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carBAMazepine

carBAMazepine
Brand names: TEGretol, TEGretol XR
Form Strength
TABLET, CHEWABLE, ORAL 100 mg
TABLET, EXTENDED RELEASE, ORAL 100 mg
Display Anticonvulsants, Miscellaneous, Antimanic Agents Class: 281292, 282800
Medication comments:
USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances.
The following outlines must be followed.
generic (Brand) Route
[Packaging: Manufacturer ⇒ Dispense]		 Activities
carBAMazepine (Carbatrol, TEGretol) PO
[Bulk ⇒ Packager]		  100 mg Chew tablet (IDBH)
100 mg ER tablet (IMH)		 Stock @ IDBH? Y
NIOSH Table 2↑
Pharmacy:
Receiving / Storage / Preparation

Exposure Risk: low
 • Handling/preparation PPE Requirements: Single CX glove and gown
• Receiving from Distributor: Standard
• Pharmacy Storage Area: Carousel
• Packaging/Reconstitution Location: Repacking area
• Compounding (Non-Sterile/Sterile) Location: n/a
• Omnicell Load: No
Transport • Transport (dose is placed inside a plastic sealable bag): Standard
Nursing:
Storage / Administration

Exposure Risk: low
 • Handling/administration PPE Requirements: Single pair of CX approved gloves. Wash hands after handling
• Storage of Finished dose in Nursing Area/Procedural Area: Patient Med Drawer
• Signage on Patient Door Required: No
• Manipulation of Dosage Form: Standard
• Special Manipulation for Administration: n/a
Disposal / Spills • Disposal of Drug Waste: Full-  blue bin 
Trace/packaging- trash
• Disposol of Used PPE: trash bin (inside plastic bag)
• Spill management: n/a
NIOSH Supplemental Information: BBW for aplastic anemia, congenital malformations in offspring of mothers who took drug, rapid trans placental passage
Reason for exemption of USP<800> Containment Requirements: Minimal manipulation for dispensing. Does not require additional manipulation for administering. Risk associated when ingested.
Enteral Drug Administration notes.
Generic
(Brand)		 Comments and Considerations Recommendations for Administration with Enteral Nutrition
carBAMazepine
(Carbatrol, TEGretol)		 Decreases absorption as adheres to tube, dilute with equal volume water, contains sorbitol Suggest that total daily dose should be divided into 4 equal doses of carBAMazepine suspension. Dilute suspension with equal amounts of diluent. Monitor levels, jejunal administration may be less effective.
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: carBAMazepine (Carbatrol, TEGretol)
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome antiepileptics ⇄ History of falls or fractures
Rationale May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation Avoid except for seizures and mood disorders.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Criteria 3: Potentially inappropriate medications: drugs to be used with caution in older adults. (Table 4)
Drug(s) antiepileptics (selected)
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es) antiepileptics (including gabapentinoids) ⇄ CNS-active agents
Risk Rationale Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
 Quality of evidence: High, Strength of Recommendation: Strong
Last updated: Sep. 18, 2025
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Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556



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