What to Know About Oxcarbazepine (Trileptal)

An Anti Epilepsy Drug Used Off-Label for Bipolar Disorder and Pain

In This Article

Trileptal (oxcarbazepine) is a prescription medication used for seizure prevention in certain types of epilepsy. This medication is taken by mouth (by tablet or liquid) and it is approved for adults and children over the age of 2 years. Oxcarbamazepine is available in generic form and as the brands Trileptal (immediate release) and Oxtellar XR (an extended release form). 

Oxcarbazepine is an anti epilepsy drug (AED) that can be used alone (monotherapy) or with another AED as adjunctive therapy. The dose is usually lower when it used as adjunctive therapy. In addition to epilepsy, oxcarbazepine is also used for the management of several medical conditions, including bipolar disorder.

Oxcarbazepine and other medications can interfere with each other and alter each other’s effectiveness—you may need your doses adjusted to manage these potential interactions.

Uses

Oxcarbazepine is used for prevention of partial seizures in epilepsy. Epilepsy is a medical condition characterized by a predisposition to seizures.

Partial seizures, also described as focal seizures, include involuntary movements such as shaking or jerking. Partial seizures begin due to abnormal nerve activity in one area of the brain. The nerve activity may or may not spread throughout the brain.

Involuntary movements of a partial seizure can involve one part of the body (such as the face, arm, or leg on one side), and when the seizure spreads throughout the brain, the involuntary movements may involve the whole body and cause impaired consciousness. 

For adults and children ages 4 and above, oxcarbazepine is approved for use as monotherapy or adjunctive therapy. For children between ages 2 to 4, it is only approved for use as adjunctive therapy. 

Off-Label Uses

While oxcarbamazepine is approved for prevention of partial seizures, it is also used for treatment of several other conditions, including:

  • Bipolar disorder: A mood disorder characterized by depression and mania.
  • Trigeminal neuralgia: Severe pain of one side of the face. 
  • Peripheral neuropathy: Pain and decreased sensation caused by certain types of nerve damage.

When used for off label, the dose of oxcarbamazepine is usually lower than the dose used for management of epilepsy.

Before Taking

Be sure to discuss any medications and medical conditions with your doctor and pharmacist before you start taking oxcarbamazepine. 

This medication may be associated with problems during pregnancy. If you have epilepsy, it is important that you discuss your plans for becoming pregnant with your doctor.

Keep in mind that seizures can be harmful to the fetus during pregnancy, so it is not considered safe to discontinue AEDs before or during pregnancy.

Precautions and Contraindications

You should not drink alcohol or use recreational drugs when you have epilepsy or while using oxcarbamazepine. Alcohol and drugs can trigger seizures and can interfere with metabolism of oxcarbamazepine. 

Other Anti Epilepsy Drugs

Oxcarbamazepine is believed to slow down seizure activity by modulating the action of sodium channels, which regulate nerve activity.

Carbamazepine is an AED that is similar to oxcarbamazepine. Carbamazepine comes in a generic form and as the brand Tegretol, Tegretol XR, Carbatrol, Epitol, and Equetro. 

Dosage 

Trileptal is available in film-coated tablets at doses of 150 mg, 300 mg, and 600 mg and it is taken twice per day. The liquid oral suspension comes in the strength of 300 mg/5 mL (60mg/mL) and it is taken twice per day.

Oxtellar XR, the extended-release form, is approved for adults and for children ages 6 and up. It comes in 150 mg, 300 mg, and 600 mg tablets and it is taken once per day.

If you are switching from adjunctive therapy to monotherapy, this means that you will stop taking multiple AEDs, and only use one. Your doctor will give you a schedule to gradually decrease one AED while increasing the other.

Keep in mind that while there are recommended initial and maintenance doses of oxcarbamazepine, your doctor may recommend a higher or lower target dose for you. The goal is to prevent your seizures without inducing side effects, and your needs and medication tolerance may differ from the standard doses.

Recommended Doses for Adults

For monotherapy and adjunctive therapy, the standard initial dose for adults is 300 mg twice per day (a total dose of 600 mg per day), with a gradual increase over a two-week period to reach a target dose of about 1200 mg per day. The maximum dose of oxcarbamazepine can go up to 2400 mg per day for adults, but 1200 mg per day is a typical dose. 

In adults, Oxtellar XR is started at 600 mg per day and the target dose per day is approximately the same as that of Trileptal. To achieve effective seizure control, some people may need to take a slightly higher dose of Oxtellar XR than their dose of immediate-release oxcarbamazepine.

Recommended Doses for Children

Young children are often given a weight-based prescription for Trileptal. It is usually easier to get the right amount of medication by taking the liquid form. Many children also feel that the liquid is easier to swallow.

Children between the ages of 4 and 16 start with a total daily dose between 8 to 10 mg/kg/day, divided twice per day. Children under age 2 or who weigh less than 20 kg (44 pounds) may start at a higher dose of 16 to 20 mg/kg/day. The dose for children, whether in tablet or oral suspension form, can be increased gradually over the course of two weeks to the maximum recommend total dose of 60 mg/kg/day. 

Children age 6 to 17 years old can start Oxtellar XR at 8 mg/kg to 10 mg/kg once daily, and should not exceed 600 mg per day in the first week. The dose can be gradually increased over a two-week period to 900 mg per day for children who weigh between 20-29 kg (44 to 64 pounds), to 1200 mg per day for children who weigh between 29.1 to 39 kg (64 to 86 pounds), and 1800 mg per day for children who weigh more than 39 kg (86 pounds).

If you or your child is switching between the tablet and oral suspension of Trileptal, you can continue to take the same dose when making the switch.

As with adults, children who are using oxcarbamazepine as monotherapy or as adjunctive therapy might not need to take the maximum allowable dose.

Modifications 

If you have kidney problems, you will need to start taking oxcarbamazepine at a lower than usual starting dose (approximately one half the typical starting dose) and increase at a slower rate than usual to a target dose that is lower than the standard recommended dose. 

Sometimes, people over age 65 also need to take a lower starting and maintenance dose of Trileptal due to metabolic differences. If you are over age 65, Oxtellar XR is recommended at an initial dose of 300 mg or 450 mg per day.

How to Take and Store 

The immediate release and liquid form of oxcarbamazepine can be taken on an empty stomach or with food. The liquid form can be taken on its own or mixed with water. It should not be warmed. Tablets should not be cut, crushed or mixed with food.

The extended release tablet should be taken on an empty stomach (about one to two hours after eating). 

Take oxcarbamazepine at the same time every day. If you are a few hours late for a dose, take your medication and then resume your regular scheduled doses. If you completely miss a dose, take your next one as scheduled, but do not take two doses because this can cause you to overdose on the medication. 

Keep in mind that missing a dose can predispose you to a seizure. 

Trileptal and Oxtellar XR should be stored at room temperature in the original container and away from light. 

Side Effects 

Oxcarbazepine can cause several side effects. The most common side effects are dizziness and somnolence (fatigue and tiredness). This can interfere with your ability to drive, swim, or safely operate machinery. 

Common 

Other side effects include fatigue, nausea, vomiting, blurred vision, double vision, coordination problems, headaches, eye jerking, tremors, and trouble walking. Some people experience mood changes such as depression and agitation. This medication can also cause an allergic reaction, with a skin rash, and/or breathing problems. Talk to your doctor if you experience any of these effects. 

Severe 

Oxcarbamazepine has been associated with suicidal ideation (thinking about or planning suicide).

Oxtellar XR can cause hyponatremia, which is a low sodium level. Hyponatremia is a serious medical condition that can cause brain damage due to severe swelling of the brain. Symptoms include tiredness, dry skin, decreased urination, loss of consciousness, and seizures. Your sodium level can be monitored with a blood test to identify this side effect before it causes problems.

Oxcarbazepine may rarely cause Stevens Johnson Syndrome. This is a severe skin reaction characterized by peeling skin and dehydration. It can be fatal, and you must seek emergency medical care immediately if you experience signs of a skin reaction when taking oxcarbamazepine. 

Discuss any side effects with your doctor—if you need to reduce your dose or completely discontinue the medication, be sure to follow the schedule for slowly reducing the dose to avoid any withdrawal effects. It is not safe to abruptly stop an AED, as this can trigger a seizure (even if you are taking this medication for treatment of a condition other than epilepsy).

Warnings and Interactions

Oxcarbazepine is very similar to carbamazepine, and they are not usually used together. 

Oxcarbazepine may change the level of phenytoin and phenobarbital, which are AEDs commonly used for prevention of partial seizures. 

Trileptal may decrease the effectiveness of oral contraceptives, so it may be necessary to use another form of birth control while you are using this AED.

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Article Sources

  1. Johnson K, Miller L, Pouliot J, Martin P. Retrospective analysis of oxcarbazepine in pregnant women with substance use disorders: focus on safetyJ Pharm Pract. 2019:089719001985070. doi:10.1177/0897190019850700

  2. Food and Drug Administration. Trileptal: highlights of prescribing information. Updated March 2017. 


  3. Food and Drug Administration. Oxtellar XR: Highlights of Prescribing Information. Updated December 2018.