Oxcarbazepine

Indications
 Oral
Monotherapy or adjunctive therapy in the treatment of partial seizures with or without secondary generalised tonic-clonic seizures
Adult: Initially, 600 mg daily in 2 divided doses; increase at a max increments of 600 mg daily at wkly intervals depending on response. Maintenance: 600-1,200 mg daily. Adjunctive therapy/refractory patients switched from other anticonvulsants: Up to 2,400 mg daily.
Child: >6 yr: 8-10 mg/kg daily in 2 divided doses; increase as necessary to max increments of 10 mg/kg daily at about wkly intervals to a max of 46 mg/kg daily. Maintenance in adjunctive therapy: 30 mg/kg daily.
CrCl (ml/min)Dosage Recommendation
<30Initially, 300 mg daily or 50% of usual dose. Increase at wkly intervals or longer.


Special Populations: Renal impairment: CrCl <30 mL/min: ½ of the usual starting dose increased at wkly intervals or longer.
Contraindications
 Hypersensitivity. Lactation.
Warnings / Precautions
 Cross-sensitivity to carbamazepine may occur. Do not discontinue abruptly. Renal and hepatic impairment. Patients at risk of hyponatraemia. May impair ability to drive or operate machinery. Pregnancy.
Adverse Reactions
 Dizziness, somnolence, headache, ataxia, fatigue, vertigo, nervousness, amnesia, abnormal thinking, insomnia, speech disorder, agitation, confusion; vomiting, nausea, abdominal pain, diarrhoea, dyspepsia, constipation, gastritis, wt gain; abnormal gait, tremor, weakness, back pain, abnormal coordination, dysmetria, sprains/strains, muscle weakness; diplopia, nystagmus, abnormal vision and accommodation; hypotension, leg oedema; rash, acne; hyponatraemia; rhinitis, chest infection, epistaxis, sinusitis.
Potentially Fatal: Stevens-Johnson syndrome, toxic epidermal necrolysis. Anaphylaxis and angioedema.
Overdose Reactions
 Symptoms: CNS depression (somnolence, ataxia). Treatment: Symptomatic and supportive.
Drug Interactions
 Reduced serum levels with carbamazepine, phenobarbitone, phenytoin, valproic acid. May reduce levels/effects of CYP3A4 substrates (e.g. benzodiazepines, calcium channel blockers, clarithromycin, ciclosporin, erythromycin, oestrogens, mirtazapine, nateglinide, nefazodone, nevirapine, protease inhibitors, tacrolimus, venlafaxine). May reduce efficacy of oral contraceptives. May reduce levels/effects of maraviroc. May increase levels of phenobarbitone, phenytoin.
See Below for More oxcarbazepine Drug Interactions
Food Interactions
 Levels may be reduced with St John's wort. Evening primrose may reduce seizure threshold and reduce the effects of oxcarbazepine.
Mechanism of Actions
 Oxcarbazepine blocks voltage-sensitive sodium channels, which inhibits repetitive firing, stabilises hyperexcited neuronal membranes and decreases release of synaptic impulses. These effects may prevent the spread of epileptic seizures.
Absorption: Well absorbed from the GI tract.
Distribution: Monohydroxy metabolite: Widely distributed; protein-binding: About 40%, mainly to albumin. Oxcarbazepine and metabolite: Cross the placental barrier and enter breast milk.
Metabolism: Metabolised in the liver to 10,11-dihydro-10-hydroxy-carbamazepine (principal metabolite; possesses antiepileptic activity).
Excretion: Via urine (mainly as metabolites). Half-life: 2 hr (oxcarbazepine); 9 hr (monohydroxy metabolite).
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 25°C (77°F).
ATC Classification
 N03AF02 - oxcarbazepine ; Belongs to the class of carboxamide derivatives antiepileptic.
Storage
 Oral: Store at 25°C (77°F).
Available As
  • Oxcarbazepine 150 mg
  • Oxcarbazepine 300 mg
  • Oxcarbazepine 450 mg
  • Oxcarbazepine 500 mg
  • Oxcarbazepine 600 mg
  • Oxcarbazepine 900 mg

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