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Home > Drug Category > Antiepileptic Medication > Trileptal and Equivalent

Trileptal (Oxcarbazepine) Information

Trileptal (oxcarbazepine) is a prescription antiepileptic drug (AED) that is a keto-analog of carbamazepine. It is approved for the treatment of Partial Seizures (simple, complex, and secondarily generalized) in adults and children, both as monotherapy and adjunctive therapy. It is structurally similar to carbamazepine but is metabolized differently, leading to fewer drug-drug interactions and generally better tolerability, particularly regarding severe dermatological reactions (though risk still exists). Following oral administration, oxcarbazepine is wholly and rapidly metabolized by hepatic enzymes into its primary active metabolite, the monohydroxy derivative (MHD). MHD is responsible for the drug's anticonvulsant activity. The mechanism of action is primarily mediated by the blocking of voltage-sensitive sodium channels, thereby stabilizing hyperexcited neuronal membranes, inhibiting repetitive neuronal firing, and reducing the propagation of synaptic impulses. Unlike carbamazepine, oxcarbazepine does not induce the enzyme that metabolizes itself (no autoinduction) and has minimal induction effect on other liver enzymes. MHD has an average half-life of approximately 9 to 10 hours.

Trileptal Side Effects

The side effect profile of Trileptal is often milder than that of its parent compound, carbamazepine, but still includes common neurological effects. The most common side effects reported include dizziness, drowsiness (somnolence), diplopia (double vision or blurred vision), ataxia (unsteadiness), nausea, vomiting, and fatigue. These central nervous system (CNS) effects are often dose-related and most pronounced during initial titration. Less common side effects include headache and tremor.

However, more serious side effects can occur. If any of the following symptoms are experienced, a patient should seek immediate medical attention:

• Anaphylaxis and Angioedema: Rare, severe allergic reactions causing swelling of the face, lips, or throat.

• Hypersensitivity Reactions/DRESS: Can occur, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), characterized by fever, rash, joint pain, and lymph gland inflammation, which may progress to severe organ involvement.

• Hyponatremia (Low Sodium): This is the most common profound side effect of oxcarbazepine. Symptoms can include nausea, malaise, headache, confusion, or increased seizure frequency. Serum sodium should be monitored before and during the initial three months of treatment.

• Severe Dermatologic Reactions (Boxed Warning for AEDs): While less common than with carbamazepine, Trileptal still carries a risk of rare but severe skin reactions, including Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Patients of Asian descent with the HLA-B*1502 allele are at a higher risk.

• Suicidal Thoughts and Behaviour: Like all AEDs, Trileptal may increase the risk of suicidal thoughts or behaviour.

Trileptal Precautions

Trileptal is contraindicated in patients with a known hypersensitivity to oxcarbazepine or any of its components. Approximately 25 percent of patients who have experienced hypersensitivity reactions (rash, allergy) to carbamazepine may also experience sensitivity to oxcarbazepine (cross-hypersensitivity); therefore, caution is advised. Due to the significant risk of hyponatremia, patients should be advised to report any symptoms of low sodium levels immediately, and their serum sodium levels should be checked regularly. Patients of Asian descent should be screened for the HLA-B*1502 allele before initiation of treatment. Trileptal can decrease the effectiveness of hormonal contraceptives, and women of childbearing potential should use alternative or high-dose estrogen birth control. Dosage should not be stopped abruptly to avoid the risk of increased seizure frequency or status epilepticus. Caution is advised for patients with renal impairment (due to MHD excretion), and a dose reduction may be necessary.

Do I need a prescription to order Trileptal?

Yes, a prescription is required from your physician to order Trileptal.