Oxcarbazepine: Difference between revisions

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==Administration==
==Administration==
*Type: anti epileptic
*Type: [[Antiepileptics]]
*Dosage Forms: 150,300,600; 300/5 mL
*Dosage Forms: 150,300,600mg; 300mg/5 mL
*Routes of Administration: PO
*Routes of Administration: PO
*Common Trade Names: Trileptal
*Common Trade Names: Trileptal
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==Adult Dosing==
==Adult Dosing==
===Partial seizures===
===Partial seizures===
*adjunct tx: Dose: 600 mg PO bid; Start: 300 mg PO bid, incr. by up to 600 mg/day qwk; Max: 2400 mg/day;  
*adjunct treatment: Dose: 600mg PO bid; Start: 300mg PO bid, increase by up to 600mg/day qwk; Max: 2400mg/day;  
*conversion to monotherapy: Dose: 1200 mg PO bid; Start: 300 mg PO bid, incr. by up to 600 mg/day qwk; Max: 2400 mg/day; D/C concomitant anticonvulsants over 3-6wk; taper dose gradually to D/C
*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: 600 mg PO bid; Start: 300 mg PO bid, incr. by 300 mg/day q3 days; Max: 2400 mg/day
*initial monotherapy: Dose: 600mg PO bid; Start: 300mg PO bid, increase by 300mg/day q3 days; Max: 2400mg/day


===Trigeminal neuralgia===
===Trigeminal neuralgia===
*450-1200 mg PO bid
*450-1200mg PO bid
*Start: 300 mg PO bid, may incr. by 600 mg/day qwk
*Start: 300mg PO bid, may increase by 600mg/day qwk


===Bipolar disorder===
===Bipolar disorder===
*600-1200 mg PO bid
*600-1200mg PO bid
*Start: 300 mg PO bid, incr. by 300 mg/day q3 days or by 600 mg/day qwk
*Start: 300mg PO bid, increase by 300mg/day q3 days or by 600mg/day qwk


==Pediatric Dosing==
==Pediatric Dosing==
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====adjunct therapy====
====adjunct therapy====
*2-3 yo
*2-3 yo
**Dose: 60 mg/kg/day PO divided bid; Start: 8-10 mg/kg/day PO divided bid up to 600 mg/day, incr. dose over 2-4wk; Max: 60 mg/kg/day
**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 16-20 mg/kg/day PO divided bid in pts <20 kg
**may start 16-20mg/kg/day PO divided BID in patients <20 kg
*4-16 yo, 20-29 kg
*4-16 yo, 20-29 kg
**Dose: 600 mg PO bid; Start: 8-10 mg/kg/day PO divided bid up to 600 mg/day, incr. to target dose over 2wk
**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
*4-16 yo, >39 kg
**Dose: 900 mg PO bid; Start: 8-10 mg/kg/day PO divided bid up to 600 mg/day, incr. to target dose over 2wk
**Dose: 900mg PO bid; Start: 8-10mg/kg/day PO divided BID up to 600mg/day, increase to target dose over 2wk


====monotherapy====
====monotherapy====
*4-16 yo, 20-24 kg
*4-16 yo, 20-24 kg
**Dose: 300-450 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy
**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
**D/C concomitant anticonvulsants over 3-6wk
**Discontinue concomitant anticonvulsants over 3-6wk
*4-16 yo, 25-34 kg
*4-16 yo, 25-34 kg
**Dose: 450-600 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy
**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
**D/C concomitant anticonvulsants over 3-6wk
**Discontinue concomitant anticonvulsants over 3-6wk
*4-16 yo, 35-44 kg
*4-16 yo, 35-44 kg
**Dose: 450-750 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy
**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
** D/C concomitant anticonvulsants over 3-6wk
**Discontinue concomitant anticonvulsants over 3-6wk
*4-16 yo, 45-49 kg
*4-16 yo, 45-49 kg
**Dose: 600-750 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy
**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
**D/C concomitant anticonvulsants over 3-6wk
**Discontinue concomitant anticonvulsants over 3-6wk
*4-16 yo, 50-59 kg
*4-16 yo, 50-59 kg
**Dose: 600-900 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy
**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
**D/C concomitant anticonvulsants over 3-6wk
**Discontinue concomitant anticonvulsants over 3-6wk
*4-16 yo, 60-69 kg
*4-16 yo, 60-69 kg
**Dose: 600-1050 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy
**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
**D/C concomitant anticonvulsants over 3-6wk
**Discontinue concomitant anticonvulsants over 3-6wk
*4-16 yo, >70 kg
*4-16 yo, >70 kg
**Dose: 750-1050 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy
**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
**D/C concomitant anticonvulsants over 3-6wk
**Discontinue concomitant anticonvulsants over 3-6wk


==Special Populations==
==Special Populations==
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*[[Lactation risk categories|Lactation risk]]: safety unknown
*[[Lactation risk categories|Lactation risk]]: safety unknown
===Renal Dosing===
===Renal Dosing===
*Adult: CrCl <30: start 150 mg bid; HD/PD: no supplement; Info: titrate dose slowly until response
*Adult: CrCl <30: start 150mg bid; HD/PD: no supplement; Info: titrate dose slowly until response
*Pediatric: CrCl <30: decr. start dose 50%, max start dose 300 mg/24h; 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===
===Hepatic Dosing===
*Adult: mild-mod impairment: no adjustment; severe impairment: not defined
*Adult: mild-mod impairment: no adjustment; severe impairment: not defined
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==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*HLA-B*1502 allele (tx-naive pts)
*HLA-B*1502 allele (treatment-naive patients)
*avoid abrupt withdrawal
*avoid abrupt withdrawal
*caution if hypersens. to carbamazepine
*caution if hypersens. to carbamazepine
*caution in elderly pts
*caution in elderly patients
*caution in pregnancy
*caution in pregnancy
*caution if hyponatremia
*caution if hyponatremia
*caution if renal impairment
*caution if renal impairment
*caution if depression or hx
*caution if depression or history


==Adverse Reactions==
==Adverse Reactions==
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*anaphylaxis
*anaphylaxis
*angioedema
*angioedema
*drug rxn w/ eosinophilia and systemic sx
*drug reaction with eosinophilia and systemic sx
*Stevens-Johnson syndrome
*Stevens-Johnson syndrome
*toxic epidermal necrolysis
*toxic epidermal necrolysis
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*aplastic anemia
*aplastic anemia
*pancreatitis
*pancreatitis
*withdrawal seizures if abrupt D/C
*withdrawal seizures if abrupt discontinuation
*withdrawal sx if abrupt D/C
*withdrawal symptoms if abrupt discontinuation


===Common===
===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==
==Pharmacology==
*Half-life:  
*Half-life: 2h (parent drug), 7-11h (parent drug, ER form), 9h (metabolite)
*Metabolism:  
*Metabolism: liver; CYP450: 2C19 inhibitor; 3A4/5 inducer; Info: active metabolite
*Excretion:  
*Excretion: urine 95% (<1% unchanged), feces <4%


==Mechanism of Action==
==Mechanism of Action==
blocks voltage-sensitive Na channels, stabilizes neural membranes, inhibits repetitive firing, and decreases synaptic impulse propagation


==Comments==
==Comments==


==See Also==
==See Also==
*[[Seizures]]
*[[Anticonvulsants]]


==References==
==References==
<references/>
<references/>
[[Category:Drugs]]
[[Category:Pharmacology]] [[Category:Neurology]]
epocrates

Latest revision as of 04:10, 8 March 2021

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

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

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