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OXCARBAZEPINE (Trileptal)
Oxcarbazepine is a 10-keto analogue of carbamazepine. It is an
anticonvulsant approved for the treatment of partial seizures with or without secondary
generalization. While it is not FDA approved for the treatment of acute mania
or bipolar disorder, there are several open studies demonstrating efficacy in
acute and prophylactic treatment. 14
Unlike carbamazepine, oxcarbazepine can be given in an oral aggressive
initial dose of 300 mg t.i.d. (900 mg per day) or 600 mg b.i.d. (1200 mg per day).
Unlike carbamazepine, it does not exhibit clinically significant
auto-induction and has fewer drug-drug interactions. These doses have been found to be
effective in the treatment of mania, although some patients required doses up to
2400 mg per day. Ghaemi et al, found that the mean dose of oxcarbazepine was
1056 mg per day, with a range from 150 mg to 2400 mg per day in a chart review
of patient with bipolar disorder (although not all had mania).17
Oxcarbazepine has another advantage over carbamazepine. It does not induce
enzymes. Carbamazepine tends to reduce the blood levels of aripiprazole,
olanzapine, and risperidone. It may also reduce the blood level of quetiapine, but
does not reduce the blood level of ziprasidone. Combination treatment for
Bipolar mania is very common. If oxcarbazepine and ziprasidone are used in
combination the physician may consider obtaining an EKG for the possibility of QTc
prolongation.
Side effects Side effects of the central nervous system include dizziness,
somnolence, diplopia, nausea, vomiting and dyspepsia. Oxcarbazepine loading is
not recommended for patients with hypersensitivity to oxcarbazepine or
carbamazepine, hyponatremia, hepatic dysfunction, and women who are pregnant or
actively breastfeeding. No serum drug level monitoring is necessary, but complete
blood counts, liver function studies and serum chemistries may require
regular monitoring.
References
14. Dunn RT, Frye MS, Tim KA, et al. The efficacy and use of anticonvulsants
in mood disorders. Clinical Neuropharmacology 21:215-235, 1998.
17. Ghaemi SN, Berv DA, Klugmaman J, et al. Oxcarbazepine treatment of
bipolar disorder. J Clin Psychiatry 64:943-945, 2003.
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