Oxcarbazepine
Administration
- Type: Antiepileptics
- Dosage Forms: 150,300,600mg; 300mg/5 mL
- Routes of Administration: PO
- Common Trade Names: Trileptal
Adult Dosing
Partial seizures
- adjunct treatment: Dose: 600mg PO bid; Start: 300mg PO bid, increase by up to 600mg/day qwk; Max: 2400mg/day;
- conversion to monotherapy: Dose: 1200mg PO bid; Start: 300mg PO bid, increase by up to 600mg/day qwk; Max: 2400mg/day; discontinue concomitant anticonvulsants over 3-6wk; taper dose gradually to discontinue
- initial monotherapy: Dose: 600mg PO bid; Start: 300mg PO bid, increase by 300mg/day q3 days; Max: 2400mg/day
Trigeminal neuralgia
- 450-1200mg PO bid
- Start: 300mg PO bid, may increase by 600mg/day qwk
Bipolar disorder
- 600-1200mg PO bid
- Start: 300mg PO bid, increase by 300mg/day q3 days or by 600mg/day qwk
Pediatric Dosing
Partial seizures
adjunct therapy
- 2-3 yo
- Dose: 60mg/kg/day PO divided bid; Start: 8-10mg/kg/day PO divided BID up to 600mg/day, increase dose over 2-4wk; Max: 60mg/kg/day
- may start 16-20mg/kg/day PO divided BID in patients <20 kg
- 4-16 yo, 20-29 kg
- Dose: 600mg PO bid; Start: 8-10mg/kg/day PO divided BID up to 600mg/day, increase to target dose over 2wk
- 4-16 yo, >39 kg
- Dose: 900mg PO bid; Start: 8-10mg/kg/day PO divided BID up to 600mg/day, increase to target dose over 2wk
monotherapy
- 4-16 yo, 20-24 kg
- Dose: 300-450mg PO bid; Start: 8-10mg/kg/day PO divided bid, increase by 5mg/kg/day q3 days if initial monotherapy or by up to 10mg/kg/day qwk if conversion to monotherapy
- Discontinue concomitant anticonvulsants over 3-6wk
- 4-16 yo, 25-34 kg
- Dose: 450-600mg PO bid; Start: 8-10mg/kg/day PO divided bid, increase by 5mg/kg/day q3 days if initial monotherapy or by up to 10mg/kg/day qwk if conversion to monotherapy
- Discontinue concomitant anticonvulsants over 3-6wk
- 4-16 yo, 35-44 kg
- Dose: 450-750mg PO bid; Start: 8-10mg/kg/day PO divided bid, increase by 5mg/kg/day q3 days if initial monotherapy or by up to 10mg/kg/day qwk if conversion to monotherapy
- Discontinue concomitant anticonvulsants over 3-6wk
- 4-16 yo, 45-49 kg
- Dose: 600-750mg PO bid; Start: 8-10mg/kg/day PO divided bid, increase by 5mg/kg/day q3 days if initial monotherapy or by up to 10mg/kg/day qwk if conversion to monotherapy
- Discontinue concomitant anticonvulsants over 3-6wk
- 4-16 yo, 50-59 kg
- Dose: 600-900mg PO bid; Start: 8-10mg/kg/day PO divided bid, increase by 5mg/kg/day q3 days if initial monotherapy or by up to 10mg/kg/day qwk if conversion to monotherapy
- Discontinue concomitant anticonvulsants over 3-6wk
- 4-16 yo, 60-69 kg
- Dose: 600-1050mg PO bid; Start: 8-10mg/kg/day PO divided bid, increase by 5mg/kg/day q3 days if initial monotherapy or by up to 10mg/kg/day qwk if conversion to monotherapy
- Discontinue concomitant anticonvulsants over 3-6wk
- 4-16 yo, >70 kg
- Dose: 750-1050mg PO bid; Start: 8-10mg/kg/day PO divided bid, increase by 5mg/kg/day q3 days if initial monotherapy or by up to 10mg/kg/day qwk if conversion to monotherapy
- Discontinue concomitant anticonvulsants over 3-6wk
Special Populations
- Pregnancy Rating: C
- Lactation risk: safety unknown
Renal Dosing
- Adult: CrCl <30: start 150mg bid; HD/PD: no supplement; Info: titrate dose slowly until response
- Pediatric: CrCl <30: decrease start dose 50%, max start dose 300mg/24h; HD/PD: no supplement; Info: titrate dose slowly until response
Hepatic Dosing
- Adult: mild-mod impairment: no adjustment; severe impairment: not defined
- Pediatric: mild-mod impairment: no adjustment; severe impairment: not defined
Contraindications
- Allergy to class/drug
- HLA-B*1502 allele (treatment-naive patients)
- avoid abrupt withdrawal
- caution if hypersens. to carbamazepine
- caution in elderly patients
- caution in pregnancy
- caution if hyponatremia
- caution if renal impairment
- caution if depression or history
Adverse Reactions
Serious
- hyponatremia
- anaphylaxis
- angioedema
- drug reaction with eosinophilia and systemic sx
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- erythema multiforme
- acute generalized exanthematous pustulosis
- suicidality
- leukopenia
- thrombocytopenia
- pancytopenia
- agranulocytosis
- aplastic anemia
- pancreatitis
- withdrawal seizures if abrupt discontinuation
- withdrawal symptoms if abrupt discontinuation
Common
- dizziness
- headache
- nausea/vomiting
- somnolence
- diplopia
- balance disorder
- fatigue/asthenia
- tremor
- hyponatremia
- visual disturbance
- nystagmus
- ataxia
- abnormal gait
- abdominal pain
- dyspepsia
- gastritis
- diarrhea
- constipation
- cognitive dysfunction
- impaired concentration
- confusion
- URI sx
- rash
- nervousness
- insomnia
- acne
- photosensitivity
Pharmacology
- Half-life: 2h (parent drug), 7-11h (parent drug, ER form), 9h (metabolite)
- Metabolism: liver; CYP450: 2C19 inhibitor; 3A4/5 inducer; Info: active metabolite
- Excretion: urine 95% (<1% unchanged), feces <4%
Mechanism of Action
blocks voltage-sensitive Na channels, stabilizes neural membranes, inhibits repetitive firing, and decreases synaptic impulse propagation
Comments
See Also
References
epocrates