The therapeutic activity of Oxcarbazepine is mainly due to its 10-monohydroxy metabolite (MHD).
Mechanism of action:
These combined actions contribute to its anticonvulsant effect.
No significant interaction with major brain neurotransmitter receptor sites has been demonstrated.
Adults: Monotherapy or adjunctive therapy for the treatment of partial seizures.
Pediatrics:
Monotherapy in children 4–16 years with partial seizures.
Adjunctive therapy in children 2–16 years with partial seizures.
Adults:
Initial: 600 mg/day in two divided doses.
Adjunctive therapy: Increase by 600 mg/day at weekly intervals; recommended dose: 1200 mg/day.
Conversion to monotherapy: Withdraw other AEDs over 3–6 weeks; titrate Oxcarb XR to 2400 mg/day in 2–4 weeks.
Initiation of monotherapy: Increase by 300 mg/day every 3rd day to 1200 mg/day.
Renal impairment (CrCl <30 mL/min): Start with half the usual dose, titrate cautiously.
Pediatrics:
Starting dose: 8–10 mg/kg/day in two divided doses.
Children 2–<4 years and <20 kg: May start with 16–20 mg/kg/day.
Maintenance: Should not exceed 60 mg/kg/day.
Adjunctive therapy (2–16 years):
Age 4–16: Achieve target maintenance dose in 2 weeks.
Age 2–<4: Achieve maximum dose in 2–4 weeks.
Conversion to monotherapy (4–16 years): Increase by 10 mg/kg/day weekly, taper other AEDs over 3–6 weeks.
Initiation of monotherapy (4–16 years): Increase by 5 mg/kg/day every 3rd day.
Dosage must be individualized under physician supervision.
CNS: Dizziness, diplopia, headache, nystagmus, abnormal gait.
GI: Nausea, vomiting, abdominal pain.
Dermatologic: Rash.
Serum electrolytes: Hyponatremia (monitor sodium levels).
Rare: Bone marrow
Minimal interaction with cytochrome P450 enzymes.
No significant interactions observed with cimetidine, dextropropoxyphene, erythromycin, or warfarin.
Caution with other antiepileptics due to possible pharmacokinetic interactions.
Known hypersensitivity to Oxcarbazepine, its components, or eslicarbazepine acetate.
Pregnancy: Category C – use only if benefits outweigh risks.
Lactation: Excreted in breast milk (milk-to-plasma ratio ~0.5); not recommended during breastfeeding.
Risk of cognitive/neuropsychiatric effects: psychomotor slowing, concentration/language problems, somnolence, fatigue, ataxia, gait disturbance.
Hyponatremia: May occur; monitor serum sodium, especially if the patient is on sodium-lowering drugs.
Use cautiously in patients with carbamazepine hypersensitivity (cross-reactivity possible).
Store below 30°C, in a dry place, protected from light and moisture.
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