Oxcarbazepine XR
OXTELLAR XR
Pronunciation: ox-kar-BAZ-e-peen (ax-TE-lar)
“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 (partial-onset) (2012)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Partial-onset seizures | Adults | 600 mg PO once daily | 1200–2400 mg once daily | 2400 mg/day |
| Partial-onset seizures | Peds 6–<17 yr | 8–10 mg/kg once daily (not to exceed 600 mg in first week) | By weight: 900 mg/day (20–29 kg), 1200 mg/day (29.1–39 kg), 1800 mg/day (>39 kg) |
Titration Increase at weekly intervals (adults 600 mg/day increments; peds 8–10 mg/kg increments)
Renal CrCl <30 mL/min: start 300 mg/day and titrate slowly; end-stage renal disease on dialysis: use immediate-release oxcarbazepine instead
Hepatic Mild-to-moderate: no adjustment; severe: not recommended (not evaluated)
Instructions
- Swallow tablets whole; do not cut, crush, or chew
- Take once daily on an empty stomach (≥1 h before or ≥2 h after meals)
- Withdraw gradually to reduce risk of increased seizures/status epilepticus
Available strengths
- ER tab 150, 300, 600 mg
- tab 150, 300, 600 mg
- susp 300 mg/5 mL
Contraindications
- Known hypersensitivity to oxcarbazepine, any component of Oxtellar XR, or to eslicarbazepine acetate (reactions have included anaphylaxis and angioedema)
Cautions
- Hyponatremia (monitor sodium)
- Anaphylaxis and angioedema
- Cross-hypersensitivity to carbamazepine (~25–30%)
- Serious dermatologic reactions (SJS/TEN; increased risk with HLA-B*1502)
- Suicidal behavior and ideation
- DRESS/multi-organ hypersensitivity
- Hematologic reactions
- Risk of seizure aggravation
- Gradual withdrawal required
Adverse reactions
- Dizziness
- Somnolence
- Headache
- Balance disorder
- Tremor
- Vomiting
- Diplopia
- Asthenia
- Fatigue
Pregnancy May cause fetal harm; structurally related to carbamazepine; associated with craniofacial (oral clefts) and cardiac (VSD) malformations
Lactation Oxcarbazepine and active metabolite (MHD) present in human milk; effects on infant unknown
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 150 mg | ER tab | 30 qd | $104.93 | not offered |
| 300 mg | ER tab | 30 qd | $141.92 | not offered |
| 600 mg | ER tab | 30 qd | $287.35 | not offered |
Other forms: Oxcarbazepine (TRILEPTAL)
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 XR in the interactive console ↗
Memory aids: interaction avatars
