Trileptal (chemically Oxcarbazepine), belongs to class of anticonvulsants and is used in treatment of epilepsy. Oxacarbazepine functions through decreasing nerve impulses in the epileptogenic area of brain that causes fits or seizure.
Indications for use of Trileptal
Following are the indications for Oxacarbazepine:
- Partial seizure in children older than 2 years as well as in adults
- Partial tonic-clonic seizure with secondary generalization
- Management of neuropathic pain in post-herpetic neuralgia, trigeminal neuralgia and some other conditions
Dosage of Trileptal
In adults for mono-therapy, Oxacarbazepine is started in an initial dose of 600 mg daily in two divided doses. Dose is increased 300 mg every third day to reach maximum dose of 2400mg per day.
When it is started as an adjunctive therapy, initial dose is 600 mg per day that can be increased up to1200 mg per day in a week time. Dose above 1200 mg may cause drug interaction with other anti-epileptic medication so when used as an adjunctive therapy; maximum dose should be 1200 mg per day.
When Trileptal is being used as an adjunctive therapy with other anti-epileptic drugs and the aim is to convert it to Oxacarbazepine mono-therapy, the dose of other drugs is tapered over 3-6 weeks and Oxcarbazepine dose is increased weekly to reach its maximum dose in 3 weeks.
Oxcarbazepine dose in children is 8-10 mg per day, maximum dose depends on the weight of the child.
Things to be discussed before starting Trileptal
Before starting Oxacarbazepine, patient should discuss with the doctor if he or she has following conditions:
- Kidney or liver disease, as they may affect the metabolism of the drug and increase side effects
- If he or she is taking any antiepileptic drug or other drugs, this is necessary to avoid drug interactions
- Any previous allergic reaction to Oxcarbazepine
Side effects of Trileptal
Side effects of Trileptal can be divided into two categories
- Most serious side effects
- Less serious side effects
Most serious side effects of Trileptal
If any of these side effects appear in patients taking Trileptal, they should immediately consult the emergency service. Drug has to be stopped in this case. The most serious side effects are:
- Allergic reaction: allergic reaction can occur to any drug so with trileptal. Manifestation of allergic reaction may be trivial like skin rash and hive or life threatening consisting of swelling of lips, face, tongue, or throat along with difficulty in breathing. This reaction should be immediately recognized and emergency help should be taken.
- Hyponatremia: in patients taking Oxcarbazepine, sodium may drop to dangerously low level, causing life-threatening hyponatremia. The symptoms of hyponatremia are nausea or vomiting, increased thirst, weakness, decreased appetite. In more severe hyponatremia, confusion, headache, hallucinations (seeing, feeling or hearing in the absence of any stimulus), muscle cramps and seizures can occur. Patients should be vigilant of these symptoms and should immediately contact their physician in case these symptoms appear.
- Change in mood of behavior: dangerous changes in mood and behavior are severe depression, anxiety, agitation, restlessness, hostility, mental or physical hyperactivity, suicidal thought or suicidal attempt.
- Sore throat accompanied with blistering, peeling of mucosa, skin rash and headache; these are manifestations of agranulocytosis developing in patient taking Oxacarbazipine.
- Yellowness of eyes or body called jaundice may be a sign of hepato-toxicity.
- Fever with flue like symptoms and swelling of lymph glands
- Easy bruising of the body
- Generalized weakness
- Decreased urine output
- Worsening of seizure
Less serious side effects of Trileptal
These side effects may settle over few days however, patient should seek expert advice on appearance of any of these side effects:
- Diarrhea
- Mild nausea or vomiting
- Pain epigastrium or stomach pain or dyspepsia
- Problem with co-ordination and difficulty in maintaining balance of the body
- Problems with speech
- Dizziness
- Sleepiness or drowsiness
- Blurring of vision
- Tremors
- Skin rash
In addition to all these side effects there may be some other side effects too. As per advice patient should immediately consult his or her physician on appearance of any new sign and symptom while taking Trileptal.
Contraindications to use of Trileptal
The only contraindication to use of Trileptal is previous allergy or hypersensitivity to Oxcarbazepine.
Drug Interactions
Oxcarbazepine inhibits enzyme CYP2C19 induces CYP3A4/5. This specific enzyme inhibition and induction affects metabolism of different drugs and can increase or decrease their plasma concentrations.
Oxacarbazepine also induces a subgroup of cytochrome P450 3A (CYP3A4 and CYP3A5). This enzyme is responsible for metabolism of certain drugs like calcium channel antagonist (dihydropyridines group), oral contraceptives and cyclosporine. When these drugs are co-administered with Oxacarbazepine, plasma concentration of these drugs decreases so is their effectiveness
Other anti-epileptics when combined with Trileptal, may have interaction with it. Concentration of phenytoin increases up to 40% when Trileptal is used as adjunctive therapy with phenytoin. So dose of phenytoin should be reduced when taken along with Trileptal. Oxcarbamazepine and Phenobarbital when taken together plasma concentration of Oxcarbazepine is decreased.
Cimetidine, erythromycin and warfarin have not shown significant drug interaction when used with Oxcarbazepine.
Pregnancy and use of Oxcarbazepine
Oxcarbazepine is category C drug in pregnancy. It has proven teratogenic effects on the fetus so if at all its use is necessary in pregnancy, potential benefits should be weighed against its hazards.
Trileptal abuse and dependence
Abuse potential with Oxcarbazepine use is minimal however physical dependence on drug has been shown in animal experiments.
Summarizing, Trileptal or Oxcarbazepine is an anti-epileptic medicine effective in treatment of partial seizures in children as well as in adults. Before it is administered, information on side effects as well as drug interaction should be kept in mind to avoid any untoward reaction. Trileptal has teratogenic effects on fetus so should carefully be used in pregnancy. The only contraindication to use of Trileptal is hypersensitivity to this drug.