oxcarbazepine


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oxcarbazepine

 [oks″kahr-baz´ĕ-pēn]
an anticonvulsant used in the treatment of partial seizures, administered orally.

oxcarbazepine

Apo-Oxcarbazepine (CA), Trileptal

Pharmacologic class: Carboxamide derivative

Therapeutic class: Anticonvulsant

Pregnancy risk category C

Action

Blocks sodium channels in neural membranes, stabilizing hyperexcitable states and inhibiting neuronal firing and impulse transmission in brain

Availability

Oral suspension: 300 mg/5-ml bottle

Tablets: 150 mg, 300 mg, 600 mg

Indications and dosages

Adjunctive therapy for partial seizures

Adults: 300 mg P.O. b.i.d. May increase by up to 600 mg/day q week, to a maximum of 1,200 mg/day.

Children ages 2 to 16: Initially, 8 to 10 mg/kg/day P.O. to a maximum of 600 mg/day

Conversion to monotherapy for partial seizures

Adults: 300 mg P.O. b.i.d. May increase by 600 mg/day at weekly intervals over 2 to 4 weeks, to a maximum of 2,400 mg/day

Children ages 4 to 16: Initially, 8 to 10 mg/kg/day P.O. given in two divided doses, increased to a maximum of 10 mg/kg/day

Initiation of monotherapy

Adults: 300 mg P.O. b.i.d., increased by 300 mg/day P.O. q 3 days up to 1,200 mg/day

Children ages 4 to 16: Initially, 8 to 10 mg/kg/day P.O. given in two divided doses; increase by 5 mg/kg q 3 days to a maximum of 1,200 mg/day

Dosage adjustment

• Renal impairment

• Children ages 2 to younger than 4 weighing less than 20 kg (44 lb)

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:

• renal impairment

• pregnant or breastfeeding patients

• children younger than age 2 (safety not established).

Administration

• Administer twice daily with or without food.

• Shake oral suspension well. If desired, mix in small glass of water.

Adverse reactions

CNS: dizziness, vertigo, drowsiness, fatigue, headache, ataxia, tremor, emotional lability

EENT: abnormal vision, diplopia, nystagmus, rhinitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia

Metabolic: hyponatremia

Skin: acne, rash

Other: thirst, allergic reactions, edema, lymphadenopathy

Interactions

Drug-drug. Carbamazepine, valproic acid, verapamil: decreased oxcarbazepine blood level

CNS depressants (including antidepressants, antihistamines, opioids, sedative-hypnotics): additive CNS depression

Felodipine, hormonal contraceptives: decreased blood levels of these drugs

Phenobarbital: decreased oxcarbazepine and increased phenobarbital blood levels

Phenytoin: increased phenytoin blood level

Drug-diagnostic tests. Sodium: decreased level

Drug-behaviors. Alcohol use: additive CNS depression

Patient monitoring

• Monitor neurologic status closely for changes in cognition, mood, wakefulness, balance, and gait.

• Check sodium level. Watch for signs and symptoms of hyponatremia.

Patient teaching

• Instruct patient to take at same time each day, with or without food.

• Tell patient to report vision changes and significant neurologic changes.

• Advise patient to have periodic eye exams.

• Tell female patient that drug makes hormonal contraceptives less effective.

• Inform patient that he may need frequent tests to check drug blood levels.

• Tell patient not to drink alcohol.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects him.

• As appropriate, review all significant adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

References in periodicals archive ?
A 68-year-old male who had had a diagnosis of epilepsy for 15 years and had been using oxcarbazepine twice a day for a year, was admitted to the emergency service with syncope.
Calcitriol 0.25 [micro]g/d, cholecalciferol 300,000 U/week, and calcium 1200 mg/d were prescribed, and the doses of oxcarbazepine were gradually reduced.
Overall, most frequently prescribed AEDs were phenytoin followed by valproate, oxcarbazepine, and carbamazepine/ clonazepam.
She experienced side effect to other drugs as mentioned earlier, hence was maintained on Aripiprazole (Since 2004) and with oxcarbazepine (Since July 2012).
Serum valproic acid level is 71 [micro]g/mL; oxcarbazepine level, <2 [micro]g/mL; ammonia level, 71 [micro]g/dL (reference range, 15 to 45 [micro]g/dL).
Moreover it was found that the Cutaneous Adverse Drug Reaction (CADR) continued despite the discontinuation of phenytoin although the use of oxcarbazepine, as replacement for phenytoin by the local doctor of the patient, remains a confounding factor.
Hyponatremia, defined as a sodium level < 135 mmol/l is a common side effect of carbamazepine and oxcarbazepine therapy.
The researchers reported findings from 1,435 person-months for levetiracetam and 2,137 person-months for oxcarbazepine.
She came under the care of a physician who prescribed a number of drugs, including meperidine, hydrocodone, tizanidine, diazepam, promethazine, alprazolam, and oxcarbazepine. The doctor prescribed injectable forms of certain medications after the patient told him her next-door neighbor was a nurse and could help administer the drugs.
Other off-label drugs include oxcarbazepine, phenytoin, lamotrigine, gabapentin, baclofen and Lyrica (pregabalin).
Oxcarbazepine and carbomazepine had higher risk than phenytoin or phenobarbitone.