Oxcarbazepine Carbamazepine

Oxcarbazepine Carbamazepine Phenobarbital Phenytoin Topiramate Valproic acid ... 

OXCARBAZEPINE CARBAMAZEPINE Variable effect on carbamazepine levels Uncertain Be aware monitor carbamazepine levels... 

Kumps, A. Simultaneous HPLC determination of oxcarbazepine, carbamazepine and their metabolites in serum. J.Liq.Chromatogr., 1984, 7, 1235-1241... 

Oxcarbazepine, carbamazepine, and six metabolites (e.g., carbamazepine 10,11-epoxide, 10,11-trans-dihydroxy-10,11-dihydrocarbamazepine) were extracted from serum and baseline resolved in 28 min [1449]. A Cjg colunm (A = 212nm) and a 20/80 acetonitrile/water (0.05% TEA at pH 6.3) mobile phase generated excellent peak shapes. Detection limits of lOng/mL were reported. 

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... 

Antipsychotics, bromocriptine, carbamazepine, chlorpropamide, cyclophosphamide, desmopressin, ecstasy, lamotrigine, monamine oxidase inhibitors, NSAIDs, oxcarbazepine, oxytocin, tricyclic antidepressants, selective serotonin reuptake inhibitors, vasopressin, vinblastine, and vincristine... 

Outside of the evidence-based guidelines, other pharmacologic treatments are commonly used or avoided. For initial treatment of absence seizures, ethosuximide and valproate are commonly used, not only in the United Kingdom, but also in the United States. Zonisamide may be also used for initial treatment of absence and myoclonic seizures. In absence and myoclonic seizures, carbamazepine, oxcarbazepine, gabapentin, tiagabine, and pregabalin should be avoided, as they have been associated with an exacerbation of these types of seizures. 

One chronic adverse effect that is of concern is osteoporosis.32,33 Carbamazepine, phenytoin, phenobarbital, oxcarbazepine, and valproate have all been shown to decrease bone mineral density, even after only 6 months of treatment. Data on the relationship between other AEDs and osteoporosis are not currently available. Multiple studies have shown the risk of osteoporosis due to chronic AED use to be similar to the risk with chronic use of corticosteroids. Patients taking carbamazepine, phenytoin, phenobarbital, or valproate for longer than 6 months should take supplemental calcium and vitamin D. Additionally routine monitoring for osteoporosis should be performed every 2 years, and patients should be instructed on ways to protect themselves from fractures. 

Oxcarbazepine Modulate sodium channels Loading dose Not recommended due to excessive adverse effects Maintenance dose 600-1200 mg/day. Start at 300 mg twice daily and titrate upward as indicated by response Half-life Not established Parent drug 2 hours 1 0-monohydroxy metabolite 9 hours Apparent volume of distribution 0.5-0.7 L/kg Protein binding 40% Primary elimination route Hepatic Diplopia, dizziness, somnolence Hyponatremia, 25-30% cross sensitivity in patients with hypersensitivity to carbamazepine... 

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

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. 

Lithium Carbamazepine Oxcarbazepine Divalproex (DVPX) Sodium/Valproic Acid (VPA) Lamotrigine... 

Oxcarbazepine Hyponatremia (serum sodium concentrations less than 125 mEq/L) has been reported and occurs more frequently during the first 3 months of therapy serum sodium concentrations should be monitored in patients receiving drugs that lower serum sodium concentrations (e.g., diuretics or drugs that cause inappropriate antidiuretic hormone secretion) or in patients with symptoms of hyponatremia (e.g., confusion, headache, lethargy, and malaise). Hypersensitivity reactions have occurred in approximately 25-30% of patients with a history of carbamazepine hypersensitivity and requires immediate discontinuation. 

Adverse Effects Adverse effects due to oxcarbazepine include drowsiness, dizziness, gastrointestinal upset, and hyponatremia, the latter two of which may be more likely than with carbamazepine. It is less likely than carbamazepine to cause hematologic abnormalities.34... 

U.S. Expert Panel 2005 Carbamazepine Lamotrigine Oxcarbazepine Levetiracetam ... 

U.S. Expert Panel 2005 Valproic acid Carbamazepine Lamotrigine Oxcarbazepine Phenobarbital Phenytoin Topiramate Valproic acid Children Carbamazepine Phenobarbital Phenytoin Topiramate Valproic acid Lamotrigine... 

Studies suggest that as monotherapy for partial seizures, lamotrigine is as effective as carbamazepine and phenytoin lamotrigine may be better tolerated. Clinical data suggest that oxcarbazepine is as effective as phenytoin, valproic acid, and immediate-release carbamazepine, with perhaps fewer side effects. 

Phenytoin, carbamazepine, phenobarbital, oxcarbazepine, and valproic acid may interfere with vitamin D metabolism, causing asymptomatic high-turnover bone disease with normal bone density or decreased bone mineral... 

Oxcarbazepine (a prodrag) is structurally related to carbamazepine, but it is converted to a monohydrate derivative, which is the active component. 

The most frequently reported side effects are dizziness, nausea, headache, diarrhea, vomiting, upper respiratory tract infections, constipation, dyspepsia, ataxia, and nervousness. It generally has fewer side effects than pheny-toin, valproic add, or carbamazepine. Hyponatremia has been reported in up to 25% ofpatients and is more likely in the elderly. About 25% to 30% of patients who have had a rash with carbamazepine will have a cross-reaction with oxcarbazepine. 

In patients converted from carbamazepine, the typical maintenance doses of oxcarbazepine are 1.5 times the carbamazepine dose. 

Carbamazepine is also commonly used for acute and maintenance therapy, but it is not FDA approved for bipolar disorder. Some data support the efficacy of oxcarbazepine, but it is also not FDA approved for bipolar disorder in the United States. 

Oxcarbazepine has mood-stabilizing effects similar to those of carbamaz-epine, but with milder side effects, no autoinduction of metabolizing enzymes, and potentially fewer drug interactions. There are fewer data supporting its efficacy than there are for carbamazepine s efficacy. 

History of hypersensitivity reaction to canbamazep/ne.Approximately 25% to 30% of patients who have had hypersensitivity reactions to carbamazepine will experience a hypersensitivity reaction with oxcarbazepine. 

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