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Drug Safety-related Labeling Changes (SrLC)

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TEGRETOL (NDA-018281)

(CARBAMAZEPINE)

Safety-related Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)

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03/20/2018 (SUPPL-58)

Approved Drug Label (PDF)

5 Warnings and Precautions

PRECAUTIONS

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Information for Patients

Patients should be advised that anaphylactic reactions and angioedema may occur during treatment with Tegretol (see WARNINGS). Advise patients to immediately report signs and symptoms suggesting angioedema (swelling of the face, eyes, lips, or tongue, or difficulty in swallowing or breathing) and to stop taking the drug until they have consulted with their healthcare provider.

WARNINGS

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Anaphylaxis and Angioedema

Rare cases of anaphylaxis and angioedema involving the larynx, glottis, lips, and eyelids have been reported in patients after taking the first or subsequent doses of Tegretol. Angioedema associated with laryngeal edema can be fatal. If a patient develops any of these reactions after treatment with Tegretol, the drug should be discontinued and an alternative treatment started. These patients should not be rechallenged with the drug.

7 Drug Interactions

Effect of Tegretol on Plasma Levels of Concomitant Agents

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In addition, Tegretol causes, or would be expected to cause, decreased levels of the following drugs, for which monitoring of concentrations or dosage adjustment may be necessary: acetaminophen, albendazole, alprazolam, aprepitant, buprenorphone, bupropion, citalopram, clonazepam, clozapine, corticosteroids (e.g., prednisolone, dexamethasone), cyclosporine, dicumarol, dihydropyridine calcium channel blockers (e.g., felodipine), doxycycline, eslicarbazepine, ethosuximide, everolimus, haloperidol, imatinib, itraconazole, lamotrigine, levothyroxine, methadone, methsuximide, mianserin, midazolam, olanzapine, oral and other hormonal contraceptives, oxcarbazepine, paliperidone, phensuximide, phenytoin, praziquantel, protease inhibitors, risperidone, sertraline, sirolimus, tadalafil, theophylline, tiagabine, topiramate, tramadol, trazodone, tricyclic antidepressants (e.g., imipramine, amitriptyline, nortriptyline), valproate, warfarin, ziprasidone, zonisamide.

Other Drug Interactions

    • Concomitant use of carbamazepine with rivaroxaban, apixaban, dabigatran, and edoxaban (direct acting oral anticoagulants) is expected to result in decreased plasma concentrations of these anticoagulants that may be insufficient to achieve the intended therapeutic effect. In general, coadministration of carbamazepine with rivaroxaban, apixaban, dabigatran, and edoxaban should be avoided.

17 PCI/PI/MG (Patient Counseling Information/Patient Information/Medication Guide)

MEDICATION GUIDE

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3. TEGRETOL may cause allergic reactions or serious problems, which may affect organs and other parts of your body like the liver or blood cells. You may or may not have a rash with these types of reactions.

Call your healthcare provider right away if you have any of the following: 

  • swelling of your face, eyes, lips, or tongue

  • a skin rash

  • painful sores in the mouth or around your eyes

  • unusual bruising or bleeding

  • frequent infections or infections that do not go away

  • fever, swollen glands, or sore throat that do not go away or come and go

  • trouble swallowing or breathing

  • hives

  • yellowing of your skin or eyes

  • severe fatigue or weakness

  • severe muscle pain