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Oxcarbazepine

Brands and Forms

  • Trileptal
    • Tablet: 150mg, 300mg, 600mg
    • Oral suspension: 60mg/ml

Uses of Oxcarbazepine

In psychiatry, Oxcarbazepine is in the treatment of Manic and Mixed Episodes in Bipolar Disorder.

In general medicine, Oxcarbazepine is used for treating seizure disorders and neuropathic pain.

How Oxcarbazepine Works

Oxcarbazepine is an anticonvulsant and mood stabilizer. It blocks voltage-sensitive sodium channels and inhibits the release of glutamate in the central nervous system.

Oxcarbazepine is a structural derivative of Carbamazepine that is thought to have less impact on liver metabolism and less risk of serious forms of anemia (like agranulocytosis) than Carbamazepine, but with otherwise similar therapeutic effects.

Cautions when Using Oxcarbazepine

Sodium levels should be monitored due to risk of hyponatremia (low sodium levels).

Use caution in people at risk for narrow angle-closure glaucoma.

Oxcarbazepine can cause serious malformations to a fetus during pregnancy, and it can also reduce the efficacy of oral contraceptives. Therefore, women who are using Oxcarbazepine should consider using other forms of contraception.

Oxcarbazepine should not be used during or within 14 days following the administration of an MAOI, because a hypertensive crisis may result.

Dosing of Oxcarbazepine

Oxcarbazepine is usually started at 600mg a day divided in two doses. It can be increased by up to 300mg/day every 3 days, to a maximum of 2400mg/day. When this medication is being added as an adjunct to another medication, the recommended target dose is 1200mg/day.

When wanting to stop this medication, the dose should be decreased gradually over a period of a few weeks.

Onset of action

For Manic and Mixed Episodes, therapeutic effects are usually seen within 2 weeks of starting Oxcarbazepine. Maximum therapeutic effects usually require several weeks or even a few months to be realized. If there are no significant effects after 2-4 weeks at the higher end of the therapeutic range then the medication may not work at all.

Kidney impairment

Oxcarbazepine is excreted by the kidneys, so the dose may need to be lowered by as much as half.

Liver impairment

No dose adjustment required for mild to moderate liver impairment.

Side-effects of Oxcarbazepine

Below is a list of most of the reported side-effects of Oxcarbazepine. Most of these side-effects occur in only a minority of individuals, and many can resolve with time while the medication is continued.

Cardiovascular: chest pain; hypotension.

Central Nervous System: dizziness; somnolence; headache; ataxia; fatigue; abnormal gait; tremor; vertigo; insomnia; memory loss; abnormal coordination; abnormal thinking; hyperesthesia; speech disorder; convulsions; EEG abnormalities; involuntary muscle contractions.

Dermatologic: rash; acne; hot flushes; purpura.

Endocrine/Metabolic: hyponatremia; weight gain.

Eyes, Ears, Nose and Throat: double vision; nystagmus; abnormal vision; taste perversion; ear infection; earache; increased sweating.

Gastrointestinal: vomiting; nausea; abdominal pain; diarrhea; constipation; dyspepsia; loss of appetite; dry mouth; gastritis; rectum hemorrhage; toothache.

Genitourinary: urinary tract infection; urinary frequency; vaginitis.

Hematologic: lymphadenopathy; easy bruising.

Musculoskeletal: muscle stiffness; muscle pains; weakness.

Psychiatric: emotional lability; anxiety; nervousness; agitation.

Respiratory: rhinitis; upper respiratory tract infection; coughing; chest infection; runny nose; sinusitis; bronchitis; pharyngitis; pneumonia.

Common side-effects of Oxcarbazepine

Dizziness, somnolence, headache, unsteadiness, fatigue, gait abnormal, tremor, vertigo, blurred vision, nystagmus, abnormal vision, vomiting, nausea, abdominal pain.

Rare but serious side-effects of note of Oxcarbazepine

  • Hyponatremia (low sodium levels)
  • Serious and potentially fatal allergic rashes, including a Stevens-Johnson syndrome, have been reported.

Oxcarbazepine overdose

No fatalities reported.

Oxcarbazepine and pregnancy

Oxcarbazepine may cause serious congenital malformations to the fetus, including neural tube defects when used in the first trimester. Using Folate 1mg/day starting early in pregnancy can help reduce the risk of these neural tube defects. In some severe cases of epilepsy, Oxcarbazepine is used in pregnancy, but in Bipolar Disorder it would be recommended to use an alternative treatment.

Medical Monitoring for Oxcarbazepine

Measure sodium levels before starting treatment, then at regular intervals.

Drug Interactions with Oxcarbazepine

  • Oxcarbazepine can reduce the efficacy of oral contraceptives.
  • Oxcarbazepine should not be used during or within 14 days following the administration of an MAOI, because a hypertensive crisis may result.
  • Oxcarbazepine blood concentrations can be reduced by Carbamazepine, Phenobarbital, Phenytoin, Primodine, Verapamil, and Valproic Acid.
  • Oxcarbazepine can reduce blood concentrations of Felodipine and Lamotrigine.
  • Oxcarbazepine at doses above 1200mg/day may increase blood concentrations of Phenytoin.