Two medicines, side by side
Carbamazepine vs levetiracetam
Carbamazepine and levetiracetam are both labeled for seizures and epilepsy. Drugs@FDA records approvals of carbamazepine since 1968 and of levetiracetam since 1999. Pharmacies paid $0.119 per carbamazepine 200 mg tablet and $0.0736 per levetiracetam 500 mg tablet (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. Only the carbamazepine label carries a boxed warning.
Check it at the source: the carbamazepine FDA label on DailyMed (effective August 20, 2026); the levetiracetam FDA label on DailyMed (effective January 28, 2026).
Highlights of the carbamazepine record
Carbamazepine (Tegretol) · label of August 20, 2026
SERIOUS DERMATOLOGIC REACTIONS AND HLA-B*1502 ALLELE SERIOUS AND SOMETIMES FATAL DERMATOLOGIC REACTIONS, INCLUDING TOXIC EPIDERMAL NECROLYSIS (TEN) AND STEVENS-JOHNSON SYNDROME (SJS), HAVE BEEN REPORTED DURING TREATMENT WITH TEGRETOL. THESE REACTIONS ARE ESTIMATED TO OCCUR IN 1 TO 6 PER 10,000 NEW USERS IN COUNTRIES WITH MAINLY CAUCASIAN POPULATIONS, BUT THE RISK IN SOME ASIAN COUNTRIES IS ESTIMATED TO BE ABOUT 10 TIMES HIGHER.
Used for
From the label: indicationsEpilepsy Tegretol is indicated for use as an anticonvulsant drug. Evidence supporting efficacy of Tegretol as an anticonvulsant was derived from active drug-controlled studies that enrolled patients with the following seizure types: Partial seizures with complex symptomatology (psychomotor, temporal lobe). Patients with these seizures appear to show greater improvement than those with other types. […]
On the market
- Earliest approval on file
- March 11, 1968
- Generic labelers
- 42 labelers
- Pharmacy cost
- $0.119 per tablet
Supply and safety
- Shortage
- A presentation being discontinued
- Recalls
- 11
Highlights of the levetiracetam record
Levetiracetam (Keppra) · label of January 28, 2026
Used for
From the label: indicationsKEPPRA is indicated for the treatment of partial-onset seizures in patients 1 month of age and older ( 1.1 ) KEPPRA is indicated for adjunctive therapy for the treatment of: Myoclonic seizures in patients 12 years of age and older with juvenile myoclonic epilepsy ( 1.2 ) Primary generalized tonic-clonic seizures in patients 6 years of age and older with idiopathic generalized epilepsy ( 1.3 ) 1.1 Partial-Onset […]
On the market
- Earliest approval on file
- November 30, 1999
- Generic labelers
- 84 labelers
- Pharmacy cost
- $0.0736 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 15
Source: FDA drug labels via openFDA (Carbamazepine label of August 20, 2026, Levetiracetam label of January 28, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do carbamazepine and levetiracetam differ on the record?
Only the carbamazepine label carries a boxed warning.
How each works, in its label's words: Carbamazepine, “It appears to act by reducing polysynaptic responses and blocking the post-tetanic potentiation.”; Levetiracetam, “A saturable and stereoselective neuronal binding site in rat brain tissue has been described for levetiracetam.”
Half-life, in each label's words: Carbamazepine, “Initial half-life values range from 25 to 65 hours, decreasing to 12 to 17 hours on repeated doses.”; Levetiracetam, “Following oral administration of twice-daily dosing for 10 days, total body clearance decreased by 38% and the …”
Generics: carbamazepine since 1986; levetiracetam since 2008 (Drugs@FDA).
| Carbamazepine | Levetiracetam | |
|---|---|---|
| Labeled for | Bipolar disorder, Seizures and epilepsy | Seizures and epilepsy |
| Pharmacologic class | Mood Stabilizer | n/a |
| How it works (label) | Mechanism of Action Tegretol has demonstrated anticonvulsant properties in rats and mice with electrically and chemically induced seizures. It appears to act by reducing polysynaptic responses and blocking the post-tetanic potentiation. | The precise mechanism(s) by which levetiracetam exerts its antiepileptic effect is unknown. A saturable and stereoselective neuronal binding site in rat brain tissue has been described for levetiracetam. |
| Half-life (label) | Initial half-life values range from 25 to 65 hours, decreasing to 12 to 17 hours on repeated doses. | Following oral administration of twice-daily dosing for 10 days, total body clearance decreased by 38% and the half-life was 2.5 hours longer in the elderly compared to healthy adults. |
| Earliest approval on file (Drugs@FDA) | March 11, 1968 | November 30, 1999 |
| First generic approved | August 14, 1986 | November 4, 2008 |
| Generic labelers (NDC) | 42 labelers | 84 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.119 per tablet (Carbamazepine 200 mg tablet) | $0.0736 per tablet (Levetiracetam 500 mg tablet) |
| 12-month price change | +0.6% | -5% |
| Boxed warning | Yes | No |
| Shortage now | A presentation being discontinued | No current entry |
| Recalls recorded | 11 | 15 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 66,615 | 132,823 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What next?
- Alternatives to carbamazepine
- every medicine labeled for the same conditions