OXCARBAZEPINE

Indications & Dose:

Monotherapy for the treatment of focal seizures with or without secondary generalised tonic

• BY MOUTH

Child 6–17 years: Initially 4–5 mg/kg twice daily (max. per dose 300 mg), then increased in steps of up to 5 mg/kg twice daily, adjusted according to response, dose to be adjusted at weekly intervals; maximum 46 mg/kg per day

Adult: Initially 300 mg twice daily, then increased in steps of up to 600 mg daily, adjusted according to response, dose to be adjusted at weekly intervals; usual dose 0.6–2.4 g daily in divided doses

Adjunctive therapy for the treatment of focal seizures with or without secondary generalised tonic-clonic seizures

•  BY MOUTH

Child 6–17 years: Initially 4–5 mg/kg twice daily (max. per dose 300 mg), then increased in steps of up to 5 mg/kg twice daily, adjusted according to response, dose to be adjusted at weekly intervals; maintenance 15 mg/kg twice daily; maximum 46 mg/kg per day

Adult: Initially 300 mg twice daily, then increased in steps of up to 600 mg daily, adjusted according to response, dose to be adjusted at weekly intervals; usual dose 0.6–2.4 g daily in divided doses

Treatment of primary generalised tonic-clonic seizures

•  BY MOUTH

Adult: Initially 300 mg twice daily, then increased in steps of up to 600 mg

Contraindications:

Hypersensitivity

Side Effects:

CNS:

Concentration difficulties, coordination abnormalities (ataxia, gait disturbances), cognitive symptoms, fatigue (15%), headache, insomnia, nystagmus, psychomotor slowing, speech or language problems, somnolence, tremor

EENT: Diplopia, abnormal vision

GI: Abdominal pain, dyspepsia, nausea, vomiting

GU: UTI, micturition frequency, vaginitis

METAB: Hyponatremia

SKIN: Rash 

Cautions:

Precautions:

Alcohol, CNS adverse effects, hormonal contraceptives, hypothyroidism, rapid withdrawal may precipitate seizures 

Interaction:

Drugs

• Note: Oxcarbazepine is an inhibitor of CYP2C19 and an inducer of CYP3A4 and CYP3A5 


• Alcohol: Additive CND depression and psychomotor impairment


•  Barbiturates: Decreases oxcarbazepine levels


•  Benzodiazepines: Additive CNS effects


•  Calcium channel blockers (dihy dropyridines): Induction of antihypertensive metaholism: decreased antihypertensive efficacy 


• Estradiol, oral contraceptives: Induction of hepatic metabolism; decreased hormonal efficacy


•  Medroxyprogesterone: Induction of hepatic metabolism: decreased hormonal efficacy 


• Lamotrigine: Induction of hepatic metabolism; decreased lamotrigine levels by 30% 


• Phenytoin: Alterations in hepatic metabolism resulting in increases in phenytoin levels/risk of toxicity and decreases in oxcarbazepine 


• Verapamil: Decreased plasma oxcarbazepine concetrations. 

Warnings:

Adverse Effects:

Lactations:

Pregnancy category C, increased incidence of fetal structural abnormalities and other manifestation of developmental toxicity have been observed in the offspring of animals; no adequate and wellcontrolled data ill humans; oxcarbazepine and MHD both excreted in human breast milk; milk:plasma ratio: 0.5 (both) 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: