Contents

Search

oxcarbazepine (Trileptal)

Indications: 1) partial seizures (FDA approved use) 2) trigeminal neuralgia 3) mania 4) mood disorders in elderly Contraindications: - avoid in patients with severe liver failure [6] - not recommended during pregnancy [9] Dosage: - adults: 600-1200 mg PO BID - mood disorders in elderly: 150 mg QD-BID Tabs: 150, 300, 600 mg; syrup 300 mg/5 mL Storage: - store in orginal container - must be used within 7 weeks once original container is opened [7] Dosage adjustment in renal failure: - yes - supplemental dose after dialysis uncertain [6] Pharmacokinetics: - metabolized in liver to 10-Hydroxycarbazepine which is eliminated in the urine Monitor: - thyroid functions tests periodically a) may decrease total serum T4 & free T4 b) serum T3 & serum TSH generally unaffected [4] - serum Na+ [4] a) hyponatremia generally occurs within 1st 3 months of therapy b) consider routine periodic monitoring c) monitor with fluid retention or dyspnea in heart failure d) monitor with renal insufficiency associated with low serum Na+ at baseline: check in 2 weeks & monthly for 3 months e) as clinically indicated Adverse effects: 1) less likely than carbamazepine to cause serious hematologic toxicity or severe skin reactions 2) other adverse effects similar to carbamazepine a) dizziness b) drowsiness, somnolence, sedation c) ataxia d) gait disturbances e) rash f) nausea 3) hyponatremia (2%), may be severe [6] 4) mild leukepenia, pancytopenia [6] 5) serious a) Stevens-Johnson syndrome [3] b) toxic epidermal necrolysis [3] c) hypersensitivity [6] d) type B drug reaction (DRESS) [6] 6) less well-tolerated in the elderly [3] 7) associated with low birth weight & small for gestational age [9] Drug interactions: 1) other anti-epileptic agents 2) may reduce efficacy of oral contraceptives 3) oxcarbazepine induces cyt P450 3A4 -> may diminish levels of drugs metabolized by cyt P450 3A4 Mechanism of action: - sodium channel blocker - diminishes release of excitatory neurotransmitters - decreases synaptic transmission

Interactions

drug interactions drug adverse effects (more general classes) monitor with anticonvulsants

Related

cytochrome P450 3A4 (cytochrome P450 C3, nifedipine oxidase, P450-PCN1, NF-25, CYP3A4)

General

anticonvulsant mood stabilizer

Database Correlations

PUBCHEM cid=34312

References

  1. Prescriber's Letter 7(2):7, Feb. 2000
  2. Kaiser Permanente Northern California Regional Drug Formulary, 2000
  3. FDA Medwatch http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#triletpal
  4. Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Detail-Document#: 260704 (subscription needed) http://www.prescribersletter.com
  5. Greiner-Sosanko E et al Drug monitoring: simultaneous analysis of lamotrigine, oxcarbazepine, 10-hydroxycarbazepine, and zonisamide by HPLC-UV and a rapid GC method using a nitrogen-phosphorus detector for levetiracetam J Chromatogr Sci. 2007 October; 45(9): 616-622 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231334/
  6. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  7. Prescriber's Letter 21(6): 2014 Oral Meds to Keep in Original Containers Detail-Document#: 300622 (subscription needed) http://www.prescribersletter.com
  8. Lin CH, Lu CH, Wang FJ et al Risk factors of oxcarbazepine-induced hyponatremia in patients with epilepsy. Clin Neuropharmacol. 2010 Nov-Dec;33(6):293-6. PMID: 20881597
  9. Kirkner RM Three Antiseizure Medications Join List for Newborn Risks. Medscape. Dec 13, 2022 https://www.medscape.com/viewarticle/985504