Eslicarbazepine

APTIOM

What it isSodium channel blocker related to oxcarbazepine; focal seizures.

Why this oneOnce-daily dosing, which oxcarbazepine does not offer.

What limits itHyponatremia as for the family. Renally adjusted; serious skin reactions.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Partial-onset seizures (monotherapy or adjunctive)	Adults	400 mg QD (or 800 mg QD if needed)	800-1600 mg QD	1600 mg QD
Partial-onset seizures (monotherapy or adjunctive)	Peds 4-17 y	Weight-based QD	Weight-based maintenance QD	1600 mg QD

Titration Increase in weekly increments of 400-600 mg

Renal Reduce dosage by 50% for moderate or severe renal impairment

Hepatic Undefined

Take whole or crushed, with or without food
Withdraw gradually to minimize risk of increased seizure frequency/status epilepticus

Suicidal behavior and ideation
Serious dermatologic reactions and DRESS
Anaphylactic reactions and angioedema
Hyponatremia
Neurological effects (dizziness, gait/coordination disturbance, somnolence, cognitive dysfunction, visual changes)
Gradual withdrawal required
Drug-induced liver injury
Hematologic reactions (pancytopenia, agranulocytosis, leukopenia)

Pregnancy Animal studies show developmental toxicity/malformations; may cause fetal harm

Lactation Undefined

NO BOXED WARNINGS

Principal riskHyponatremia

Cost, est. cash$300–$2,500/month

Generic entry2021

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.

CYP3A4 inducer (moderate)