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Tegretol (Carbamazepine)

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Overview

Carbamazepine is marketed under the name Tegretol

What is Tegretol ?
Tegretol is a drug most often used to treat pain, epilepsy, and seizures. It is less commonly used to treat bipolar disorder, schizophrenia, and other psychiatric disorders. Tegretol is also known as carbamazepine.

What is being tested?
The Food and Drug Administration (FDA) recommends individuals be tested before receiving tegretol. Testing is recommended particularly for patients of Chinese and Asian ancestry, who may be at risk of developing serious skin reactions. Certain individuals are at risk for developing Stevens–Johnson syndrome and toxic epidermal necrolysis, which can be fatal. These serious reactions are related to a genetic variant called HLA-B*1502 allele, which is present in about 15% of people from Hong Kong, Thailand, Malaysia, and parts of the Philippines. For other individuals, testing can help establish the appropriate dose a person should receive.

How will this affect my health care?
If testing reveals that you are at risk of developing a skin reaction, an alternative medication will likely be prescribed. Testing may also help your doctor decided the appropriate dose that you should receive.

More Questions? The National Society of Genetic Counselors has developed a directory to help locate genetic counseling services near you.

Background

Why test for genetic interactions with Tegretol?
By performing a test on your DNA, we may be able to anticipate how you will respond to tegretol and to adjust your treatment accordingly. In the video to the right, Dr. Murray Brilliant (Marshfield Clinic) explains that we all respond to drugs differently, and that genetic testing is helpful in guiding treatment.

How will this affect my treatment?
The test result will tell you whether it is safe for you to receive tegretol. If it is safe, the test result may help your doctor decide the correct amount you should receive.

Can taking Tegretol cause any problems?
For the majority of people taking tegretol will not cause any problems. However, if you start to experience skin reaction, you should contact your doctor immediately. In addition, you may be having a serious reaction to tegretol and should immediately contact your doctor if you have any of the following:

  • Fever
  • Sore throat
  • Rash
  • Ulcers in the mouth
  • Easy bruising
  • Swollen lymph nodes
  • Dizziness of vomiting
  • Yellowing of your skin (jaundice)

    Are any other complications associated with Tegretol?
    Tegretol should not be taken if you are pregnant.

    Taking tegretol may increase your risk of harming yourself, of having suicidal thoughts, or of committing suicide. It is important that you and your family be aware of any unusual changes in behavior or mood after you begin taking tegretol. You should contact your doctor immediately if you experience any of these symptoms.

    Tegretol may interact with other drugs. You should report any drug you are taking to your doctor, even non-prescription drugs or herbal products.

    Taking alcohol with tegretol is not advised as it may cause drowsiness.

    Dizziness and drowsiness may while taking tegretol – please take extra care when driving, operating machinery or doing any other tasks that might be potentially dangerous tasks.

    Who is affected?

    A small proportion of people have a genetic difference that either increases or reduces how they metabolize tegretol, which may warrant a change in treatment. As described immediately below, individuals of Asian ancestry may be particularly at risk for experiencing serious side effects.

    Do different populations respond differently to Tegretol?

    Testing is recommended particularly for patients of Chinese and Asian ancestry, who may be at risk of developing serious skin reactions. These may include Stevens–Johnson syndrome and toxic epidermal necrolysis, which can be fatal. These serious reactions are related to a genetic variant called HLA-B*1502 allele, which is present in about 15% of people from Hong Kong, Thailand, Malaysia, and parts of the Philippines. For other individuals, testing can help establish the appropriate dose a person should receive.

    Do reactions to Tegretol and other drugs run in my family?

    We typically inherit two gene copies from each parent. If you have a genetic difference that affects how you respond to tegretol, it is likely to have been inherited from one or both of your parents, and it is possible you will pass this to your children. However, this is not always the case, and a large variety of inheritance scenarios are possible. If you are concerned about this, we strongly advise you to discuss with your doctor or healthcare provider.

    Is there a difference between being a carrier and being predisposed to a particular drug response?

    You may carry a genetic a difference that does not affect how you respond to tegretol, but may affect how your children might respond. A full discussion of the relevant scenarios/implications are beyond the scope of this site, however, and we recommend you discuss with your doctor or healthcare provider if this is a concern.

    Why do genetic differences make people respond to tegretol differently?

    It is thought that individuals that are particularly sensitive to tegretol have difficulty metabolizing the drug, which fails to break down normally. Similarly, differences in response to tegretol may be related to how well the drug is transported through the bloodstream.

    More Questions? The National Society of Genetic Counselors has developed a directory to help locate genetic counseling services near you.
  • Genetic Test

    Weblink to Learn.Genetic Module, Making SNPs Make Sense

    What is the test?
    Serious negative reactions to tegretol are significantly related to a genetic difference, called the HLA-B*1502 allele, which is most common in individuals with Asian ancestry, particularly South Asia. Other genetic difference that increase risk of negative reactions to tegretol include HLA-B58 (more common in individuals of European ancestry), and HLA-A*3101 (most common in individuals with Japanese and European ancestry).

    What will the test result mean?

    Essentially, the test result will tell your doctor whether you are likely to experience negative side effects as a result of taking tegretol. The test can also tell you whether your recommended tegretol dosage should be different from normal recommendations.

    How is the test being performed?
    Testing is performed on your DNA, usually extracted from a blood sample. For many patients, your hospital or treatment center may already have some of your DNA stored in a biobank. You may be asked for an additional sample or be asked to give us permission to do testing on the existing samples.

    Will it hurt?
    For some patients, we may need an additional blood sample. Taking blood may cause some pain, bleeding or bruising at the spot where the needle enters your body. Rarely, taking blood may cause fainting or infection.

    Is it safe?
    There is a risk that you may experience pain or bleeding if you need to give an additional blood sample. Risks concerning privacy are discussed under Privacy & Sharing.

    How long will I have to wait for results?
    Unfortunately, we cannot give an accurate estimate for the time you will have to wait for results - this will depend on the resources available at the center where you receive treatment.

    Is this a standard test?
    Although increasingly more common, this test is not yet standard, and is typically offered as part of a research study.

    What type of test is this?
    Is this test intended to confirm a diagnosis? No
    Is this test intended to predict a family history of disease? No
    Is this test intended to check if I am a carrier for a particular disease? No
    Is this test intended to screen for genetic disorders? No
    Is this test intended to screen for disorders related to pregnancy? No
    Is this test intended to screen for disorders related to newborns? No

    Will I need to have this test done more than once?
    No, you should not need to have this test done more than once. You will need to keep track of your testing result in order to share with all of your doctors, including those you see at other medical care centers.

    More Questions? The National Society of Genetic Counselors has developed a directory to help locate genetic counseling services near you.

    Treatment

    How will this test affect my treatment?

    For most people tested, it is likely that your treatment options will stay the same and that you will begin treatment with tegretol as scheduled, or you will maintain you treatment with tegretol. If this is not the case, your doctor will either change your recommended dose of tegretol or recommend a new treatment.

    In the embedded video, Dr. Dan Roden (Vanderbilt University) explains the science of pharmacogenetics can help us discover single gene variants that predict potential catastrophic reactions to a drug.

    How will this result be used?

    The result will be put into your medical record for your doctor to use when deciding about prescribing you tegretol. Your doctor may:

  • Do other tests to see how you might respond to tegretol
  • Do nothing and continue with your planned course of treatment
  • Switch your dosage of tegretol
  • Give you another medication that is not tegretol to treat your condition
  • You should follow your doctor's instructions when taking any medication. Do not change your medications on your own before speaking with your doctor.

    Will I be referred to a specialist?
    It is unlikely that you will be referred to a specialist, but you may request an appointment with a genetic counselor.

    Is there anything else I should know?
    You should follow your doctor's instructions when taking any medication. Do not change your medications on your own before speaking with your doctor.

    More Questions? The National Society of Genetic Counselors has developed a directory to help locate genetic counseling services near you.

    Privacy & Sharing

    Should I tell other healthcare providers about my test result?
    If your doctor who prescribes medication for you doesn't already know about your test result, we do recommend that you share this information with him/her. However, as explained by Maureen Smith (Nortwestern University) in the embedded video, what you decide to do with your results is up to you.

    Who will see my test results?
    People who have access to your medical record will be able to see your genetic test result. This may include health professionals such as doctors, nurses, pharmacists, and genetic counselors. However, health professionals from other centers or hospitals will likely not have access to your results.

    Should I tell other healthcare providers about my test result?
    If your doctor who prescribes medication for you doesn't already know about your test result, you should share this information with him/her.

    Should my other family members be tested to see how they might respond to tegretol?
    You may want to share your test results with your family, since they might have the same genetic variant as you. If you are expected to experience negative side effects related to tegretol, they may want to consider being tested also.

    Will this affect my health insurance?
    No, your health insurance will not be affected by this tegretol test result.

    Who can I contact if they have any more questions?
    You can contact your local center, where you received the test. We have also included a recommend list of resources in the Videos & More tab to the right.

    Is it there a risk to my privacy?
    Research that uses information from medical records and that involves genetic testing can affect your privacy. Your participation in this research will be held strictly confidential, and only coded numbers will be used to identify specimens and research records. While it is impossible to absolutely guarantee that information in our secure system will never be known by others, we are taking every possible precaution to see that this does not happen.

    More Questions? The National Society of Genetic Counselors has developed a directory to help locate genetic counseling services near you.

    Risks

    What Should I Do If I Have Concerns About Genetic Test Results?
    If you are concerned about genetic test results you have received, you should discuss your concerns with your doctor. Your doctor should be able to explain results to you, and may recommend you to a genetic counselor or another doctor that can further help you understand your results. Maureen Smith (Northwestern University) discusses these concerns in the embedded video/

    Is there a reason why I may be a specific risk?
    Testing is recommended for all individuals undergoing or considering undergoing treatment with tegretol.

    Is there a reason why I may be a specific risk?
    Testing is recommended for all individuals undergoing or considering undergoing treatment with tegretol.

    Are there any implications for having children?
    No.

    If I am found to have a specific gene variant, am I at increased risk?
    For some individuals, there gene test result may indicate that they are at an increased risk of responding poorly to tegretol. Testing is done to help guide your doctor chose the best treatment for you.

    Can I expect to experience emotional consequences related to my test result?
    A range of reactions are possible and normal. Some patients may experience anxiety or other negative reactions related to their use/potential use of tegretol. If this is the case, please discuss with your doctor, who can address your concerns and refer you another health professional if required.

    Can I expect to experience social consequences related to my test result?
    We do not anticipate any social consequences related to use/potential use of tegretol. As always, however, if you do experience any negative social reactions, please discuss with your doctor who can address your concerns.

    Can I expect to experience an increase in anxiety?
    Many individual experience increased anxiety related to genetic testing. Again, please discuss with your doctor if this is the case.

    Are there any implications in terms of discrimination arising from the test result?
    Health insurance companies are prevented by law from discriminating against you based on your genetic test results. However, the same law does not apply to long-term disability insurance or to life insurance.

    If I am found to be at increased risk for responding poorly to tegretol, are there similar health implications for my family?
    If results indicate that you may respond poorly to tegretol, your family may be more likely to have a similar response should tegretol ever be considered an option for them. As such, you may want to discuss your results with your family.

    Are there likely to be emotional consequences for my family?
    Similar to patients, family members may experience a range of reactions, which is normal. We recommend that if you discuss any questions or problems with your healthcare provider.

    More Questions? The National Society of Genetic Counselors has developed a directory to help locate genetic counseling services near you.

    Videos & More

    Dr. Dan Roden explains that if you give the same dose of a drug to a large number of people, responses will vary. Some people will have a great response, some will have no response, while others will experience adverse side effects. Some of this variability resides in our genes. The science of pharmacogenetics is the science of trying to understand the genes that contribute to the variability of drug action.

    You can view more videos at our Resources section.

    RECOMMENDED WEBSITES

    Find a Genetic Counselor directory developed by the National Society of Genetic Counselors.

    Genetics Home Reference has basic information about genetics and links to other resources about genetics.

    Medline Plus has more information about tegretol, other drugs, and other health conditions.

    Lab Tests Online provides patient-centered reviews about lab testing and drug products.

    Daily Med provides high quality information about marketed drugs.

    The Pharmacogenomics Knowledge Base is a resource for medical professionals about how variation in human genetics leads to variation in response to drugs.

    About

    Are there geographical differences in service or treatment related to tegretol?
    Different centers have different policies in terms of how tests are administered and results shared. However, the results discussed in this document should be relevant to most individuals tested for tegretol-gene interactions.

    How is this paid for?
    If you received this test as part of the eMERGE research study, neither you nor your insurance company will have to pay anything toward this test

    When was this content last updated?
    January 15, 2014.

    More Questions? The National Society of Genetic Counselors has developed a directory to help locate genetic counseling services near you.
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