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Oxcarbazepine is a mood
stabilizer which, like others in this class, was originally developed to
treat epilepsy. Oxcarbazepine is a
newer version of carbamazepine, which was associated with serious rashes,
drops in blood count, and problems in its interactions with other
drugs. Although oxcarbazepine has
not been associated with these problems, there may still be a potential for
them to occur.
Oxcarbazepine has not been studied
as extensively in bipolar disorder as carbamazepine has. However, there is as yet no reason to
believe that oxcarbazepine will not also prove to be an effective mood
stabilizer.
How does it work?
Oxcarbazepine helps stabilize
nerve cell firing.
What types are available and how is it taken?
Oxcarbazepine should be taken
twice a day, with or without food. The total daily dose ranges from 600 to
2400mg. If you miss a dose, ask yourself if you are closer to the dose you
missed or to your next dose. If you
are closer to your next dose, just wait and take it then, otherwise
it’s ok to take the dose you missed.
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Name
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Strengths
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Description
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Approximate price
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Oxcarbazepine (Trileptal)
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Tablets: 150, 300 and 600mg. Liquid (60mg/ml).
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Newer version of carbamazepine.
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60 tabs of: 150mg $66, 300mg $110, 600mg $208.
(Novartis).
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How long will I need to take it for?
After your
symptoms have resolved, oxcarbazepine continues to work to prevent future episodes
of bipolar disorder. Going without it can lead to more bipolar episodes,
and after too many episodes your brain can get in a habit (called
“kindling”) of mood swings that is harder to treat. Therefore, it is best to take
oxcarbazepine regularly as long as side effects are not a problem. If it is
ever stopped, it should be done slowly to prevent a sudden return of
symptoms.
What side effects can I expect?
Common side effects:
Dizziness (10-40%, dose-related),
vertigo or “spinning” feeling (5-10%, dose-related), poor
coordination (5-10%, dose related), trouble walking (5-25%, dose-related),
poor concentration (1-3%, dose-related), tired (10-20%, dose-related),
tremor, headache (5-10%), changes in vision (5-10%, dose-related), double
vision (10-40%, dose-related), mild weight loss, nausea/vomiting (5-30%,
dose-related), stomach pain (5-10%), indigestion (5%).
Rare but serious side effects:
Low sodium (hyponatremia): Symptoms of low sodium include nausea,
fatigue, headache, flu-like feelings, confusion and seizures. This
condition is very treatable and occurs in 2-3% of people taking
oxcarbazepine. The risk is greatest
during the first 3 months.
Potential side effects:
Stevens-Johnson Syndrome (a dangerous rash that appears as blistering of
the skin and mouth) and drops in blood count (including platelets which are
necessary for blood-clotting and white-blood cells necessary to fight
infection) are rare reactions associated with carbamazepine. Although they have not been associated
with oxcarbazepine, there remains a potential risk of these.
An allergic
reaction is possible with any medication.
Symptoms include the following; stop the medication and call me if
these occur:
Pounding heartbeat; swelling of the face, throat, tongue, lips, eyes,
hands, feet, ankles, or lower legs; hoarseness; difficulty swallowing or
breathing; hives; rash.
Overdose
The following are symptoms of overdose:
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Muscle twitching
or severe discoordination, confusion or loss of consciousness, seizures,
imbalance while walking, slurred speech, nausea and vomiting.
A high
level can be dangerous. If you think your level is too high, do the
following:
·
Stop
oxcarbazepine, call your doctor or go to the
emergency room.
Precautions
Since oxcarbazepine may cause drowsiness or
discoordination, Make sure you know how you react to it before you
drive, use machines, or do anything else that could be dangerous if you are
not alert, well-coordinated, or able to see well.
Contraception:
Oxcarbazepine can reduce the effectiveness of
oral-contraceptives.
Pregnancy:
Oxcarbazepine is a category-C drug and should be avoided if
possible during pregnancy, especially during the first trimester. It has
caused fetal defects in animal-studies.
Carbamazepine is known to produce defects in human pregnancies.
Breast-feeding: Oxcarbazepine comes out in breast
milk. Talk to your doctor if you
plan to breast-feed while taking it.
Children: Oxcarbazepine has been approved
for the treatment of epilepsy in children ages 4 and above.
Older adults: Oxcarbazepine
may be removed from the body more slowly in people after age 65, so lower
dosages may be needed.
Personal or family history
of allergic reaction to carbamazepine or tegretol: there
is a risk (approximately 30%) of having a similar reaction to
oxcarbazepine.
Medical problems that can worsen with
these oxcarbazepine:
- Thyroid
illness (oxcarbazepine can lower T4 thyroid)
Drug Interactions
Oxcarbazepine can lower levels of:
Oral contraceptives, calcium-channel
blockers (verapamil, femlodipine; by 30%).
Oxcarbazepine
can raise levels of:
Phenobarbital (by 14%), phenytoin
(by 40%),
Drugs that
can lower oxcarbazepine levels:
Depakote (by 18%), phenytoin (by
30%), carbamazepine (by 40%), phenobarbital (by 25%)
Alcohol and
Street Drugs
Although these do not interact
directly with oxcarbazepine, they may worsen the side effects or worsen the
symptoms of bipolar disorder.
Storage
- Keep
out of the reach of children.
- Store
away from heat and direct light.
- Do
not store in the bathroom, near the kitchen sink, or in other damp
places. Heat or moisture may cause the medicine to break down.
- Do
not keep outdated medicine or medicine no longer needed. Be sure that
any discarded medicine is out of the reach of children.
Updated 9/21/4 by Chris Aiken,
M.D.
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