Trileptal (Oxcarbazepine) - Oral

What Is Trileptal?

Trileptal (oxcarbazepine) is a prescription oral anti-epilepsy drug (AED), also referred to as an anticonvulsant, used to prevent seizures in adults and children ages 2 and older with certain types of epilepsy. It is also used off-label for treating neuropathic pain, bipolar disorder, and other conditions.

This medication interacts with ion channels, which generally facilitate nerve cell activity in the brain and the nerves throughout the body. Oxcarbazepine stabilizes neuronal activity and prevents the overfiring of neurons, stopping the spread of seizure activity.

Trileptal is available in tablet or oral suspension form. Oxcarbazepine is also available in an extended-release tablet formulation under the brand name Oxtellar XR.

Drug Facts

Generic Name: Oxcarbazepine

Brand Name: Trileptal

Drug Availability: Prescription

Therapeutic Classification: Anticonvulsant

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Oral

Active Ingredient: Oxcarbazepine

Dosage Form: Tablet, oral suspension

What Is Trileptal Used For?

Trileptal is approved to treat partial seizures, also called focal onset seizures, which begin in one region of the brain. Partial seizures are more common than generalized seizures, which start on both sides of the brain. A partial seizure can spread throughout the whole brain, resulting in a secondarily generalized seizure. Trileptal can treat a secondarily generalized seizure, but it cannot treat a primary generalized seizure.

Trileptal is approved for the following indications: 

  • By itself (monotherapy) in adults and children aged 4 and older with partial seizures
  • Adjunctive (add-on) treatment in adults and children aged 2 and older with partial seizures

Oxtellar XR (extended-release oxcarbazepine) is indicated for use in people 6 years and older.

How to Take Trileptal

Trileptal comes as a tablet and an oral suspension. You can take Trileptal by mouth, with or without food. If taking the oral suspension, shake it in the container before you measure it out for use. Make sure to use the oral suspension within seven weeks of opening the bottle.

Trileptal is usually prescribed twice daily; you should take it at the same time each day to prevent inconsistent drug levels. Inconsistent levels of Trileptal in the body can result in a seizure.

If taking Oxtellar XR, you should take each dose on an empty stomach at least one hour before or at least two hours after a meal. The extended-release tablet is typically taken once per day.

Storage

Store the suspension form of Trileptal in its original containers. Keep the tablets in a sealed and light-resistant container. Keep this medication out of reach from children and pets.

Trileptal should be stored at 77 F. However, it is OK to expose Trileptal to temperatures between 15 F and 86 F.

Pay close attention to expiration dates for the suspension, as the medication will expire sooner once the bottle is opened.

Off-Label Uses

Oxcarbazepine is sometimes prescribed off-label as a single therapy (monotherapy) where it is approved for add-on therapy (adjunctive therapy). Off-label means a drug is prescribed for purposes that are not on the Food and Drug Administration (FDA)-approved label.

Other off-label uses include: 

How Long Does It Take Trileptal to Work?

Trileptal can start to take effect in the body within a few hours, but it might take up to a few weeks to notice changes in symptoms.

What Are the Side Effects of Trileptal?

Oxcarbazepine is usually well tolerated, but sometimes the side effects can be intolerable or severe. You can experience the side effects of Trileptal when taking it alone or with other treatments.

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effects for adults and children are:

  • Dizziness, balance problems
  • Severe fatigue
  • Double vision
  • Nausea and vomiting
  • Ataxia
  • Abnormal vision
  • Headaches
  • Nystagmus (jerking eye movements)
  • Tremor
  • Walking problems

These side effects may improve over time, but they can persist.

Severe Side Effects

If you have reacted to carbamazepine, there is a risk that you could have a similar response to oxcarbazepine. Additionally, you can have serious side effects from taking oxcarbazepine even if you have been able to take carbamazepine without any side effects.

Serious side effects of oxcarbazepine include:

  • Hyponatremia: Can cause lightheadedness, dizziness, passing out, or convulsions 
  • Serious skin reactions: May include a rash, blisters, and ulcers on the skin 
  • Suicidal ideation or behavior: Can include thoughts of suicide or planning suicide 
  • Confusion or trouble thinking 
  • Severe tiredness or sleepiness 
  • Severe problems with balance and coordination 
  • Drug reaction with eosinophilia and systemic symptoms (DRESS)
  • Multi-organ hypersensitivity: Can cause nausea, vomiting, fevers, or loss of consciousness 
  • Thrombocytopenia: Can cause low blood platelets and bleeding
  • Worsening seizures 

Call your healthcare provider or seek emergency medical attention if you develop any of these problems. Sometimes Trileptal can lead to worsening seizures during pregnancy.

Long-Term Side Effects

Generally, the side effects of oxcarbazepine should resolve soon after stopping the medication. However, the lasting effects of severe reactions—such as organ failure—can be harmful to you in the long term.

Therefore, you must seek medical attention as soon as you develop signs of severe side effects.

Report Side Effects

Trileptal may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Trileptal Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release tablets):
    • For seizures:
      • For patients taking oxcarbazepine alone or together with other medicines:
        • Adults—At first, 600 milligrams (mg) once a day for 1 week. Your doctor may adjust your dose in the following weeks as needed. However, the dose is usually not more than 2400 mg per day.
        • Older adults—At first, 300 or 450 mg once a day. Your doctor may adjust your dose as needed.
        • Children 6 to 16 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 8 to 10 milligrams (mg) per kilogram (kg) of body weight per day as a single dose. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1800 mg per day.
        • Children younger than 6 years of age—Use is not recommended.
  • For oral dosage forms (suspension and tablets):
    • For seizures:
      • For patients taking oxcarbazepine together with other medicines:
        • Adults and children 17 years of age and older—At first, 300 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1200 mg per day.
        • Children 4 to 16 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 8 to 10 milligrams (mg) per kilogram (kg) of body weight per day, divided into 2 doses. Your doctor may adjust your dose as needed. However, the dose is usually not more than 600 mg per day, divided into 2 equal doses.
        • Children 2 to 4 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 8 to 10 mg per kg of body weight per day, divided into 2 doses. For patients weighing less than 20 kg, the starting dose is 16 to 20 mg per kg of body weight per day, divided in 2 doses. Your doctor may adjust your dose as needed. However, the dose is usually not more than 600 mg per day, divided into 2 equal doses.
        • Children younger than 2 years of age—Use and dose must be determined by your doctor.
      • For patients switching from another medicine to oxcarbazepine:
        • Adults and children 17 years of age and older—At first, 300 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 2400 mg per day.
        • Children 4 to 16 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 8 to 10 milligrams (mg) per kilogram (kg) of body weight per day, divided into 2 doses. Your doctor may adjust your dose as needed.
        • Children younger than 4 years of age—Use and dose must be determined by your doctor.
      • For patients who are not taking any seizure medicine:
        • Adults and children 17 years of age and older—At first, 300 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 1200 mg per day.
        • Children 4 to 16 years of age—Dose is based on body weight and must be determined by your doctor. The starting dose is 8 to 10 milligrams (mg) per kilogram (kg) of body weight per day, divided into 2 doses. Your doctor may adjust your dose as needed.
        • Children younger than 4 years of age—Use and dose must be determined by your doctor.

Modifications

Your prescriber may adjust your Trileptal dose if you are also using medications that may interact with oxcarbazepine (e.g., phenobarbital) or other certain AEDs.

If you have kidney impairment, your healthcare provider will prescribe half the usual starting dose and then increase your dose slowly until an optimal response is achieved.

Missed Dose

If you miss your dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose. Do not take two doses at one time.

Overdose: What Happens If I Take Too Much Trileptal?

Accidentally or deliberately taking too much oxcarbazepine is harmful. An overdose can cause several problems.

Effects of oxcarbazepine overdose include:

  • Nausea or vomiting
  • Somnolence (severe tiredness, inability to stay alert)
  • Aggression or agitation
  • Hypotension (low blood pressure)
  • Tremors or dyskinesia 
  • Confusion
  • Convulsions
  • Impaired coordination
  • Decreased consciousness or coma
  • Blurred vision or double vision 
  • Dizziness
  • Shortness of breath
  • QT prolongation, a type of heart problem
  • Headaches
  • Miosis (pupil constriction) or nystagmus
  • Reduced urine production

If you have taken too much oxcarbazepine, seek medical attention. A healthcare provider will monitor you and determine if you need treatment. No specific medication reverses oxcarbazepine’s effects, so treatment will include medical management tailored to your symptoms.

In some situations, a gastric lavage procedure might be necessary to remove the excess drug from your digestive system if it hasn’t been fully absorbed into your blood.

What Happens If I Overdose on Trileptal?

If you think you or someone else may have overdosed on Trileptal, call your healthcare provider or the Poison Control Center (1-800-222-2222).

If someone collapses or isn’t breathing after taking Trileptal, call 911 immediately.

Precautions

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It is very important that your doctor check you or your child's progress at regular visits. This is to make sure the medicine is working properly and to allow for changes in your dose. Blood tests will also be needed to check for unwanted effects.

Tell your doctor if you become pregnant while using this medicine. Your doctor may need you to be monitored carefully during your pregnancy and after giving birth.

Hyponatremia (low sodium in the blood) may occur while you are using this medicine. Check with your doctor right away if you or your child develop confusion, decreased urine output, dizziness, fast or irregular heartbeat, headache, muscle pain or cramps, nausea or vomiting, weakness, or swelling of the face, ankles, or hands while using this medicine.

This medicine may cause serious types of allergic reactions, including anaphylaxis and angioedema, which can be life-threatening and require immediate medical attention. Call your doctor right away if you or your child have itching, hives, hoarseness, trouble breathing or swallowing, or any swelling of your face, eyes, lips, tongue, arms, or legs while you are using this medicine.

This medicine may cause drug reaction with eosinophilia and systemic symptoms (DRESS). It is a serious allergic reaction that may affect several parts of the body (eg, liver, kidneys, muscle, joints). Check with your doctor right away if you or your child have more than one of the following symptoms: dark urine, extra fluid around the face, fever, headache, itching, joint swelling, muscle aches, rash, stomach pain, swollen glands, unusual tiredness, or yellow eyes or skin.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using this medicine.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you or your caregiver notice any of these side effects, tell your doctor right away.

Do not stop using this medicine suddenly without talking first to your doctor. You may need to slowly decrease your dose before stopping it completely.

This medicine may cause some people to become dizzy, drowsy, lightheaded, clumsy, unsteady, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you think you or your child have a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

Check with your doctor before using this medicine with other medicines that affect the central nervous system (CNS). The use of other medicines that affect the CNS with oxcarbazepine may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

Oral contraceptives (birth control pills) containing estrogen, ethinyl estradiol, levonorgestrel, or progestin, contraceptive progestin injections (eg, Depo-Provera®), and contraceptive implant forms of progestin (eg, Norplant®) may not work properly if you take them while you are taking oxcarbazepine. Unplanned pregnancies may occur. You should use a different or additional means of birth control while you are taking oxcarbazepine. If you have any questions about this, check with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Trileptal?

 You should not take Trileptal if you have a known hypersensitivity to oxcarbazepine or any of its components or to another anticonvulsant medication called eslicarbazepine acetate.

Oxcarbazepine is only recommended for use during pregnancy if the potential benefit outweighs the potential risk to the fetus. There are no studies involving oxcarbazepine use in pregnant people However, oxcarbazepine is similar in structure to another AED called Tegretol (carbamazepine), which is known to increase the risk of birth defects.

Consult with your healthcare provider if you are breastfeeding or plan to breastfeed. Oxcarbazepine can be passed to infants through human milk, so you may need to decide with your healthcare provider whether to stop nursing or stop taking the medication.

What Other Medications Interact With Trileptal?

Some medications can interact with oxcarbazepine. Your healthcare provider may provide guidelines regarding adjusting doses if you have to take oxcarbazepine and a medication with which it interacts.

Medications that interact with oxcarbazepine include:

  • Dilantin (phenytoin): Phenytoin is an AED. Oxcarbazepine can cause phenytoin levels to be higher than expected. 
  • Carbamazepine, phenytoin, phenobarbital: These AEDs can decrease the level of activity of oxcarbazepine.
  • Oral contraceptives: Oxcarbazepine may decrease the effectiveness of hormonal contraceptives. Your healthcare provider may recommend a different form of birth control if you use an oral contraceptive to prevent pregnancy. If you are using an oral contraceptive for another purpose, you and your healthcare provider might need to evaluate its effectiveness and consider changing.

This is not a complete list of all the drugs that may interact with Trileptal. Always keep an up-to-date list of all the medicines you take and share this information with your healthcare provider and pharmacist.

What Medications Are Similar?

There are over 30 AEDs available, many of which have the same indications as Trileptal.

The generic version of Trileptal, oxcarbazepine, is used for the same indications as Trileptal. Additionally, oxcarbazepine is available in the extended-release formulation as Oxtellar XR.

The most similar AEDs to oxcarbazepine are:

  • Tegretol (carbamazepine), available as a brand and generic formulation 
  • Aptiom (eslicarbazepine), which is not available in a generic formulation

This is a list of drugs also prescribed for seizure disorders. It is NOT a list of drugs recommended to take with Trileptal. In fact, you should not take these drugs together.

Frequently Asked Questions

  • What is Trileptal used for?

    Trileptal prevents partial-onset seizures for adults and children over age 2. Healthcare providers may also prescribe it off-label to treat neuropathic pain, bipolar disorder, and schizoaffective disorder.

  • How does Trileptal work?

    Oxcarbazepine affects the ion channels in the nerve cell membrane, which modifies nerve activity in the brain and the nerves of the body.

  • What drugs should not be taken with Trileptal?

    There are no strict drug contraindications for oxcarbazepine. However, it can interact with phenytoin, carbamazepine, phenobarbital, and oral contraceptives.

  • How long does it take for Trileptal to work?

    Trileptal is rapidly absorbed in the body and starts to have an effect within hours. The body eliminates most of the drug within one day.

  • What are the side effects of Trileptal?

    Trileptal can have many side effects, including dizziness, impaired coordination, nausea and vomiting, headaches, and extreme fatigue. Severe and less common side effects include skin reactions, loss of consciousness, worsening seizures, and organ failure.

  • How do I safely stop taking Trileptal?

    You should not abruptly stop taking oxcarbazepine. When it is time for you to discontinue this medication, a healthcare provider will give you a schedule to gradually wean yourself off. You might begin another medication to replace its therapeutic effects.

How Can I Stay Healthy While Taking Trileptal?

If you are taking oxcarbazepine, you need to make sure also to take care of your health to prevent side effects.

Things you can do to stay healthy while taking oxcarbazepine:

  • Take as directed: Do not adjust this medication except as instructed by your healthcare provider. 
  • Don’t stop abruptly: Stopping the use of oxcarbazepine can cause you to have a seizure. 
  • Avoid seizure triggers: If you are taking oxcarbazepine for seizure control, ensure you know what causes your seizures and try to avoid these triggers. Common seizure triggers include alcohol, lack of sleep, high fevers, and flashing lights. 
  • Maintain good blood sugar control: If you are taking Trileptal to treat diabetic neuropathy symptoms, it is important to control your blood sugar to avoid worsening your diabetes. 
  • Counseling and stress management: Stress can worsen bipolar disorder and schizoaffective disorder. A therapist can help you understand your illness and cope with the symptoms effectively.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  8. Park CW, Ahn JH, Lee TK, et al. Post-treatment with oxcarbazepine confers potent neuroprotection against transient global cerebral ischemic injury by activating Nrf2 defense pathway. Biomed Pharmacother. 2020;124:109850. doi:10.1016/j.biopha.2020.109850

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.