Some of the uncommon side effects of tegretol xr that can become severe include sudden behavioral changes in children, agitation, confusion especially in elderly people , loss of touch with reality, loss of balance or control over actions, trembling of muscles, stiffness or jerking, nausea followed by severe vomiting, unsteady and shuffling walk, sudden mood swings, suicidal thoughts, constant tiredness and insomnia, twisting and uncontrolled movements of the neck, back, and face, and loss of interest.

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The principal metabolite of Tegretolcarbamazepine-10,11-epoxidehas anticonvulsant activity as demonstrated in several in vivo animal models of seizuresThough clinical activity for the epoxide has been postulatedthe significance of its activity with respect to the safety and efficacy of Tegretol has not been established.
The pharmacokinetic parameters of Tegretol disposition are similar in children and in adultsHoweverthere is a poor correlation between plasma concentrations of carbamazepine and Tegretol dose in childrenCarbamazepine is more rapidly metabolized to carbamazepine-10,11-epoxidea metabolite shown to be equipotent to carbamazepine as an anticonvulsant in animal screensin the younger age groups than in adultsIn children below the age of 15there is an inverse relationship between CBZ-E/CBZ ratio and increasing agein one report from 0.44 in children below the age of 1 mail buyfree.co.za. year to 0.18 in children between 10 to 15 years of age
Carbamazepine mustthereforebe considered to be carcinogenic in Sprague-Dawley ratsBacterial and mammalian mutagenicity studies using carbamazepine produced negative resultsThe significance of these findings relative to the use of carbamazepine in humans isat presentunknown.
Tegretol and its epoxide metabolite are transferred to breast milkThe ratio of the concentration in breast milk to that in maternal plasma is about 0.4 for Tegretol and about 0.5 for the epoxideThe estimated doses given to the newborn during breastfeeding are in the range of 2 to 5 mg daily for Tegretol and 1 to 2 mg daily for the epoxide.
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in clinical studies, tegretol suspension, conventional tablets, and xr tablets delivered equivalent amounts of drug to the systemic circulation.