Oxcarbazepine anticonvulsant

The miscellaneous anticonvulsants are contraindicated in patients with known hypersensitivity to any of the dru. Carbamazepine is contraindicated in patients with bone marrow depression or hepatic or renal impairment and during pregnancy (Category D). Valproic acid is not administered to patients with renal impairment or during pregnancy (Category D). Oxcarbazepine (Trileptal), a miscellaneous anticonvulsant, may exacerbate dementia... 

First, initiate and/or optimize mood-stabilizing medication lithium3 or lamotrigine6 Alternative anticonvulsants carbamazepine, oxcarbazepine, or valproate... 

Alternative anticonvulsants valproate,0 carbamaze-pine,0 or oxcarbazepine. 

Other anticonvulsants snch as oxcarbazepine, gabapentin, and lamotrigine may also be helpful in treating the affective lability and impulsivity seen in BPD, though little data is available. Each of these medications is discussed in Chapter 3. 

Mueller AA, Stoll KD. Carbamazepine and oxcarbazepine in the treatment of manic syndromes studies in Germany. In Emrich HM, Okuma T, Muller AA, eds. Anticonvulsants in affective disorders. Amsterdam Excerpta Medica, 1984 139-147. 

Another group of mood-stabilizing drugs that are also anticonvulsant agents have become more widely used than lithium. These include carbamazepine and valproic acid for the treatment of acute mania and for prevention of its recurrence. Lamotrigine is approved for prevention of recurrence. Gabapentin, oxcarbazepine, and topiramate are sometimes used to treat bipolar disorder but are not approved by FDA for this indication. Aripiprazole, chlorpromazine, olanzapine, quetiapine, risperidone, and ziprasidone are approved by FDA for the treatment of manic phase of bipolar disorder. Olanzapine plus fluoxetine in combination and quetiapine are approved for the treatment of bipolar depression. 

In addition to phenytoin, carbamazepine, and lamotrigine, metabolically optimized analogs of these drugs, such as fosphenytoin and oxcarbazepine, show clinical promise. Other anticonvulsants that block sodium channels, among several mechanisms of action, include zonisamide, felbamate, topiramate, and valproate (Fig. 5). 

Alternative anticonvulsants valproate, carbamazte pine, or oxcarbazepine. 

Alternative anticonvulsants valproate, carbte mazepin or oxcarbazepine. 

Other mood stabilizing anticonvulsants (carbamazepine, oxcarbazepine, lamotrigine)... 

Atypical anti psych otics may be preferable to lithium or anticonvulsants such as oxcarbazepine if treatment of bipolar disorder is required during pregnancy... 

Atypical antipsychotics and anticonvulsants such as valproate may be safer than oxcarbazepine during the postpartum period when breast feeding... 

Bromide (1857) was the first drug to be used for the treatment of epilepsy, but it is now obsolete. Phenobarbital, introduced in 1912, controlled patients resistant to bromides. The next success was the discovery in 1938 of phenytoin (a hydantoin) which is structurally related to the barbiturates. Since then many other drugs have been discovered, but phenytoin still remains a drug of choice in the treatment of major epilepsy. Over the past ten years there has been a dramatic increase in the number of new anticonvulsant drugs (vigabatrin, gabapentin, lamotrigine, topiramate, oxcarbazepine, levetiracetam), but none has been shown to be superior to the major standard anticonvulsants (phenytoin, carbamazepine and sodium valproate). 

Of the newer anticonvulsants, lamotrigine, gabapentin, tiagabine, and vigabatrin have little or no teratogenic potential in animals, whereas oxcarbazepine and topira-mate are teratogenic in rodents. However, animal studies are not necessarily apphcable to humans and chnical data are stiU insufficient to assess the effects of newer drugs on the development of the human fetus (153). 

Schachter SC. The next wave of anticonvulsants focus on levetiracetam, oxcarbazepine and zonisamide. CNS Drugs 2000 14 229 9. 

True hypersensitivity reactions to phenytoin are related to the "aromatic" anticonvulsants. Thus, in patients in whom a reaction is suspected, other arene anticonvulsants such as carbamazepine, oxcarbazepine, phenobarbital, or primidone should be avoided, as there is a high rate of cross-reactivity (estimated as high as 80%). Valproic acid is an agent that can be safely used as an alternative anticonvulsant in such patients. 

The two chemical classes, ureas and monoacylureas. have a long history of producing compounds with anticonvulsant activity. The numerical yield of clinically useful compounds has not been great, however. Most of the simpler compounds have gone by the way. For convenience of grouping, carba-mazepine and oxcarbazepine can be considered N.N-diacyl-ureas. 

Oxcarbazepine. Oxcarbazepine is a new, relatively safe anticonvulsant however, crosshypersensitivity was noted in patients previously hypersensitive to carbamazepine (25-30%). Asymptomatic hyponatremia has occurred in clinical trials during the first 3 months of therapy. Clinicians are advised to monitor serum sodium levels for patients during maintenance treatment. 

A review of the second-generation anticonvulsants reveals that screening or serendipity led to the development of felbamate (10), 1am-otrigine (11), zonisamide (13), topiramate (15), and levetiracetam (16) on the other hand, clobazam (4d) and oxcarbazepine (12) were developed by structural variation of known agents (78). Only three, vigabatrin (8), gabapentin (9), and tiagabine (14), were developed by mechanism-based rational development (78). 

Lithium and valproate are the mainstays of treatment for both acute mania and prophylaxis for recurrent manic and depressive episodes. Anticonvulsants such as lamotrigine, carbamazepine, and oxcarbazepine and atypical antipsy-chotics such as aripizrazole, olanzapine, risperidone, queti-... 

All anticonvulsants (except gabapentin), atypical antipsychotics, benzodiazepines, and calcium channel blockers require liver metabolism, and dosage adjustments may be needed (e.g., 25-50% reduction of normal doses) Carbamazepine or oxcarbazepine Alternative lamotrigine Acute mania or mixed episode first choice lithium... 

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