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Tegretol (carbamazepine) and Pregnancy
The information below will help you determine if your prenatal exposure to carbamazepine will increase the fetal
risk above the background risk. With every pregnancy, any women has a 3 to 5 percent chance of having a baby
with a birth defect. The information contained in this fact sheet should not be used as a substitute for the medical
care and advice of your health care provider.
What is Tegretol?
a long space between the nose and the upper lip, and small
Tegretol is a medication commonly used to control
fingernails. Other studies have reported a 2 to 3 times
seizures in the treatment of epilepsy. Tegretol is also used in
increased risk for major birth defects, such as heart defects and
the treatment of bipolar affective disorder, schizophrenia,
cleft lip, in epileptic women who are taking Tegretol. In
trigeminal neuralgia and other specific pain disorders. The
addition, some studies have reported an increased frequency of
generic name of Tegretol is carbamazepine.
growth retardation and small head size. It is often hard to
determine if the birth defects were caused by the medication,
I have been taking Tegretol for many years. Can this affect
the woman's epilepsy, or a combination of both.
my ability to get pregnant?
Folic acid, a B vitamin, has been found to reduce the
Yes. Studies have found that the long-term use of
risk for neural tube defects and possibly for other structural
seizure medications in women with seizure disorders is
birth defects in the general population. Because women
associated with menstrual and infertility problems.
taking Tegretol have a higher risk of having a baby with a
neural tube defect, it is recommended that all women taking
I am taking Tegretol, but I would like to stop taking it before
Tegretol take 4 mg/day of folic acid before becoming
becoming pregnant. How long does Tegretol stay in your
pregnancy and during pregnancy. It is not known whether
body?
taking folic acid along with Tegretol will reduce the risk for
The liver breaks down Tegretol; therefore, each
birth defects.
individual's ability to break down the medication is different.
On average, your body adjusts to Tegretol after 3 - 5 weeks of
Can taking Tegretol during pregnancy affect my baby's
a treatment with a fixed dose. When a person first starts to
development?
take Tegretol, its half-life (the time is takes to eliminate one
Researchers are just beginning to evaluate the
half of the drug from your body) ranges between 25 _ 65
development of children who have been exposed to Tegretol
hours. After repeated doses, the half-life decreases to 12 _ 17
during pregnancy. Some studies have found slightly increased
hours. Therefore, after long-term treatment, most of the
risks for developmental delays in children exposed to Tegretol
Tegretol should be gone from a person's body 3 - 5 days after
versus children not exposed to Tegretol or other
the last dose.
anticonvulsants. Other studies have found no differences in
Please talk to your doctor before you decide to stop
development in exposed children versus unexposed children.
taking Tegretol. The benefits of taking the medication for
Further research is needed to answer this question completely.
your medical condition, and the possible adverse outcomes of
not taking it, may outweigh the benefits of stopping the use of
I have been taking Tegretol to control my epilepsy for the
Tegretol in pregnancy.
last few years and I just found out I am pregnant. What tests
A pregnant woman also should not change seizure
are available to see if my baby has spina bifida or other birth
medications (anticonvulsants) during pregnancy without the
defects?
advice of her doctor. All anticonvulsant medications appear to
Prenatal testing for neural tube defects (such as spina
have some risks for the exposed fetus. Therefore the
bifida) is available in pregnancy. There are a few different
medication, which best controls seizures for each woman, is
ways that this can be done. Maternal serum screening (also
the medication of choice for her pregnancy.
called the blood test or the triple screen blood test) measures
the quantity of a substance called alpha fetoprotein (AFP) in
Can taking Tegretol during my pregnancy cause birth
the mother's blood. This protein is made by the fetal liver and
defects?
crosses into the mother's blood through the placenta. In cases
Many studies have evaluated Tegretol use for
where there is a small hole in the baby's spine or other body
epilepsy during pregnancy. This medication does cross the
structure, the AFP levels are sometimes higher than normal.
placenta. In pregnancies exposed to Tegretol during the first
Having the maternal serum screen around 15 _ 20 weeks
trimester, a number of human studies have shown a 1% risk
gestation may help you to know if your baby is at risk. If your
for neural tube defects. The general population risk for having
AFP level is found to be high, further prenatal testing, such as
a baby with a neural tube defects, such as spina bifida, is 0.1%
a specialized ultrasound exam, and/or an amniocentesis, may
(1/1000 births), therefore taking Tegretol in the first trimester
be offered to you and can help determine if there is an opening
of pregnancy will increase the risk for having a baby with a
in the spine. The maternal serum screen test is usually offered
neural tube defect. In addition, some studies have suggested
for free by the state in which you live and is normally
an increase in minor malformations such as a small nose with
provided to you by your obstetrician.
Amniocentesis is a test that measures the amount of
Can I take Tegretol while breast feeding?
AFP and the amount of another substance specific to the
Tegretol is excreted into breast milk. However, the
baby's nervous system, called acetylcholinesterase (ACHE),
amount of Tegretol found in infant blood is low and does not
in the amniotic fluid surrounding the baby. This test is done
seem to build up over time. The American Academy of
by taking out a small amount of the amniotic fluid through a
Pediatrics and the World Health Organization considers the
needle inserted into the uterus and is usually performed
drug to be compatible with breast feeding.
between 17 and 21 weeks gestation. An elevated amount of
AFP and presence of ACHE in the amniotic fluid sample can
April 2003
diagnose most open neural tube defects. An ultrasound that
Copyright by OTIS. Reproduced by permission.
looks specifically at the baby's spine can also detect many
neural tube defects. Ultrasounds can frequently detect other
REFERENCES
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recommended for any woman taking Tegretol during
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could harm both her and the baby) and premature labor is
increased in the woman with epilepsy. It is unknown how
severe a seizure must be to be harmful to the fetus.