Trileptal (oxcarbazepine) is a second-generation antiepileptic drug (AED) indicated for the treatment of partial seizures in adults and children as young as 2 years of age, both as monotherapy and adjunctive therapy. Its active metabolite, 10-hydroxycarbazepine (MHD), exerts a primary mechanism of action through voltage-sensitive sodium channel blockade, stabilizing hyperexcited neuronal membranes and inhibiting repetitive neuronal firing. This profile offers a favorable pharmacokinetic and side effect spectrum compared to first-generation agents, making it a cornerstone in modern epilepsy management protocols. Clinical evidence supports its efficacy in reducing seizure frequency and improving quality of life metrics in diverse patient populations.

Features

• Active ingredient: Oxcarbazepine
• Mechanism: Voltage-gated sodium channel blockade
• Formulations: Film-coated tablets (150mg, 300mg, 600mg) and oral suspension (300mg/5mL)
• Metabolism: Rapidly reduced to active metabolite 10-hydroxycarbazepine (MHD)
• Half-life: MHD approximately 8–10 hours
• Protein binding: MHD ~40%
• Excretion: Primarily renal (>95% as metabolites)

Benefits

• Effective reduction in partial seizure frequency with established monotherapy and adjunctive efficacy
• Lower risk of severe cutaneous adverse reactions compared to carbamazepine
• Minimal induction of hepatic cytochrome P450 enzymes, reducing drug interaction potential
• Linear pharmacokinetics allowing predictable dose-response relationships
• Favorable cognitive side effect profile relative to older antiepileptic drugs
• Pediatric-friendly formulation availability including oral suspension

Common use

Trileptal is primarily prescribed for the treatment of partial seizures, with or without secondary generalization, in both adult and pediatric populations. It is approved for initial monotherapy in adults and as conversion to monotherapy in adults and children aged 4-16 years. Additionally, it is utilized as adjunctive therapy in adults and children aged 2-16 years. Off-label applications include treatment of bipolar disorder, neuropathic pain conditions such as trigeminal neuralgia, and as an alternative in patients who develop hypersensitivity reactions to carbamazepine.

Dosage and direction

Adults (monotherapy): Initiate with 600mg/day in two divided doses; may increase by 300mg/day every third day to recommended dose of 1200mg/day. Doses >1200mg/day show increased adverse effects without demonstrated additional benefit.

Adults (adjunctive therapy): Initiate with 600mg/day in two divided doses; maximum recommended dose 1200mg/day.

Pediatric patients (aged 2-16 years): Dose based on body weight:

• 20-29 kg: 900mg/day
• 29.1-39 kg: 1200mg/day

• 39 kg: 1800mg/day

Administer with or without food. Tablets should be swallowed whole; oral suspension should be shaken well before use. Dose adjustments required in patients with renal impairment (CrCl <30 mL/min).

Precautions

Hyponatremia (sodium <125 mmol/L) may develop in up to 3% of patients; monitor serum sodium levels during initiation and maintenance, particularly in patients receiving concomitant medications that may lower sodium levels. Caution advised in patients with pre-existing cardiac conditions, including conduction abnormalities. Multi-organ hypersensitivity reactions (DRESS) have been reported; discontinue if suspected. May cause dizziness and somnolence; advise patients regarding operating machinery or driving until familiar with medication effects. Periodic monitoring of liver function tests recommended.

Contraindications

Hypersensitivity to oxcarbazepine, eslicarbazepine, or any component of the formulation. Not recommended in patients with atrioventricular (AV) block. Contraindicated in patients with syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Possible side effect

Very common (>10%): Dizziness, somnolence, headache, fatigue, nausea, vomiting, diplopia, ataxia Common (1-10%): Hyponatremia, tremor, rash, abdominal pain, constipation, diarrhea, vertigo Uncommon (0.1-1%): Leukopenia, elevated liver enzymes, coordination abnormalities Rare (<0.1%): Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatitis, pancreatitis Frequency not known: Multi-organ hypersensitivity reactions, systemic lupus erythematosus, arrhythmias

Drug interaction

Strong inducers of CYP3A4/5 (carbamazepine, phenytoin, phenobarbital) may decrease MHD concentrations. May reduce efficacy of hormonal contraceptives; additional non-hormonal contraception recommended. May increase phenytoin levels; monitor and adjust phenytoin dose accordingly. Caution with other CNS depressants (alcohol, benzodiazepines, opioids). Concomitant use with other sodium channel blockers may increase risk of cardiac conduction disorders.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule to ensure stable plasma concentrations. Consult healthcare provider if multiple doses are missed.

Overdose

Symptoms may include drowsiness, dizziness, nausea, vomiting, hyperkinesia, hyponatremia, ataxia, nystagmus, coma, and convulsions. Management includes gastric lavage if presented early, activated charcoal, and supportive care with monitoring of vital signs, electrolyte levels (particularly sodium), and cardiac function. Hemodialysis may be effective due to low protein binding of MHD. Contact poison control center for latest guidance.

Storage

Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F). Keep container tightly closed. Protect from moisture. Oral suspension: Use within 7 weeks of first opening; do not freeze. Keep out of reach of children. Do not use after expiration date printed on packaging.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Trileptal is available by prescription only. Healthcare professionals should consult full prescribing information before administration. Patients should not adjust dosage or discontinue medication without consulting their physician. Individual response to medication may vary based on genetic, metabolic, and clinical factors.

Reviews

Clinical trials demonstrate 30-50% responder rates (≥50% seizure reduction) in adjunctive therapy across studies. Monotherapy trials show non-inferiority to phenytoin and valproate with improved tolerability profiles. Long-term extension studies indicate maintained efficacy over 2-5 years with acceptable safety profile. Real-world evidence supports effectiveness in diverse patient populations, though individual response varies based on epilepsy syndrome, concomitant medications, and genetic factors. Patient-reported outcomes indicate improved quality of life measures particularly related to cognitive side effect profile compared to older antiepileptic drugs.