Oxcarbazepine
Trileptal · Oxtellar XR
Anticonvulsant / Mood StabilizerGeneric availableTDM data
Oxcarbazepine and its active metabolite (MHD, 10-monohydroxy derivative) exert anticonvulsant activity primarily through blockade of voltage-sensitive sodium channels, resulting in stabilization of hyperexcited neural membranes, inhibition of repetitive neuronal firing, and diminution of propagation of synaptic impulses. Additionally, increased potassium conductance and modulation of high-voltage activated calcium channels may contribute to the anticonvulsant effect.
Compare Oxcarbazepine →FDA-Approved Indications
- Partial-onset seizures — monotherapy or adjunctive therapy
What Sets This Drug Apart
- Better tolerated than carbamazepine with fewer drug interactions — no autoinduction of metabolism
- Clinically significant hyponatremia (Na <125 mEq/L) in 2.5% — higher than carbamazepine and requires sodium monitoring
- ~25-30% cross-reactivity risk with carbamazepine allergy — cannot assume safe switch in carbamazepine-allergic patients
- Weight-neutral mood stabilizer — advantage over valproate, lithium, and many SGAs for patients concerned about weight
- Weaker enzyme inducer than carbamazepine but still reduces oral contraceptive efficacy — backup contraception advised
- Available as extended-release (Oxtellar XR) for once-daily dosing — potential adherence advantage