oxcarbazepine (Trileptal)
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Indications
- partial seizures (FDA approved use)
- trigeminal neuralgia
- mania
- 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
Pharmacokinetics
- metabolized in liver to 10-Hydroxycarbazepine which is eliminated in the urine
Monitor
- thyroid functions tests periodically
- serum Na+[4]
- hyponatremia generally occurs within 1st 3 months of therapy
- consider routine periodic monitoring
- monitor with fluid retention or dyspnea in heart failure
- monitor with renal insufficiency associated with low serum Na+ at baseline: check in 2 weeks & monthly for 3 months
- as clinically indicated
Adverse effects
- less likely than carbamazepine to cause serious hematologic toxicity or severe skin reactions
- other adverse effects similar to carbamazepine
- dizziness
- drowsiness, somnolence, sedation
- ataxia
- gait disturbances
- rash
- nausea
- hyponatremia (2%), may be severe[6]
- mild leukepenia, pancytopenia[6]
- serious
- less well-tolerated in the elderly[3]
- associated with low birth weight & small for gestational age[9]
Drug interactions
- other anti-epileptic agents
- may reduce efficacy of oral contraceptives
- oxcarbazepine induces cyt P450 3A4
- may diminish levels of drugs metabolized by cyt P450 3A4
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) anticonvulsants with statins
Mechanism of action
- sodium channel blocker
- diminishes release of excitatory neurotransmitters
- decreases synaptic transmission
More general terms
Additional terms
References
- ↑ Prescriber's Letter 7(2):7, Feb. 2000
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 2000
- ↑ 3.0 3.1 3.2 3.3 FDA Medwatch http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#triletpal
- ↑ 4.0 4.1 4.2 Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 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/
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 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 - ↑ 7.0 7.1 Prescriber's Letter 21(6): 2014 Oral Meds to Keep in Original Containers Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300622&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/20881597
- ↑ 9.0 9.1 9.2 Kirkner RM Three Antiseizure Medications Join List for Newborn Risks. Medscape. Dec 13, 2022 https://www.medscape.com/viewarticle/985504