treat manic, hypomanic, or mixed episodes of bipolar disorder. It lowers the excitability of nerve receptors that affect mood and motivation. While there are some risks and side effects to watch out for when taking Tegretol, the good news is that studies show this medication to be effective and generally well-tolerated in people with bipolar disorder. This article discusses the most common Tegretol side effects and the more serious ones that may occur. It also covers tests you may need before you take this medication to prevent potential severe side effects. Other Uses In addition to seizures and bipolar disorder, it's also prescribed for pain relief in trigeminal neuralgia. Most Common Tegretol Side Effects The most common side effects while taking Tegretol are: DizzinessDrowsinessUnsteadinessNauseaVomiting Such side effects tend to be more intense when you start taking the medication but may decrease with time as your body adjusts to the drug. Talk with your doctor if these side effects are persistent or bothersome. If you experience drowsiness, it's important to discuss driving with your doctor or other activities that could be dangerous if you are not fully alert. Potential for Severe Skin Rash One rare side effect of Tegretol described in case reports is a serious and potentially fatal skin reaction called Stevens-Johnson syndrome and/or toxic epidermal necrolysis. This serious skin rash usually occurs within the first few months of taking Tegretol. People of Asian ancestry who carry a certain gene called the HLA-B*1502 allele may be at an increased risk for developing this skin rash. This is why before taking Tegretol, certain patients (those with ancestry in populations where the gene may be present) will need to undergo a screening genetic blood test. That being said, an absence of the gene doesn't mean a person cannot develop a serious rash. Likewise, having the gene doesn't mean a person will absolutely develop a severe rash. This is why it's critical for a person on Tegretol to follow up frequently with their doctor for periodic skin checks. Call your doctor immediately if you develop symptoms such as: Swelling of the tongue, lips, or face;HivesBlisters on the skinBlisters on the mucous membranes of the eyes, nose, mouth, or genitals Potential for Bone Marrow Problems Other potential rare but serious side effects of Tegretol are aplastic anemia and agranulocytosis. These reactions involve the depression of a person's bone marrow, which is where infection-fighting cells (white blood cells), blood-making cells (red blood cells), and blood-clotting cells (platelets) are produced. Some signs of bone marrow depression to watch out for include: Easy bruisingSwollen lymph nodesThe presence of tiny red dots (petechiae) on your body—a sign that you are bleeding into your skin To monitor for bone marrow problems, your doctor will check your blood cell counts before and during treatment with Tegretol. Other Health Concerns Liver dysfunction may also occur on Tegretol so a blood test of your liver function will be drawn prior to starting Tegretol and at regular intervals. Signs of liver dysfunction that a person on Tegretol should watch out for include yellowing of the skin, nausea or vomiting, or a loss of appetite. Kidney problems can also occur with Tegretol. Your urine and a kidney blood test will be checked. Heart problems, especially heart block, are other potential severe reactions. It's important to tell your doctor if you have ever had an abnormal electrocardiogram (ECG). Finally, eye changes may occur with Tegretol, so an eye exam is warranted before starting Tegretol and periodically when on it. Like other anticonvulsants, Tegretol may increase a person's risk of suicidal thinking and behavior. Be sure to seek emergent medical attention if you or a loved one's mood or behavior is changing and concerning while on Tegretol. What to Tell Your Doctor Be sure and tell your doctor all of your medical conditions and problems. Some may mean that you cannot take Tegretol or need to be monitored more closely. It's important to provide your doctor with a list of all your medications, including prescriptions, over-the-counter medications, herbals, vitamins, and supplements. Some may interact with Tegretol and require your Tegretol dose to decrease or increase. It's also wise to inform your doctor if you drink alcohol and be candid about the amount and frequency. You will need to be more careful about alcohol intake while taking Tegretol and may need to cut down. Treating Bipolar Disorder 5 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Chen CH, Lin SK. Carbamazepine treatment of bipolar disorder: a retrospective evaluation of naturalistic long-term outcomes. BMC Psychiatry. 2012;12:47. doi:10.1186/1471-244X-12-47 Al-quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh). 2015;20(2):107-14. doi:10.17712/nsj.2015.2.20140501 Abuzneid YS, Alzeerelhouseini HIA, Rabi D, et al. Carbamazepine induced Stevens-Johnson Syndrome that developed into toxic epidermal necrolysis: Review of the literature. Case Rep Dermatol Med. 2022;2022:6128688. doi:10.1155/2022/6128688 Food and Drug Administration. Tegretol (carbamazepine). Koutsampasopoulos K, Zotos A, Papamichalis M, Papaioannou K. Carbamazepine induced atrial tachycardia with complete AV block. Hippokratia. 2014;18(2):185-6. By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.