Carbamazepine (Tegretol, Equetro)

I tried to get on Trobalt, my doctor was keen but the drug is not yet available in my country, although it is approved for release, so until it is released by GSK I cannot access it.

I was wondering if anyone has tried Carbamazepine?

Carbamazepine

Abstract
Objectives: There is strong evidence in the literature about the effect of local anesthetics such as lidocaine in controlling tinnitus; these agents act by stabilizing hair cell membrane and cochlear nerve fibers. However, the effect of intravenous lidocaine is transient, and its oral analog (tocainide) does not have the same efficacy for long-term treatment in patients with tinnitus. Some oral anti-epileptic drugs (carbamazepine, for instance) have been used alternatively in several studies.

The mechanism of action of carbamazepine and its derivatives is relatively well-understood. Carbamazepine stabilizes the inactivated state of Voltage-gated sodium channels, making fewer of these channels available to subsequently open. This leaves the affected cells less excitable until the drug dissociates. Carbamazepine has also been shown to potentiate GABA receptors made up of alpha1, beta2, gamma2 subunits. This mechanism may contribute to its efficacy in neuropathic pain and manic-depressive illness.

 

Carbamazepine is Tegretol. I took a related drug, Trileptal, without any effect. Some people have had some impact on tinnitus with these drugs, but the mechanism is quite different than Retigabine.

 

I was prescribed Tegeretol 400 mg when I first got tinnitus. I was on it for 6 months but unfortunately it didn't do anything for me. It didn't make it worse, didn't make it better.

 

Ok, for some reason, I decided to give Tegretol another shot.

My tinnitus was kinda bothersome in the morning, so I took about 500 mg Tegretol.

I decided to combine it with Lyrica (Pregabalin), I took around 200-250 mg of that dope. I mixed some Flupirtine as well (100 mg, a very small dose) to see what happens (therefore, I took a sodium blocker, a calcium modulator and a potassium modulator).

My tinnitus is pretty much gone for the entire day. I think I can hear something in my office at home (complete silence) but it is so soft that I actually enjoy it.

But there are side effects. I walk like a drunk person and I have some problems pronouncing complex words.

However, this has been one of the best days since I got tinnitus. I don't know if the effect will last after I go to bed. Today has been like before I got the tinnitus.

 

Next Day Update: Ok, the drunk walking is gone and I can speak like a normal person but the tinnitus is still pretty much gone. There is a very slight hiss but it's not bothersome in any way. I believe its gonna get louder but that's just a hunch, I'll wait and see.

I'm certainly not cured but I will definitely use the Tegretol-Lyrica cocktail when I feel worse in the future. Funny thing is, I used Tegretol with Gabapentin (the predecessor of Lyrica) in the past with good results, but I can't remember the dosage. It was certainly lower than the dosage I used yesterday and there are slight chemical differences between Gabapentin and Lyrica.

I don't know if this combo will work on everyone, my tinnitus is not due to acoustic trauma, more like idiopathic, therefore if anyone tries it... YMMV.

 

As I suspected, the tinnitus is getting a tiny bit louder today - but that's to be expected. It's still very low though. Totally weird.

The combo kept (and keeps) the ringing extremely low for more than 24 hours. Quite a bit more actually. This sht is good.

Tegretol (Carbamazepine) is (chemically) a sodium channel blocker - to be more precise, its mechanism of action is to "close" some voltage gated sodium channels, reducing their availability to any brain function that might require them. This drug is very easy to get, depending on where you live. It is sold freely in pharmacies in my country and it's dirt cheap (no prescription required). It is one of the main drugs used to treat epilepsy.

Lyrica (Pregabalin) is (primarily) a calcium channel modulator - its mechanism of action is not fully understood, it basically binds to a gene related with calcium channels and that may lead to increased production of GABA in the brain. GABA is a "feel good" neurotransmitter, it is also considered one of the possible treatments for tinnitus. Lyrica is also easy to get as its used for a ton of conditions. It is sold freely in pharmacies where I live (no prescription required).

Flupirtine is a potassium channel modulator. Much of the current research for tinnitus is targeted towards potassium channels. I just thought that it would make my drug cocktail more potent. Flupirtine is very hard to get. It's not sold in my country, I had to order it from a shady on-line pharmacy (from Russia, I believe). It's actually sold as a painkiller, so I don't think it's a scheduled/controlled substance anywhere in the world.

However, each one of the aforementioned drugs is extremely dangerous and not something you want to mess with. Combining them is probably not a great idea (it's actually totally idiotic), however I feel like I've researched them enough to be a guinea pig and I live near a hospital - which is a big plus So I wouldn't recommend to anyone trying my stupid cocktail. But I'll definitely use it again when my tinnitus becomes too bothersome.

 

In the Swedish leaflet, Tegretol has tinnitus and hyperacusis listed as "rare side effects" (1 of 1000 users).

 

This shit seems sketchy. I tried it but never a high dose, certainly not for a month (3 days). It seemed to make my low frequency tinnitus worse.

 

FYI: I took Tegretol 200 mg in the evenings for 3 months (January, February and March 2022). It was prescribed by my psychiatrist. No effect on my tinnitus. No side effects.

 

It's interesting to think about what would happen if, instead of taking a high dose of multiple drugs simultaneously, you take lower doses and spread it out over the course of a couple weeks or months.

The difficult part is figuring out which drugs to take in which doses, and finding a doctor who is willing to prescribe accordingly.

 

Day 5 on Carbamazepine 2 x 100 mg.

Tinnitus and hyperacusis symptoms are quite bad at the moment, but not sure if the Carbamazepine is the culprit. I still want to take the risk and try a higher dose next week.

@grate_biff, may I ask how your pain hyperacusis was caused? Was it through noise exposure or something else? Do you suffer from setbacks? Maybe the mechanism behind your hyperacusis is different from mine.

I think if people are really suicidal because of the tinnitus or hyperacusis, they should at least try out some type of polypharmacy before doing the irreversible.

I think some type of mixture of a calcium channel blocker (Keppra, Nifedipine, Flunarizine, Cinnarizine, Pregabalin), potassium channel opener (Epidiolex, Gabapentin, Flupirtine), HCN2 closer (Ivabradine) and purinergic receptor antagonist (Ambroxol, Gefapixant) has a good chance of at least alleviating noxacusis symptoms.

 

Yes, I've thought this for a while. Possibly low doses of:

• Nortriptyline
• Flupentixol
• Gabapentin
• Clonazepam
• Cyclobenzaprine

All have shown success in some patients, so it is possibly a better way than a high dose, single medicine solution. At least that way it may break up the signal better as you are modulating several neurotransmitters at once.

 

I saw this picture in an article about polypharmacy in migraine management, I think the same advantages and disadvantages could apply to polypharmacy in tinnitus treatment. "Although small in sample size, multiple studies show that individuals whose migraine attack frequency is not reduced by a single agent may have an equal or greater response with polypharmacy, even at lower doses, with few tolerability issues."



"The principle underlying rational polypharmacy [for epilepsy] is that the combination of two medications with differing mechanisms of action may result in supra-additive or synergistic anticonvulsant effects, with infra-additive [reduced] toxicity."

 

I took Carbamazepine for 3 days, one tablet at bedtime. My sleep improved and tinnitus at night was drowned out by about half. In the morning after waking up, for a couple more hours I felt the tninitus was muffled, after which it returned to the baseline.

I borrowed just 3 pills from an epileptic friend. I will definitely go to the doctor and ask him to prescribe me Carbamazepine, I will try to take it longer and at a higher dosage.

 

@Vadimus, any update?

 

Have you tried Nortriptyline?

 

No, but if I do, I will write about it in the Nortriptyline thread.

 

No, I haven't tried Carbamazepine yet.

 

I have been prescribed it, but haven't decided whether to take. If I do, I will do the same.

 

I've been on Carbamazepine for 6 weeks now. I have currently used 1200 mg for more than a week.

I have not noticed an effect on my tinnitus.

At some point during these 6 weeks I felt like the Carbamazepine helped with the stabbing pain aspect of hyperacusis, but I experienced this pain relieving effect only for a couple of days.

After these six weeks I feel like I'm pretty much at the same point at which I started. I might have possibly suffered a setback which is now compensated by the 1200 mg Carbamazepine hence the hyperacusis will feel the same as before the start of the treatment. I will in all likelihood quit this drug this week. We'll see what kinds of symptoms emerge after quitting.

I have not experienced serious side effects.

 

I'm sorry to hear that. I also find it puzzling, as Carbamazepine was the most potent drug I've ever tried for my tinnitus & noxacusis.

We respond so differently to drugs. But your experience also helped me to realize that my severe benzo withdrawal probably weigh as much as my nerve damage/loss/sensitization.

I hope we eventually find something for relief.

 

Was Carbamazepine better than Baclofen for you? I never knew you took it. What kind of reduction did you have and what dosage did you take?

 

See @Danny Boy's (RIP) Keppra thread!

 

You think it caused toxicity issues?

 

Tegretol? No, just interaction issues.

 

It alone had a profound effect on your tinnitus at therapeutic doses?

Yes, @Danny Boy seemed to mix a lot of medications.

 

My tinnitus was totally gone for 3 days, then came back.

Tinnitus must feel "important" to the brain. It's like it finds a way to brake through and can only be abrupted temporarily by medications.

This is my experience.

 

I don't come around here much, but I did want to sound off on Carbamazepine. I started taking it a year or so ago as I developed MEM/TTTS on top of my tinnitus, which sucks. After months, my ENT mentioned Carbamazepine could help, and I've tried it. It doesn't affect my tinnitus at all, but it does make my MEM/TTTS stop or make it so minimal that I'm happy.

I started on 1200 mg a day, with no issues with my tinnitus. Then again, my tinnitus is somatic (don't work in IT and slouch, it will bite you on the ass).

 

I have been reading (a lot) that serotonin seems to increase hyperactivity in fusiform cells, i.e. increasing tinnitus, and Nortriptyline reduces depression by increasing serotonin levels.

Is there anything you have seen or read to the contrary in that Nortriptyline may calm the nervous system?

I am trying to find just one or two positive reasons to try it for throat spasms and tightness due to possible FND (10 mg dose daily) but seem to be failing every time for both FND, and also not increasing the volume of tinnitus (which is already very severe).

 

2 studies (1989, 1993) showed efficacy. It does not raise all serotonin receptors the way an SSRI does.

Have you tried Nortriptyline for a few weeks or are you just looking at the box?

+ this is the CARBAMAZEPINE thread!