Oxcarbazepine

Administration

  • Type: anti epileptic
  • Dosage Forms: 150,300,600; 300/5 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