Oxcarbazepine
TRILEPTAL
What it isSodium-channel blocker related to carbamazepine; focal seizures.
Why this oneLess hepatic enzyme induction and hematologic toxicity than carbamazepine makes it easier to combine with other drugs.
What limits itHyponatremia is more prominent than with carbamazepine; screen the same HLA-B skin-reaction risk allele when ancestry warrants.
FDA-approved for
- seizures (2000)
Off-label
- bipolar disorder
- neuropathic pain
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Adjunctive therapy, partial seizures | Adults | 600 mg/day BID | 1200 mg/day | |
| Conversion to monotherapy | Adults | 600 mg/day BID | 2400 mg/day | |
| Initiation of monotherapy | Adults | 600 mg/day BID | 1200 mg/day | |
| Adjunctive / monotherapy, partial seizures | Peds 2-16 yr | 8-10 mg/kg/day BID (2-<4 yr, <20 kg: 16-20 mg/kg/day) | weight-based maintenance | 60 mg/kg/day (age 2-<4) |
Titration Adjunctive: increments up to 600 mg/day at weekly intervals; monotherapy initiation: increments 300 mg/day every 3rd day; peds monotherapy initiation: 5 mg/kg/day every 3rd day
Renal CrCl <30 mL/min: initiate at one-half usual starting dose and increase slowly
Hepatic Undefined (not studied in severe hepatic impairment)
Instructions
- May take with or without food
- Withdraw gradually to minimize risk of seizure aggravation
Contraindications
- Known hypersensitivity to eslicarbazepine acetate (cross-sensitivity)
Cautions
- Hyponatremia (monitor serum sodium)
- Anaphylactic reactions and angioedema
- Cross-hypersensitivity to carbamazepine
- Serious dermatologic reactions (SJS/TEN)
- Suicidal behavior and ideation
- DRESS/multi-organ hypersensitivity
- Cognitive/neuropsychiatric effects (somnolence, coordination)
- Withdraw AEDs gradually
Adverse reactions
- Dizziness
- Somnolence
- Diplopia
- Fatigue
- Nausea
- Vomiting
- Ataxia
- Abnormal vision
- Headache
- Nystagmus
- Tremor
- Abnormal gait
Pregnancy Pregnancy exposure registry (NAAED); active metabolite (MHD) levels may decrease during pregnancy
Lactation Oxcarbazepine and active metabolite (MHD) present in human milk; effects on infant unknown
NO BOXED WARNINGS
Principal riskHyponatremia, more than carbamazepine
Cost, est. cash$5–$150/month
Generic entry2007
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHyponatremia, dizziness and serious rash; interactions are less extensive than carbamazepine.
Mechanism of action: Oxcarbazepine ballicule
Open Oxcarbazepine in the interactive console ↗
Memory aids: mascots and interaction avatars
Trileptal trashes sodium → hyponatremia is common
