Epilepsy oxcarbazepine

Depression is a common problem in patients with epilepsy, with approximately 30% having symptoms of major depression at some point.34 Patients with epilepsy should be routinely assessed for signs of depression, and treatment should be initiated if necessary. Certain AEDs may exacerbate depression, for example levetirac-etam and phenytoin. Other AEDs (e.g., lamotrigine, carba-mazepine, and oxcarbazepine) maybe useful in treating depression. Changes in mood can be precipitated by addition or discontinuation of an AED. If treatment for depression is necessary, caution should be exercised in choosing an agent that does not increase seizure frequency and does not interact with AEDs. 

Kutluay E, McCague K, D Souza ID, Beydoun A. Safety and tolerability of oxcarbazepine in elderly patients with epilepsy. Epilepsy Behavior 2003 4 i 08-175. 

Oxcarbazepine is less potent than carbamazepine, both in animal models of epilepsy and in epileptic patients clinical doses of oxcarbazepine may need to be 50% higher than those of carbamazepine to obtain equivalent seizure control. Some studies report fewer hypersensitivity reactions to oxcarbazepine, and cross-reactivity with carbamazepine does not always occur. Furthermore, the drug appears to induce hepatic enzymes to a lesser extent than carbamazepine, minimizing drug interactions. Although hyponatremia may occur more commonly with oxcarbazepine than with carbamazepine, most adverse effects that occur with oxcarbazepine are similar in character to reactions reported with carbamazepine. 

Marson AG et al Levetiracetam, oxcarbazepine, remacemide and zonisamide for drug resistant localization-related epilepsy A systematic review. Epilepsy Res 2001 46 259. 

Reinikainen, K. J., Keranen, T., Halonen, T., Komulainen, H., Riekinen, P. J. Comparison of oxcarbazepine and carbamazepine a double-blind study, Epilepsy Res 1987, 1,284-289. 

Rattya J, Turkka J, Pakarinen AJ, Knip M, Kotila MA, Lukkarinen O, Myllyla VV, Isojarvi JI. Reproductive effects of valproate, carbamazepine, and oxcarbazepine in men with epilepsy. Neurology 2001 56(l) 31-6. 

Isojarvi JI, Turkka J, Pakarinen AJ, Kotila M, Rattya J, Myllyla VV. Thyroid function in men taking carbamazepine, oxcarbazepine, or valproate for epilepsy. Epilepsia 2001 42(7) 930-4. 

Leppik IE. Three new drugs for epilepsy levefiracefam, oxcarbazepine, and zonisamide. J Child Neurol. 2002 f7 SuppI f S53-7. 

Skin rash reactions to carbamazepine may resolve in 75% of patients with epilepsy when switched to oxcarbazepine thus,... 

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). 

The safety and efficacy of oxcarbazepine 300 and 2400 mg/day have been studied in patients with refractory partial epilepsy in a double-blind, randomized trial (8). Dizziness, fatigue, somnolence, and nausea, mostly transient and mild to moderate, were the most frequent adverse events. 

Two doses of oxcarbazepine have been compared in a double-blind, parallel-group, randomized trial in patients with uncontrolled partial-onset epilepsy who had previously taken carbamazepine monotherapy (10). After two open phases in 143 patients, 96 were randomized to oxcarbazepine 300 or 2400 mg/day for 126 days. The time to meet an exit criterion was significantly in favor of oxcarbazepine 2400 mg/day. In aU, 24 of the 47 non-rando-mized patients withdrew because of an adverse event, most commonly dizziness, ataxia, headache, nansea, vomiting, or fatigne. Three withdrew becanse of laboratory abnormalities, one each with leukopenia, hjrponatre-mia, and hjrperglycemia. Headache, dizziness, and nansea were the only adverse events that occurred in more than 10% in either gronp. Similar adverse events were reported in the randomized patients, but none withdrew. 

Bares G, Walker EB, Eiger CE, ScarameUi A, Stefan H, Sturm Y, Moore A, Flesch G, Kramer L, D Souza J. Oxcarbazepine placebo-controUed, dose-ranging trial in refractory partial epilepsy. Epilepsia 2000 41(12) 1597-607. 

Schmidt D, Arroyo S, Baulac M, Dam M, Dulac O, Friis ML, Kalviainen R, Kramer G, van Parys J, Pedersen B, Sachdeo R. Recommendations on the clinical use of oxcarbazepine in the treatment of epilepsy a consensus view. Acta Neurol Scand 2001 104(3) 167-70. 

Lakehal F, Wmden CJ, Kalhorn TF, Levy RH. Carbamazepme and oxcarbazepine decrease phenytom metabolism through mhibition of CYP2C19. Epilepsy Res 2002 52(2) 79-83. 

Marson AG, Hutton JL, Leach JP, Castillo S, Schmidt D, White S, Chaisewikul R, Privitera M, Chadwick DW. Levetiracetam, oxcarbazepine, remacemide and zonisamide for drug resistant localization-related epilepsy a systematic review. Epilepsy Res 2001 46(3) 259-70. 

I Place in Therapy. Oxcarbazepine is indicated for use as monotherapy or adjunctive therapy in the treatment of partial seizures in adults and as monotherapy and adjunctive therapy in the treatment of partial seizures in patients as young as 4 years of age with epilepsy. It is also a potential first-fine drug for patients with primary generalized convulsive seizures. Oxcarbazepine may be effective in patients not demonstrating a response to carbamazepine. 

Oxcarbazepine is an anticonvulsant. The pharmacologic activity is primarily through the 10-monohydroxy metabolite (MHD) of oxcarbazepine, but the exact mechanism is unknown. It may block voltage-sensitive sodium channels resulting in stabilization of hyperexcited neural membranes, inhibition of repetitive neuronal firing, and diminution of propagation of synaptic impulses. It is indicated as a monotherapy or adjunctive therapy in the treatment of partial seizures in patients with epilepsy. 

Oxcarbazepine (Trileptal ) is the 10-keto analogue of carbamazepine (Fig. 20.6). It is indicated as monotherapy or adjunctive therapy for partial seizures in adults with epilepsy, as monotherapy for the treatment of partial seizures in children 4 years of age or older, and as adjunct therapy in children 2 to 4 years of age. 

Gelisse P, Genton P, Kuate C, et ai. Worsening of seizures by oxcarbazepine in Juvenile idiopathic generalized epilepsies. Epilepsia 2004 45 1282-1286. 

Mintzer S, Boppana P, Toguri J, et ai. Vitamin D levels and bone turnover in epilepsy patients taking carbamazepine and oxcarbazepine. Epilepsia 2006 47 510-515. 

Striano S, Striano P, DiNocera P, et ai. Relationship between serum mono-hydroxy-carbazepine concentrations and adverse effects in patients with epilepsy on high-dose oxcarbazepine therapy. Epilepsy Res 2006 69 170-176. 

Lott, R. S. and Hehnboldt, K., Oxcarbazepine a carbamazepine analogue for partial seizures in adults and children with epilepsy, Formulary, 35 1-9, 2000. 

Oxcarbazepine (TRILEPTAL, Novartis Pharmaceuticals Corporation) is used for the treatment of partial seizures in people with epilepsy. 

Dextropropoxyphene 65 mg three times daily for 7 days did not affect the steady-state levels of the active metabolite of oxcarbazepine in 7 patients with epilepsy or trigeminal neuralgia. ... 

In a study in 12 healthy subjects citalopram 40 mg daily for 2 weeks caused no change in the pharmacokinetics of carbamazepine 400 mg once daily. An approximate 30% decrease in citalopram levels occurred in 6 patients taking citalopram 40 to 60 mg daily when they were given carbamazepine 200 to 400 mg daily for 4 weeks. Despite this decrease, the combination was considered clinically useful. Similarly, two patients with epilepsy, major depression, and panic disorder had increased citalopram levels (one had an improved antidepressant response, but the other patient experienced tremor and increased anxiety) when their treatment with carbamazepine was replaced by oxcarbazepine. ... 

Pisani F, Fazio A, Oteri G, Artesi C, Xiao B, Perucca E, Di Perri R, Effects of the antidepressant drug viloxazine on oxcarbazepine and its hydro lated metabolites in patients with epilepsy, Acta Neurol Scand (1994) 90, 130-2. 

Lakehal F, Wurden CJ, Kalhom TF, Levy RH. Carbamazepine and oxcarbazepine decrease phenytoin metabolism through inhibition of CYP2C19. Epilepsy Res (2002) 52, 79-83. 

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