TEGRETOL 100 MG / 5ML LIQUID - patient leaflet, side effects, dosage

1. What Tegretol Liquid is and what it’s used for

Tegretol Liquid is a white suspension tasting of caramel.

Carbamazepine, the active ingredient in Tegretol Liquid, can affect the body in several different ways. It is an anti-convulsant medicine (prevents fits), it can also modify some types of pain and can control mood disorders.

Tegretol is used

• To treat some forms of epilepsy
• To treat a painful condition of the face called trigeminal neuralgia
• To help control serious mood disorders when some other medicines

don’t work.

2. Things to consider before you start to take Tegretol Liquid

Some people MUST NOT take Tegretol Liquid. Talk to your doctor if:

• you think you may be hypersensitive (allergic) to carbamazepine or similar drugs such as oxcarbazepine (Trileptal), or to any of a related group of drugs known as tricyclic antidepressants (such as amitriptyline or imipramine).

If you are allergic to carbamazepine there is a one in four (25%) chance that you could also have an allergic reaction to oxcarbazepine.

• you think you may be allergic to any of the other ingredients of Tegretol Liquid (these are listed at the end of the leaflet). Signs of a hypersensitivity reaction include swelling of the face or mouth (angioedema), breathing problems, runny nose, skin rash, blistering or peeling.
• you have any heart problems,
• you have ever had problems with your bone marrow,
• you have a blood disorder called porphyria,
• you have taken drugs called monoamine oxidase inhibitors (MAOIs), used to treat depression, within the last 14 days.

A small number of people being treated with anti-epileptics such as carbamazepine have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor. Serious skin rashes (Stevens- Johnson syndrome, toxic epidermal necrolysis) have been reported with the use of carbamazepine. Frequently, the rash can involve ulcers of the mouth, throat, nose, genitals and conjunctivitis (red and swollen eyes). These serious skin rashes are often preceded by influenza-like symptoms fever, headache, body ache (flu-like symptoms). The rash may progress to widespread blistering and peeling of the skin. The highest risk for occurrence of serious skin reactions is within the first months of treatment.

These serious skin reactions can be more common in people from some Asian countries. The risk of these reactions in patients of Han Chinese or Thai origin may be predicted by testing a blood sample of these patients. Your doctor should be able to advise if a blood test is necessary before taking carbamazepine.

If you develop a rash or these skin symptoms, stop taking carbamazepine and contact your doctor immediately.

If you experience dizziness, drowsiness, decrease in blood pressure, confusion, due to Tegretol treatment, this may lead to falls.

You should also ask yourself these questions before taking Tegretol Liquid. If the answer to any of these questions is YES, discuss your treatment with your doctor or pharmacist because Tegretol Liquid might not be the right medicine for you.

• Are you pregnant or planning to become pregnant?
• Are you breastfeeding?

It is important to tell your doctor or pharmacist if you are taking any other medicines for epilepsy at the same time as carbamazepine and you are pregnant, think you may be pregnant, or are planning to have a baby (see also the information in Section 2 on pregnancy and breast-feeding).

• Do you suffer from the sort of epilepsy where you get mixed seizures which include absences?
• Do you have any mental illness?
• Are you allergic to an epilepsy medicine called phenytoin, primidone or phenobarbital?
• Do you have liver problems?
• Do you have kidney problems associated with low sodium blood level

or do you have kidney problems and you are taking certain medicines that lower sodium blood levels (diuretics such as hydrochlorothi­azide, furosemide)?

• Are you elderly?
• Do you have any eye problems such as glaucoma (increased pressure in the eye) or do you have difficulty retaining your urine?
• Do you have an intolerance to some sugars? (Tegretol Liquid contains sorbitol).

Are you taking other medicines?

Because of the way that Tegretol works, it can affect, and be affected by, lots of other things that you might be eating or medicines that you are taking. It is very important to make sure that your doctor knows all about what else you are taking, including anything that you have bought from a chemist or health food shop. It may be necessary to change the dose of some medicines, or stop taking something altogether.

Tell the doctor if you are taking:

• Hormone contraceptives, e.g. pills, patches, injections or implants. Tegretol affects the way the contraceptive works in your body, and you may get breakthrough bleeding or spotting. It may also make the contraceptive less effective and there will be a risk of getting pregnant. Your doctor will be able to advise you about this, and you should think about using other effective contraceptives. If you are a female of childbearing age you should use an effective method of contraception throughout your treatment and for a period of 28 days, after discontinuation of treatment.
• Hormone Replacement Therapy (HRT). Tegretol can make HRT less effective.
• Any medicines for depression or anxiety.
• Corticosteroids (‘steroids’). You might be taking these for inflammatory conditions such as asthma, inflammatory bowel disease, muscle and joint pains.
• Anticoagulants to stop your blood clotting.
• Antibiotics to treat infections including skin infections and TB (e.g. ciprofloxacin).
• Antifungals to treat fungal infections.
• Painkillers containing paracetamol, dextropropoxyphene,

tramadol, methadone or buprenorphine.

• Other medicines to treat epilepsy.
• Medicines for high blood pressure or heart problems.
• Antihistamines (medicines to treat allergy such as hayfever, itch, etc).
• Diuretics (water tablets).
• Cimetidine or omeprazole (medicines to treat gastric ulcers).
• Isotretinoin (a medicine for the treatment of acne).
• Metoclopramide or aprepitant (anti-sickness medications).
• Acetazolamide (a medicine to treat glaucoma – increased pressure in the eye).
• Danazol or gestrinone (treatments for endometriosis).
• Theophylline or aminophylline (used in the treatment of asthma).
• Ciclosporin, tacrolimus or sirolimus (immunosuppres­sants, used after transplant operations, but also sometimes in the treatment of arthritis or psoriasis).
• Drugs to treat schizophrenia (e.g. paliperidone, aripiprazole).
• Cancer drugs (e.g. temsirolimus, cyclophosphamide, lapatinib).
• The anti-malarial drug, mefloquine.
• Drugs to treat HIV.
• Levothyroxine (used to treat hypothyroidism).
• Tadalafil (used to treat impotence).
• Albendazole (used to treat worms).
• Bupropion (used to help stop smoking).
• A herbal remedy called St John’s Wort or Hypericum.
• Drugs or supplements containing Vitamin B (nicotinamide).

Pregnancy, breastfeeding and fertility Pregnancy

Your doctor will discuss with you the potential risk of taking Tegretol during pregnancy since it may cause harm or abnormalities in the unborn child.

You must discuss your epilepsy treatment with your doctor well before you become pregnant. If you do get pregnant while you’re taking Tegretol Liquid you must tell the doctor straightaway. It is important that your epilepsy remains well controlled, but, as with other anti-epilepsy treatments, there is a risk of harm to the foetus. Make sure you are very clear about the risks and the benefits of taking Tegretol Liquid.

If you are pregnant, or think you may be pregnant, you must tell your doctor straight away and discuss possible risks the epilepsy medicine you are taking might pose to your unborn baby.

If you are planning to become pregnant you should discuss your epilepsy treatment with your doctor as early as possible before you become pregnant.

You should not stop your treatment without discussing this with your doctor. Suddenly stopping may lead to breakthrough seizures which may harm you and your unborn baby. It is important that your epilepsy remains well controlled.

Taking carbamazepine during pregnancy increases the chance that the baby may have a physical birth abnormality (major congenital malformations). Studies with women treated with carbamazepine for epilepsy have shown that on average 4–5 babies in every 100 will have serious physical birth abnormalities. This is compared with 2 to 3 babies in every 100 born to women who do not have epilepsy.

These abnormalities can develop early in pregnancy, even before you know you are pregnant. The most common types of major congenital malformations reported for carbamazepine include spina bifida (where the bones of the spine are not properly developed); facial and skull malformations including cleft lip/palate; skeletal, heart, urinary tract and sexual organ malformations.

Studies have found that the risk of physical birth abnormalities increases with increasing doses of carbamazepine. Therefore, it is important that where possible you are prescribed the lowest dose to control your epilepsy.

Ask your doctor about taking folic acid when trying for a baby and during pregnancy. Folic acid may lower the general risk of serious physical birth abnormalities that exists with all pregnancies.

Taking more than one epilepsy medicine at the same time may also increase the risk of physical birth abnormalities. This means that where possible, your doctor should consider using one epilepsy medicine to control your epilepsy.

Studies suggest that taking carbamazepine during pregnancy does not increase the risk the child may have difficulties with learning and thinking ability.

Breastfeeding

Mothers taking Tegretol Liquid can breastfeed their babies, but you must tell the doctor as soon as possible if you think that the baby is suffering side effects such as excessive sleepiness, skin reaction or yellow skin and eyes, dark urine or pale stools.

Fertility

You should use an effective method of contraception throughout your treatment with Tegretol and for a period of 28 days, after discontinuation of treatment. Irregularity of the menstrual period may occur in women taking hormonal contraceptives (birth control medicines) and Tegretol. The hormonal contraceptive may become less effective and you should consider using a different or additional non-hormonal contraceptive method. Ask your doctor about effective contraception.

Will there be any problems with driving or using machinery?

Tegretol Liquid can make you feel dizzy or drowsy, or may cause blurred vision, double vision, or you may have a lack of muscular coordination, especially at the start of treatment or when the dose is changed. If you are affected in this way, or if your eyesight is affected, you should not drive or operate machinery.

Tegretol Liquid contains propyl hydroxybenzoate, methyl hydroxybenzoate, sorbitol and propylene glycol:

• Propyl hydroxybenzoate (E216) and methyl hydroxybenzoate (E218), which may cause allergic reactions (possibly delayed).
• Sorbitol (E420): This medicine contains 175mg sorbitol in each milliliter, which is equivalent to 175mg/ml. Sorbitol is a source of fructose. If your doctor has told you that you (or your child) have an intolerance to some sugars or if you have been diagnosed with hereditary fructose intolerance (HFI), a rare genetic disorder in which a person cannot break down fructose, talk to your doctor before you (or your child) take or receive this medicine. Sorbitol may cause gastrointestinal discomfort and mild laxative effect.
• Propylene glycol (E1520): This medicine contains 125mg propylene glycol in each 100mg/5ml, which is equivalent to 25mg/ml. If your baby is less than 4 weeks old, talk to your doctor or pharmacist before giving them this medicine, in particular if the baby is given other medicines that contain propylene glycol or alcohol.

Information about sodium content:

This medicine contains less than 1mmol sodium (23mg) per ml, that is to say essentially ‘sodium free’.

Other special warnings

• Drinking alcohol may affect you more than usual. Discuss whether you should stop drinking with your doctor.
• Eating grapefruit, or drinking grapefruit juice, may increase your chance of experiencing side effects.
• Your doctor may want you to have a number of blood tests before you start taking Tegretol and from time to time during your treatment. This is quite usual and nothing to worry about.

3. how to take tegretol liquid

The doctor will tell you how much Tegretol Liquid to take and when to take it. Always follow his/her instructions carefully. The dose will be on the pharmacist’s label. Check the label carefully. It is important to take the liquid at the right times. If you are not sure, ask your doctor or pharmacist. Keep taking your medicine for as long as you have been told, unless you have any problems. In that case, check with your doctor.

Your doctor will usually start Tegretol at a fairly low dose which can then be increased to suit you individually. The dose needed varies between patients. You can take Tegretol Liquid during, after or between meals. Shake the bottle before you measure out your dose. You are usually told to take a dose two or three times a day.

To treat epilepsy the usual doses are:

Adults: 800–1,200mg a day, although higher doses may be necessary. If you are elderly you might require a lower dose.

Children aged up to and over 1 year: Usually 10–20mg/kg body weight daily in several divided doses. Your doctor will tell you how much liquid the child should take.

To treat trigeminal neuralgia the usual dose is: 600–800mg a day. The maximum dose is 1200mg a day. If you are elderly you might require a lower dose. Once the pain is controlled your doctor will probably reduce the dose.

To treat mood swings the usual dose is: 400–600mg a day

What if you forget to take a dose?

If you forget to take a dose, take one as soon as you remember. If it is nearly time for your next dose, though, just take the next dose and forget about the one you missed.

What if you take too much liquid?

If you accidentally take too much Tegretol Liquid, tell your doctor or your nearest hospital casualty department. Take your medicine pack with you so that people can see what you have taken.

4. possible side effects

Tegretol Liquid does not usually cause problems, but like all medicines, it can sometimes cause side effects.

Some side effects can be serious

Stop taking Tegretol Liquid and tell your doctor straight away if you notice:

• Serious skin reactions such as rash, red skin, blistering of the lips, eyes or mouth, or skin peeling accompanied by fever. These reactions may be more frequent in patients of Chinese or Thai origin
• Mouth ulcers or unexplained bruising or bleeding
• Sore throat or high temperature, or both
• Yellowing of your skin or the whites of your eyes
• Swollen ankles, feet or lower legs
• Any signs of nervous illness or confusion
• Pain in your joints and muscles, a rash across the bridge of the nose and cheeks and problems with breathing (these may be the signs of a rare reaction known as lupus erythematosus)
• Fever, skin rash, joint pain, and abnormalities in blood and liver function tests (these may be the signs of a multi-organ sensitivity disorder)
• Bronchospasm with wheezing and coughing, difficulty in breathing, feeling faint, rash, itching or facial swelling (these may be the signs of a severe allergic reaction)
• Pain in the area near the stomach
• You experience a fall due to dizziness, drowsiness, decrease in blood

pressure, confusion.

The side effects listed below have also been reported.

More than 1 in 10 people have experienced:

Leucopenia (a reduced number of the cells which fight infection making it easier to catch infections); dizziness and tiredness; feeling unsteady or finding it difficult to control movements; feeling or being sick; changes in liver enzyme levels (usually without any symptoms); skin reactions which may be severe.

Up to 1 in 10 people have experienced:

Changes in the blood including an increased tendency to bruise or bleed; fluid retention and swelling; weight increase; low sodium in the blood which might result in confusion; headache; double or blurred vision; dry mouth.

Up to 1 in 100 people have reported:

Abnormal involuntary movements including tremor or tics; abnormal eye movements; diarrhoea; constipation.

Up to 1 in 1,000 people have reported:

Disease of the lymph glands; folic acid deficiency; a generalised allergic reaction including rash, joint pain, fever, problems with the kidneys and other organs; hallucinations; depression; loss of appetite; restlessness; aggression; agitation; confusion; speech disorders; numbness or tingling in the hands and feet; muscle weakness; high blood pressure (which may make you feel dizzy, with a flushed face, headache, fatigue and nervousness); low blood pressure (the symptoms of which are feeling faint, light headed, dizzy, confused, having blurred vision); changes to heart beat; stomach pain; liver problems including jaundice; symptoms of lupus.

Up to 1 in 10,000 people have reported:

Changes to the composition of the blood including anaemia; porphyria; meningitis; swelling of the breasts and discharge of milk which may occur in both male and females; abnormal thyroid function tests; osteomalacia (which may be noticed as pain on walking and bowing of the long bones in the legs); osteoporosis; increased blood fat levels; taste disturbances; conjunctivitis; glaucoma; cataracts; hearing disorders; heart and circulatory problems including deep vein thrombosis (DVT), the symptoms of which could include tenderness, pain, swelling, warmth, skin discoloration and prominent superficial veins; lung or breathing problems; severe skin reactions including Stevens-Johnson syndrome (These reactions may be more frequent in patients of Chinese or Thai origin); sore mouth or tongue; liver failure; increased sensitivity of the skin to sunlight; alterations in skin pigmentation; acne; excessive sweating; hair loss; increased hair growth on the body and face; muscle pain or spasm; sexual difficulties which may include reduced male fertility, loss of libido or impotence; kidney failure; blood spots in the urine; increased or decreased desire to pass urine or difficulty in passing urine.

The following have also been reported, but the frequency cannot be estimated from the available information:

Severe skin reactions, accompanied by feeling unwell and changes in blood results. Diarrhoea, abdominal pain, and fever (signs of inflammation of the colon), reactivation of herpes virus infection (can be serious when immune system is depressed), complete loss of nails, fracture, decrease in the measure of the bone density, drowsiness, memory loss, purple or reddish-purple bumps that may be itchy.

Do not be alarmed by this list. Most people take Tegretol Liquid without any problems.

If any of the symptoms become troublesome, or if you notice anything else not mentioned here, please go and see your doctor. He/she may want to give you a different medicine.

There have been reports of bone disorders including osteopenia and osteoporosis (thinning of the bone) and fractures. Check with your doctor or pharmacist if you are on long-term antiepileptic medication, have a history of osteoporosis, or take steroids.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects, you can help provide more information on the safety of this medicine.

5. how to store tegretol liquid

Keep out of the sight and reach of children.

Do not store above 30°C.

Keep the container in the outer carton in order to protect from light and heat. Keep the container tightly closed.

Do not take the Liquid after the expiry date which is stated on the carton and bottle label after ‘Exp’. The expiry date refers to the last day of that month.

If the liquid becomes discoloured or shows any signs of deterioration, seek the advice of your pharmacist.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6. Further information

What Tegretol Liquid contains

The active ingredient is carbamazepine.

Each 5ml contains 100mg carbamazepine.

The other ingredients are avicel RC 581, caramel aroma 52929A, methyl hydroxybenzoate, hydroxyethylce­llulose 300, propylene glycol, polyoxyethylene glycol 400 stearate, propyl hydroxybenzoate E216, saccharin sodium, sorbic acid, sorbitol solution and water deionised.

What Tegretol Liquid looks like and content

250ml amber glass bottle with a white tamper evident/child-resistant cap contained within a cardboard carton. The bottle is accompanied by a clear, plastic 5ml spoon.

Manufactured by: Novartis (Hellas) A.E.B.E., 12 km National Road Athens – Lamia No 1, 14451 Metamorfosi, Greece.

Licence holder: B&S Healthcare, Unit 4, Bradfield Road, Ruislip, Middlesex, HA4 0NU, UK. ______

Tegretol ® 100mg/5ml Liquid; PL 18799/2257 I POM I

Leaflet date: 24.11.2021

Tegretol is a registered trademark of Novartis AG.

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