Carbamazepine (Tegretol®)

Last Update: 18 Nov 2024

Medication

Table of content

1. What Is Carbamazepine? 2. Carbamazepine During Pregnancy 3. Risks 4. Benefits 5. Breastfeeding 6. Key Takeaways 7. Research limits

Welcome to our Fact Sheet on Carbamazepine (Tegretol®) during pregnancy and breastfeeding. The information given is based on current research and may be updated with new scientific knowledge. This information does not replace personalized advice from healthcare professionals.

1. What Is Carbamazepine?

Carbamazepine, also known by its brand name Tegretol®, is an anti-seizure medication (ASM). It works on the central nervous system, so the nerves and brain. Carbamazepine is used to:

Control certain types of epileptic seizures
Manage some types of pain
Stabilize moods in bipolar disorder.

This medication acts like a traffic controller on the sodium channels in the nervous system to calm overactive neurons tooltip in the brain and stop them from sending too many signals.

Imagine these sodium channels as gates on neurons that control the flow of traffic on a busy road. When the light is green, they let in particles called sodium (salt) that help send signals such as neurotransmitters tooltip between neurons. These signals tell our body what to do, like moving our arms or feeling happy or experiencing pain. Carbamazepine adds a traffic controller to help keep these gates in check when the traffic light malfunctions, ensuring that traffic flows smoothly without sudden surges or blockages.

Tip: It is especially important to continue taking folic acid supplements while you are taking carbamazepine because the medication reduces folic acid in the body. If you’re planning a pregnancy or just found out you’re pregnant, your healthcare team will recommend taking a dose of folic acid between 1 and 5mg/day.

How to have a healthy pregnancy with epilepsy.

Learn more

2. Can I Take Carbamazepine During Pregnancy?

If you’re pregnant and taking carbamazepine, it’s important to continue your treatment until you can talk to your healthcare professional. Suddenly stopping carbamazepine can cause seizures, which can be dangerous for both you and your baby.

If you need to start carbamazepine while you’re pregnant, your healthcare provider will carefully consider the advantages and risks of the treatment and medical conditions. They may adjust your dosage to find the best option for you and your baby throughout your pregnancy.

It’s generally recommended to continue taking your carbamazepine when you are pregnant. Any change in the way you take carbamazepine, whether you’re pregnant or not, should be managed with the help of a healthcare professional like a pharmacist or physician.

Pregnancy greatly changes your internal biology and impacts the baby’s development, so it’s important to talk with your healthcare professional if you recently discover that you’re pregnant or you’re planning a pregnancy.

Do not wait until your first prenatal appointment to discuss the effects of medications with your healthcare provider. Most drug-related risks occur during the first trimester of pregnancy during organogenesis, when the embryo’s organs are forming.

Regular monitoring and open communication with your healthcare team are crucial. Ideally, pregnancy is planned at least 1 year ahead, that way, if changes to therapy are necessary they are made safely.

Note: Its important to inform your healthcare professional that you gave birth right away, since medications adjustments may be necessary early on to avoid side effects from dose changes made during pregnancy.

3. What Are the Risks of Carbamazepine Associated with Pregnancy?

As with any medication, it’s important to talk to your healthcare team to evaluate the advantages and potential risks so that you and your baby can get the best care. The risks and benefits of continuing carbamazepine during your pregnancy should ideally be discussed before getting pregnant, especially before the first trimester, which is a key period for the baby’s organ development.

Miscarriages, congenital malformations tooltip, premature births and other complications can occur in any pregnancy for many different reasons. This is known as the background risk. Here, we compare this background risk with the risks associated with taking the medication.

Carbamazepine is generally not a first-choice medication for pregnant women. because of observed obstetrical complications and congenital malformations.

By planning a year before becoming pregnant, you can work with your healthcare team to make the necessary adjustments. Depending on your health condition, your healthcare professional may decide that it is still safer to continue carbamazepine during pregnancy.

Some studies have shown a slightly higher risk of congenital malformations tooltip, especially spina-bifida (malformation of the spine), since carbamazepine affects the levels of folic acid in the body. The risks is higher with higher doses of carbamazepine. A slightly higher risk of low Apgar scores and an increased chance of neurodevelopmental disorders compared to the general population have also been reported. More research is needed.

The table below summarizes the potential risks based on current evidence. Remember, these risks are relative and can be influenced by factors like the mother’s age, genetics, ethnicity, lifestyle, and other medical conditions.

What are malformations like spina bifida?

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Table 1. Risks associated with carbamazepine during pregnancy.

For who?	What?	What does research say?
For the pregnant person	Ability to get pregnant	While it’s unclear if carbamazepine directly affects fertility tooltip, long-term use of seizure medications may cause irregular periods, which can make it harder to get pregnant.
For the pregnant person	Miscarriages	Most studies did not find a higher risk of miscarriages compared to the background risk tooltip. Some studies show a slightly higher chance, but it’s difficult to determine if carbamazepine, the medical condition, or other factors are the cause.
For the unborn child	Congenital Malformations	Several studies found a slightly higher risk of malformations compared to the background risk (5 out of 100 vs 3 out of 100 pregnancies) tooltip. The more common malformations were spina-bifida and cleft palate.
	Growth	No increased risks of having a baby with a higher or lower birth weight (less 5 pounds 8 ounces [2,500 grammes]) was found tooltip. More research is needed to fully understand this risk.
	Premature Birth	Not enough research to determine if there’s an increased risk of premature birth (< 37 weeks).
	Neonatal Health	Slightly increased risk of low Apgar score tooltip (below 7) tooltip.
For future child/adult	Brain Development	Some research shows a slightly higher risk of developmental delays, language delays, or attention deficit disorders (ADHD) tooltip. More research is needed to confirm these risks.

* The risks that increased when compared to the background chance in the population are in bold.

4. Aside From the Risks, What Are the Benefits of Carbamazepine?

Taking carbamazepine during pregnancy can offer several benefits, which should be carefully weighed against its risks.

While there are risks associated with using carbamazepine during pregnancy, the benefits of controlling seizures often outweigh the potential risks. Maintaining good seizure control is essential for both the mother and the baby, as uncontrolled seizures can lead to complications such as injury (sometimes leading to placental abruption), preterm labor, and even miscarriage.

Here are some potential benefits of carbamazepine during pregnancy:

Effective Seizure Control: Carbamazepine is very effective in controlling seizures, which can help prevent complications that might arise from seizures during pregnancy, such as those triggered by sleep deprivation or stress.

Improved Quality of Life: By reducing seizures, carbamazepine can help you feel healthier and manage daily life better, which benefits both you and your baby’s development.

Enhanced Maternal Care: Good seizure control can improve your ability to care for yourself and your baby, leading to better nutrition, sleep, and more active participation in prenatal care.

Prevention of Pregnancy Complications: By preventing seizures, carbamazepine can help avoid complications during pregnancy and childbirth.

Postpartum Benefits: Effective seizure control during pregnancy can also help prevent postpartum complications related to seizures.

If you need carbamazepine during pregnancy, it’s important to continue taking it without medical advice, as the benefits of preventing seizures generally outweigh the potential risks. Always discuss your treatment options with your healthcare provider to ensure the best outcome for both you and your baby.

5. Will I Be Able to Breastfeed?

Breastfeeding is a personal choice. Remember, if you have questions about your situation, you can seek help from your healthcare professional (doctor, nurse, pharmacist) or a lactation consultant.

Carbamazepine does pass into breast milk, but the amount is typically too low to affect your baby’s growth or development. Thus, this medication seems compatible with breastfeeding if it’s what you want.

Monitoring your baby’s health is recommended. Keep an eye on your baby for any signs of jaundice, drowsiness, or poor weight gain. If you notice any of these symptoms, reach out to your child’s healthcare provider.

To ensure the safety of your baby, discuss your situation with your healthcare provider. They can help you weigh the benefits of breastfeeding against potential risks and decide on the best approach for both your health and your baby’s well-being.

6. Key Takeaways

Carbamazepine (Tegretol®) helps control seizures related to epilepsy and mood swings associated with bipolar disorder.
Taking carbamazepine during pregnancy can increase the chance of major and minor birth defects, including spina-bifida and cleft palate.
There is a possible increased chance of brain development disorders like language delays and ADHD in babies exposed to carbamazepine during pregnancy.
Even though there are potential risks, if carbamazepine is needed to control seizures during pregnancy, it’s usually best to continue taking it because the benefits of preventing seizures outweigh the potential harm to your baby.
Always discuss with your healthcare team to weigh the risks and benefits associated with taking carbamazepine during pregnancy or while breastfeeding.

7. Research Is Great, But It Is Not Perfect

Making informed health decisions also involves considering the current state of scientific knowledge. Here are some considerations on what our committee of experts has concluded on the quantity and quality of studies conducted to date on carbamazepine during pregnancy:

Variability in Dosages Studied: Research often includes a wide range of dosages, making it hard to determine the safest and most effective dose for pregnant women.

Different Forms of Epilepsy: Studies may not always differentiate between types of epilepsy, which could affect how carbamazepine works or its risks during pregnancy.

Potential Confounding Factors: Pregnant or breastfeeding women taking carbamazepine might also be using other medications or have different health conditions, which can make it difficult to isolate the effects of carbamazepine alone.

Population Diversity: Research often lacks representation of diverse populations, so findings may not apply equally to all women, depending on their background or health.

These limitations highlight the importance of discussing treatment options with a healthcare provider to understand the potential risks and benefits based on your individual circumstances.

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