Oxcarbazepine (Trileptal)

Class

Anticonvulsant

Mechanism

Blocks voltage-gated sodium channels, stabilizing hyperexcited neural membranes and inhibiting repetitive neuronal firing.

FDA-Approved Use

Partial seizures, adjunctive therapy for generalized tonic-clonic seizures

Off-Label Use

Bipolar disorder, neuropathic pain, restless leg syndrome (RLS)

Formulation

Tablets, oral suspension

Titration

300 mg p.o. twice daily, titrated based on clinical response and tolerability

Dose Range

600–2400 mg/day, though many patients respond within the 900–1500 mg/day range

Kinetics

Metabolized to active monohydroxy derivative; less CYP3A4 induction than carbamazepine; primarily renal excretion

Common AEs

Dizziness, somnolence, headache, nausea, hyponatremia

Serious/Rare AEs

Hyponatremia, hypersensitivity reactions

Monitoring

Serum sodium levels, renal function, signs of hypersensitivity

Black Box Warning

None

Considerations

Use with caution in elderly patients and those with dementia due to sedative effects and fall risk. Dose adjustments may be necessary in renal impairment. Oxcarbazepine may be used cautiously in individuals with developmental disabilities, especially when seizures or mood symptoms co-occur; careful monitoring is recommended due to sedation and electrolyte disturbance risks.