II. Indications
III. Mechanism
- Dibenzazepine Anticonvulsant with chemical structure similar to Tricyclic Antidepressants
- Primary anticonvulsant effects
- Inhibits Neuron depolarization and Glutamate release
- Sodium Channel Blocker (similar to Eslicarbazepine and Oxcarbazepine)
- Other effects
IV. Adverse Effects: Common (Dose related)
V. Adverse Effects: Other
-
Hyponatremia
- Monitor Serum Sodium
- Higher risk than with Carbamazepine
- Risk Factors include Diuretic use, elderly, Selective Serotonin Reuptake Inhibitor use
- Cardiac Arrhythmia
- Osteoporosis (longterm use)
- Bone Marrow suppression
-
Life-Threatening Drug-Induced Rashes (25-30% chance of cross sensitivity with Carbamazepine)
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS Syndrome)
- Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis (TEN)
- Most common with asian descent and HLA-B 1502 Mutation (and possibly HLA-B3101)
VI. Dosing
- Adult (includes elderly)
- Initial: 300 mg orally twice daily
- Increase by 300 mg/day every 3 to 7 days
- Typical effective dose 1200 mg/day divided twice daily
- Maximum: 2400 mg/day
- Child: Age 2 to 16 years old
- Initial: 8-10 mg/kg/day (up to 600 mg/day) divided twice daily
- May be increased by 5 mg/kg/day up to every 3 days, up to target typical dose or maximum dose
- Typical effective dose
- Age 2 to 4 years old
- Maximum 60 mg/kg/day divided twice daily
- Age 4 to 16 years old
- Weight 20 to 29 kg: 900 mg/day divided twice daily
- Weight 29 to 39 kg: 1200 mg/day divided twice daily
- Weight >39 kg: 1800 mg/day divided twice daily
- Age 2 to 4 years old
VII. Safety
- Pregnancy Category C
- Avoid in Lactation
VIII. Metabolism
- Renal excretion
- Decrease dose to 50% if Creatinine Clearance < 30 ml/min
IX. Drug Interactions
- Fewer Drug Interactions than with Carbamazepine (no autoinduction and less enzyme induction)
- Decreases Oral Contraceptive efficacy (and may impact etonogestrel implant efficacy)
- Interacts with Dihydropyridine Calcium Channel Blockers
- Mechanisms
X. Resources
- Oxcarbazepine (DailyMed)
XI. References
- (2022) Presc Lett, Resource #361206, Antiseizure Medications
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Liu (2017) Am Fam Physician 96(2): 87-96 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| oxcarbazepine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| OXCARBAZEPINE 150 MG TABLET | Generic | $0.14 each |
| OXCARBAZEPINE 300 MG TABLET | Generic | $0.20 each |
| OXCARBAZEPINE 300 MG/5 ML SUSP | Generic | $0.28 per ml |
| OXCARBAZEPINE 600 MG TABLET | Generic | $0.39 each |
| trileptal (on 8/17/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| TRILEPTAL 300 MG TABLET | Generic | $0.20 each |
| TRILEPTAL 300 MG/5 ML SUSP | Generic | $0.28 per ml |
| TRILEPTAL 600 MG TABLET | Generic | $0.38 each |
| oxtellar xr (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| OXTELLAR XR 150 MG TABLET | $7.70 each | |
| OXTELLAR XR 300 MG TABLET | $10.74 each | |
| OXTELLAR XR 600 MG TABLET | $19.63 each | |