Oxcarbazepine
TRILEPTAL
Pronunciation: ox-kar-BAZ-e-peen (trye-LEP-tal)
“Oscar Leapt”
Trileptal trashes sodium → hyponatremia is common
What it isA prodrug. Oxcarbazepine itself is essentially inactive: it is rapidly reduced to licarbazepine, the 10-monohydroxy derivative (MHD), and that metabolite does the sodium-channel blocking. Its ballicule carries no pegs for the same reason lisdexamfetamine carries none.
Why this oneThe blue arrow points at eslicarbazepine because that is the nearest entity in this library. Strictly, what you make from oxcarbazepine is licarbazepine — predominantly, but not exclusively, its S-enantiomer. Eslicarbazepine is that S-enantiomer, sold separately as APTIOM, so the arrow names the right molecule and the wrong product.
What limits itLess hepatic enzyme induction and hematologic toxicity than carbamazepine makes it easier to combine with other drugs.
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
Available strengths
- tab 150, 300, 600 mg
- ER tab 150, 300, 600 mg
- susp 300 mg/5 mL
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
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 150 mg | tab | 60 BID | $6.37 | offered |
| 300 mg | tab | 60 BID | $10 | offered |
| 600 mg | tab | 60 BID | $19.02 | offered |
Other forms: Oxcarbazepine XR (OXTELLAR XR)
Generic entry2007
NO BOXED WARNINGS
Principal riskHyponatremia, more than carbamazepine
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHyponatremia, dizziness and serious rash; interactions are less extensive than carbamazepine.
Active metabolites
Open Oxcarbazepine in the interactive console ↗
Memory aids: interaction avatars
