Oxcarbazepine adjunctive therapy

The newer AEDs were first approved as adjunctive therapy for patients with refractory partial seizures. To date, lamotrigine, topiramate, and oxcarbazepine have received FDA approval for use in monotherapy in patients with partial seizures. Felbamate has monotherapy approval but causes significant side effects. 

Adjunctive therapy (600 mg/day twice/day) - If clinically indicated, the dose may be increased by a maximum of 600 mg/day at approximately weekly intervals the recommended daily dose is 1200 mg/day. Daily doses more than 1200 mg/day show somewhat greater effectiveness in controlled trials, but most patients were not able to tolerate the 2400 mg/day dose, primarily because of CNS effects. Observe and monitor closely the plasma levels of the concomitant AEDs during the period of oxcarbazepine titration, especially at oxcarbazepine doses more than 1200 mg/day. 

Adjunctive therapy - 8 to 10 mg/kg not to exceed 600 mg/day twice/day. Achieve the target maintenance dose of oxcarbazepine over 2 weeks,... 

Oxcarbazepine has been shown to be effective as adjunctive therapy or monotherapy for partial seizures in patients 4 to 16 years of age. 

Adjunctive therapy/monotherapy in pediatric patients previously treated with other AEDs - The most commonly observed (5% or more) adverse experiences seen in association with oxcarbazepine in pediatric patients were similar to those seen in adults. 

The safety and efficacy of oxcarbazepine 600-2400 mg/ day as adjunctive therapy for uncontrolled partial seizures have been studied in a randomized, double-bhnd, placebo-controUed study in 694 patients aged 15-65 years (7). During the double-bhnd phase, 76%, 84%, 90%, and 98% of patients respectively taking placebo or oxcarbazepine 600,1200, or 2400 mg/day reported one or more adverse events. The most common adverse events were related to the nervous and gastrointestinal systems. 

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. 

Oxcarbazepine (OXC) is EDA approved for monotherapy and adjunctive therapy of partial seizures in adults and adjunctive therapy for partial seizures in children >4 years old. 

Pharmacotherapy is the cornerstone of acute and maintenance treatment of bipolar disorder. Mood-stabilizing drugs are the usual first-choice treatments and include lithium, divalproex, carbamazepine, and lamotrigine. Atypical antipsychotics other than clozapine are also approved for treatment of acute mania. Lithium, lamotrigine, olanzapine, and aripiprazole are approved for maintenance therapy. Drugs used with less research support and without Food and Drug Administration (FDA) approval include topiramate and oxcarbazepine. Benzodiazepines are used adjunctively for mania. 

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