Eslicarbazepine
APTIOM
Pronunciation: es-li-kar-BAZ-e-peen (ap-TEE-om)
“Slick car App time”
What it isSodium-channel blocker, prodrug of oxcarbazepine's active metabolite; focal seizures, alone or adjunctive, from age 4.
Why it mattersOnce-daily dosing as standard, versus twice-daily immediate-release oxcarbazepine.
What it changesHyponatremia as with oxcarbazepine; dizziness, diplopia and somnolence; renally adjusted. SJS and DRESS reported.
Pearls
- Lowers hormonal contraceptive levels; advise backup contraception.
Eslicarbazepine prescription history
Animated chart of estimated U.S. prescriptions per year, Antiseizure meds (1869–2026). Eslicarbazepine enters in 2014 (estimated).
FDA-approved for
- partial-onset seizures (2013)
Off-label
- trigeminal neuralgia
Principal riskHyponatremia
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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; by weight | 11-21 kg 200 mg QD; 22-31 kg 300 mg QD; 32-38 kg 300 mg QD; >38 kg 400 mg QD | 11-21 kg 400-600 mg QD; 22-31 kg 500-800 mg QD; 32-38 kg 600-900 mg QD; >38 kg 800-1200 mg QD | Top of weight-band maintenance: 600 / 800 / 900 / 1200 mg QD (11-21 / 22-31 / 32-38 / >38 kg) |
Titration Adults: weekly increments of 400-600 mg. Peds: no more often than weekly; increment ≤ initial dose for weight band (200 / 300 / 300 / 400 mg)
Renal Reduce dosage by 50% for moderate or severe renal impairment
Hepatic Undefined
Instructions
- Take whole or crushed, with or without food
- Withdraw gradually to minimize risk of increased seizure frequency/status epilepticus
Available strengths
- tab 200, 400, 600, 800 mg
Contraindications
- Hypersensitivity to oxcarbazepine (cross-reactivity)
Cautions
- 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)
Adverse reactions
- Dizziness
- Somnolence
- Nausea
- Headache
- Diplopia
- Vomiting
- Fatigue
- Vertigo
- Ataxia
- Blurred vision
- Tremor
Pregnancy Animal studies show developmental toxicity/malformations; may cause fetal harm
Lactation Undefined
Cost
Generic entry2021
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Memory aids: interaction avatars
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Self-check
- How often is eslicarbazepine dosed?
Once daily. - Which electrolyte abnormality is highlighted with eslicarbazepine?
Hyponatremia.