Carbamazepine for facial pain

If you have chronic pain in the face, we might prescribe you a medicine called carbamazepine. Chronic pain (also called persistent pain) is long-term pain that lasts for more than 3 months.

Carbamazepine is a medicine used to treat epilepsy. It can also be taken for nerve pain caused by diabetes (peripheral neuropathy) or if you have a painful condition of the face called trigeminal neuralgia.

This medicine is only available on prescription. Always follow the amount prescribed (dose) by your doctor, and read the leaflet that comes with your medicine.

Carbamazepine is also known by the brand names Carbagen® and Tegretol®.

Taking carbamazepine

Most people take carbamazepine 1 to 4 times each day.

  • Try to space your doses of carbamazepine evenly through the day. For example, first thing in the morning, lunchtime, afternoon and in the evening.
  • You can take carbamazepine with or without food.

To prevent the chance of side effects, your doctor will start you on a low dose of carbamazepine. They will increase it gradually over a few days or weeks.

When you find a dose that suits you, it will usually stay the same (unless your condition changes, or your doctor starts you on a new medicine that might affect carbamazepine).

Not everyone needs to have the maximum dose, which is 1,600mg a day for facial pain.

It usually takes a couple of weeks for carbamazepine to work.

How much to take (dose)

Day Morning Lunchtime Afternoon Night time
1 to 3 100mg -- -- 100mg
4 to 6 100mg 100mg -- 100mg
7 to 9 100mg 100mg 100mg 100mg
10 to 12 200mg 100mg 100mg 100mg
13 to 15 200mg 100mg 100mg 200mg
16 to 18 200mg 200mg 100mg 200mg
19 to 21 200mg 200mg 200mg 200mg
22 to 24 200mg 200mg 200mg 400mg
25 onwards 400mg 200mg 200mg 400mg

If you forget to take the medicine

If it's less than 8 hours before the next dose is due, it is better to leave out the missed dose, and take your next dose as normal.

Do not take 2 doses at the same time to make up for a forgotten dose.

If you often forget doses, it might help to set an alarm to remind you. You can ask your pharmacist for advice on other ways to help you remember to take your medicine.

Side effects

Like all medicines, carbamazepine can cause side effects. But lots of people have no side effects or only minor ones.

Skin rashes

It's common to get a skin rash with carbamazepine. Most skin rashes are not serious.

Tell your GP or go to A&E immediately if:

you notice flu-like symptoms, followed by a red or purple rash that spreads and forms blisters which peel off.

This can develop into a life-threatening skin condition called a severe cutaneous adverse reaction.

These reactions are a rare side effect of carbamazepine. It's more likely to happen in the first 8 weeks of using carbamazepine, or when the dose is increased too quickly. It can also happen if carbamazepine is stopped suddenly for a few days and restarted at the same dose as before, without reducing the dose and increasing it slowly again.

To help prevent the chance of you getting a rash that could be confused with a severe cutaneous adverse reaction, try not start any new medicines, foods or products during the first 3 months of treatment with carbamazepine.

Do not start taking carbamazepine within 2 weeks of a viral infection, vaccination, or rash caused by something else.

Common side effects

Common side effects of carbamazepine include:

  • feeling dizzy, sleepy or tired
  • feeling sick (nausea) or being sick (vomiting)
  • headaches
  • dry mouth
  • putting on weight

These side effects might happen in more than 1 in 100 people. They're usually mild and go away by themselves.

Serious side effects

It's unusual to have serious side effects after taking carbamazepine.

Tell your GP immediately if you have:

  • unusual bleeding or bruising, mouth sores, infections, a high temperature or sore throat (these can be signs of a blood disorder)
  • thoughts of harming or killing yourself (a few people taking carbamazepine have had suicidal thoughts)
  • a severe rash with flushing, blisters or ulcers
  • yellowing of skin or whites of eyes (these can be signs of a liver problem)
  • pain in your joints and muscles, a rash across the bridge of your nose and cheeks, and problems breathing (these are signs of lupus)

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to carbamazepine.

Contact your GP or go to your nearest A&E immediately if:

  • you get a skin rash that might include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are not all the side effects of carbamazepine. For a full list see the leaflet inside your medicine packet.

Pregnancy and breastfeeding

There's no firm evidence that carbamazepine is harmful to an unborn baby. However, for safety, your doctor will only advise you to take it during pregnancy if the benefits of the medicine outweigh the risks.

Carbamazepine does pass into breast milk. There have been some reports of side effects in breastfed babies, including sleeping more and not feeding well.

Taking carbamazepine with other medicines

There are some medicines that interfere with the effects of carbamazepine. Make sure your hospital doctor knows about any other medicines you take, including medicines you buy from a pharmacy or shop, and any herbal remedies.

Do not take St John's wort, the herbal remedy for depression, while you are being treated with carbamazepine. This is because St John's wort can make carbamazepine less effective.

Repeat prescriptions

Your GP gives you a repeat prescription for carbamazepine. You can take this to your local pharmacy.

Make sure you ask for your repeat prescription early to make sure that you do not run of medicine or miss any doses.

Resource number: 4830/VER1
Last reviewed: November 2022
Next review: November 2025

Contact us

If you have any questions about your medicine for facial pain, please contact the oral medicine team.

Phone: 020 7188 4399, Monday to Friday, 9am to 5pm

Do you have any comments or concerns about your care?

Contact our Patient Advice and Liaison Service (PALS)

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