Trileptal: Advanced Seizure Control with Oxcarbazepine
| Product dosage: 150mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 60 | $0.73 | $43.86 (0%) | 🛒 Add to cart |
| 90 | $0.66 | $65.79 $59.34 (10%) | 🛒 Add to cart |
| 120 | $0.63 | $87.72 $75.68 (14%) | 🛒 Add to cart |
| 180 | $0.60 | $131.58 $107.50 (18%) | 🛒 Add to cart |
| 270 | $0.58 | $197.37 $155.66 (21%) | 🛒 Add to cart |
| 360 | $0.56
Best per pill | $263.16 $202.96 (23%) | 🛒 Add to cart |
| Product dosage: 300mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 30 | $1.72 | $51.60 (0%) | 🛒 Add to cart |
| 60 | $1.38 | $103.20 $82.56 (20%) | 🛒 Add to cart |
| 90 | $1.27 | $154.80 $114.38 (26%) | 🛒 Add to cart |
| 120 | $1.21 | $206.40 $145.34 (30%) | 🛒 Add to cart |
| 180 | $1.15 | $309.60 $207.26 (33%) | 🛒 Add to cart |
| 270 | $1.11
Best per pill | $464.40 $301.00 (35%) | 🛒 Add to cart |
| Product dosage: 600mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 30 | $2.87 | $86.00 (0%) | 🛒 Add to cart |
| 60 | $2.15 | $172.00 $129.00 (25%) | 🛒 Add to cart |
| 90 | $1.91 | $258.00 $172.00 (33%) | 🛒 Add to cart |
| 120 | $1.79 | $344.00 $215.00 (38%) | 🛒 Add to cart |
| 180 | $1.67 | $516.00 $301.00 (42%) | 🛒 Add to cart |
| 270 | $1.60
Best per pill | $774.00 $430.86 (44%) | 🛒 Add to cart |
Synonyms | |||
Trileptal (oxcarbazepine) is a second-generation antiepileptic drug (AED) approved for the treatment of partial seizures in adults and children as monotherapy or 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. With a favorable pharmacokinetic profile and reduced risk of severe idiosyncratic reactions compared to first-generation agents, Trileptal represents a cornerstone in modern epilepsy management, offering robust efficacy and a generally well-tolerated side effect profile.
Features
- Active ingredient: Oxcarbazepine
- Available formulations: Film-coated tablets (150mg, 300mg, 600mg) and oral suspension (60mg/mL)
- Mechanism: Blocks voltage-gated sodium channels, reducing neuronal hyperexcitability
- Metabolism: Rapidly reduced to active metabolite 10-hydroxycarbazepine (MHD)
- Half-life: MHD exhibits a half-life of approximately 8–10 hours
- Excretion: Primarily renal (95% as metabolites, <1% unchanged)
- No autoinduction of metabolism, unlike carbamazepine
Benefits
- Provides effective reduction in seizure frequency and severity in partial-onset seizures with or without secondary generalization
- Lower risk of severe dermatological reactions (e.g., Stevens-Johnson syndrome) and hepatic enzyme induction compared to carbamazepine
- Linear pharmacokinetics and predictable dose-response relationship facilitate therapeutic drug monitoring
- Suitable for pediatric populations (ages 4–16) with weight-based dosing
- Minimal drug interactions with non-enzyme inducing AEDs and many non-AEDs
- Available in multiple formulations allowing for flexible dosing and administration
Common use
Trileptal is indicated as monotherapy or adjunctive therapy in the treatment of partial seizures in adults and in children 4 years of age and older. It may also be used off-label for the treatment of bipolar disorder, trigeminal neuralgia, and neuropathic pain, though these uses are not FDA-approved. Clinical studies demonstrate significant reduction in seizure frequency compared to placebo, with responder rates (≥50% reduction in seizure frequency) reaching 40-50% in adjunctive therapy trials.
Dosage and direction
Adults (monotherapy): Initiate with 600 mg/day (300 mg BID). May increase by 300 mg/day at weekly intervals to a recommended daily dose of 1200 mg/day (600 mg BID). Doses up to 2400 mg/day have been studied.
Adults (adjunctive therapy): Initiate with 600 mg/day (300 mg BID). May increase by 600 mg/day at weekly intervals. Recommended daily dose is 600–2400 mg/day.
Children (4–16 years): Initiate at 8–10 mg/kg/day, not to exceed 600 mg/day. Target maintenance dose should be achieved over two weeks, based on weight: 20–29 kg: 900 mg/day; 29.1–39 kg: 1200 mg/day; >39 kg: 1800 mg/day. Doses should be divided BID.
Dosage adjustment is recommended in patients with renal impairment (CrCl <30 mL/min). Administration with or without food is acceptable; oral suspension should be shaken well before use.
Precautions
Hyponatremia (sodium <125 mmol/L) may occur in up to 3% of patients. Serum sodium levels should be monitored during initiation and maintenance therapy, particularly in patients receiving concomitant medications that lower sodium or those with conditions predisposing to hyponatremia. Caution is advised in patients with renal impairment due to reduced clearance of the active metabolite. Serious dermatological reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported—though less frequently than with carbamazepine. Patients of Asian ancestry carrying the HLA-B*1502 allele may be at increased risk and should be screened if possible. Trileptal may cause dizziness and somnolence; patients should be cautioned about operating machinery or driving until they know how the medication affects them.
Contraindications
Trileptal is contraindicated in patients with known hypersensitivity to oxcarbazepine or any component of the formulation. Cross-hypersensitivity with carbamazepine occurs in approximately 25–30% of patients; careful monitoring is required when switching between these agents.
Possible side effect
Very common (≥10%): Dizziness, somnolence, headache, fatigue, nausea, vomiting, diplopia, vertigo, ataxia Common (1–10%): Hyponatremia, rash, abdominal pain, tremor, alopecia, constipation, diarrhea Uncommon (0.1–1%): Leukopenia, elevated liver enzymes, coordination abnormalities, nystagmus Rare (<0.1%): Anaphylaxis, angioedema, drug reaction with eosinophilia and systemic symptoms (DRESS), hepatitis, pancreatitis, agranulocytosis Most adverse reactions are dose-related and often diminish with continued therapy or dose reduction.
Drug interaction
Trileptal may reduce the efficacy of hormonal contraceptives; additional non-hormonal contraception is recommended. It may decrease serum concentrations of felodipine, verapamil, and other CYP3A4 substrates. Strong CYP3A4 inducers (e.g., carbamazepine, phenytoin, phenobarbital) may decrease MHD concentrations. Coadministration with other CNS depressants may potentiate sedative effects. Caution is advised with lithium (increased neurotoxicity risk) and diuretics (increased hyponatremia risk).
Missed dose
If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped and the regular dosing schedule resumed. Doubling of doses is not recommended.
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. Hemodialysis may be effective due to the drug’s renal excretion profile. There is no specific antidote.
Storage
Store at 25°C (77°F); excursions permitted to 15–30°C (59–86°F). Keep oral suspension in original container and use within 7 weeks of first opening. Protect from light and moisture. Keep out of reach of children.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and individualized treatment recommendations. Dosage and administration should be tailored to the patient’s clinical status, comorbidities, and concomitant medications. Not all possible interactions or side effects are listed here.
Reviews
Clinical trials and post-marketing surveillance demonstrate consistent efficacy and tolerability. In a meta-analysis of 11 randomized controlled trials, Trileptal showed a significant reduction in seizure frequency compared to placebo (RR 0.67, 95% CI 0.60–0.75). Patient-reported outcomes often highlight improved quality of life due to reduced seizure burden and manageable side effects. However, some patients report cognitive dulling or persistent dizziness requiring dose adjustment or discontinuation. Overall, it remains a widely prescribed option in epilepsy care.