Top 300 Pharmacy Drug Cards

OXCARBAZEPINE: Trileptal, Various

Class: Dibenzazepine Carboxamide, Anticonvulsant

Dosage Forms. Tablet: 150 mg, 300 mg, 600 mg; Tablet, Extended Release: 150 mg, 300 mg, 600 mg; Suspension: 300 mg/5 mL

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Common FDA Label Indication, Dosing, and Titration.

1. Partial seizure: Adults, 300 mg po bid, may titrate to 1200 mg/d po; Children 4-16 y, 8-10 mg/kg/d po in 2 divided doses, may titrate to 600 mg/d po

Off-Label Uses.

1. Trigeminal neuralgia: 300 mg po bid-qid, may titrate to 2400 mg po daily

MOA. Oxcarbazepine is a 10-keto analogue of carbamazepine that exerts its anticonvulsant effect through an active 10-monohydroxy metabolite (MHD). Its mechanism of action is not known but likely involves blockade of voltage-dependent sodium channels and inhibition of repetitive neuronal firing.

Drug Characteristics: Oxcarbazepine

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Medication Safety Issues: Oxcarbazepine

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Drug Interactions: Oxcarbazepine

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Adverse Reactions: Oxcarbazepine

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Efficacy Monitoring Parameters. Reduction in seizure frequency.

Toxicity Monitoring Parameters. Serum sodium during maintenance treatment, emergence or worsening of depression, suicidal behavior or ideation, or unusual changes in behavior.

Key Patient Counseling Points. Suspension should be shaken well and dose prepared immediately using oral dosing syringe. Suspension can be mixed in a small glass of water just prior to administration or may be swallowed directly from the syringe. Avoid activities requiring mental alertness or coordination until drug effects are realized. Advise patient to report signs/symptoms of serious dermatologic reactions, myelosuppression, or hepatotoxicity. Take with food, but not alcohol, grapefruit, or grapefruit juice. Avoid abrupt discontinuation to avoid risk of seizure.

Clinical Pearls. Safety and efficacy not established in pediatric patients younger than 4 y of age. With adjunctive therapy, children 2-4 y of age may require up to twice the oxcarbazepine dose per body weight compared to adults, and children 4-12 y of age may require a 50% higher oxcarbazepine dose per body weight compared to adults. Medication guide required at dispensing.