Select a medication above to begin.
Trileptal
oxcarbazepine
Adult Dosing .
Dosage forms: TAB: 150 mg, 300 mg, 600 mg; SUSP: 300 mg per 5 mL
partial seizures
- [adjunct tx]
- Dose: 600 mg PO bid; Start: 300 mg PO bid, incr. by up to 600 mg/day qwk; Max: 2400 mg/day; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually to D/C
- [conversion to monotherapy]
- Dose: 1200 mg PO bid; Start: 300 mg PO bid, incr. by up to 600 mg/day qwk; Max: 2400 mg/day; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; D/C concomitant anticonvulsants over 3-6wk; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually to D/C
- [initial monotherapy]
- Dose: 600 mg PO bid; Start: 300 mg PO bid, incr. by 300 mg/day q3 days; Max: 2400 mg/day; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually to D/C
trigeminal neuralgia (off-label)
- [450-1200 mg PO bid]
- Start: 300 mg PO bid, may incr. by 600 mg/day qwk; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually to D/C
bipolar disorder (off-label)
- [600-1200 mg PO bid]
- Start: 300 mg PO bid, incr. by 300 mg/day q3 days or by 600 mg/day qwk; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; dose adjustment may be needed during pregnancy and/or postpartum; taper dose gradually to D/C
renal dosing
- [adjust dose amount]
- CrCl 10-50: may decr. usual dose by up to 25%; CrCl <10: decr. usual dose by 50%; Info: start 150 mg bid if CrCl <30; titrate dose slowly until response
- HD: decr. usual dose by 50%, on dialysis days admin. after dialysis; supplement not defined; PD: decr. usual dose by 50%; supplement not defined
hepatic dosing
- [see below]
- mild-moderate impairment: no adjustment; severe impairment: not defined
Peds Dosing .
- Dosage forms: TAB: 150 mg, 300 mg, 600 mg; SUSP: 300 mg per 5 mL
partial seizures
- [adjunct tx, 2-3 yo]
- Dose: 60 mg/kg/day PO divided bid; Start: 8-10 mg/kg/day PO divided bid up to 600 mg/day, incr. dose over 2-4wk; Max: 60 mg/kg/day; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; may start 16-20 mg/kg/day PO divided bid in pts <20 kg; taper dose gradually to D/C
- [adjunct tx, 4-16 yo, 20-29 kg]
- Dose: 450 mg PO bid; Start: 8-10 mg/kg/day PO divided bid up to 600 mg/day, incr. to target dose over 2wk; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; taper dose gradually to D/C
- [adjunct tx, 4-16 yo, 29.1-39 kg]
- Dose: 600 mg PO bid; Start: 8-10 mg/kg/day PO divided bid up to 600 mg/day, incr. to target dose over 2wk; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; taper dose gradually to D/C
- [adjunct tx, 4-16 yo, >39 kg]
- Dose: 900 mg PO bid; Start: 8-10 mg/kg/day PO divided bid up to 600 mg/day, incr. to target dose over 2wk; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; taper dose gradually to D/C
- [monotherapy, 4-16 yo, 20-24 kg]
- Dose: 300-450 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; D/C concomitant anticonvulsants over 3-6wk; taper dose gradually to D/C
- [monotherapy, 4-16 yo, 25-34 kg]
- Dose: 450-600 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; D/C concomitant anticonvulsants over 3-6wk; taper dose gradually to D/C
- [monotherapy, 4-16 yo, 35-44 kg]
- Dose: 450-750 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; D/C concomitant anticonvulsants over 3-6wk; taper dose gradually to D/C
- [monotherapy, 4-16 yo, 45-49 kg]
- Dose: 600-750 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; D/C concomitant anticonvulsants over 3-6wk; taper dose gradually to D/C
- [monotherapy, 4-16 yo, 50-59 kg]
- Dose: 600-900 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; D/C concomitant anticonvulsants over 3-6wk; taper dose gradually to D/C
- [monotherapy, 4-16 yo, 60-69 kg]
- Dose: 600-1050 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; D/C concomitant anticonvulsants over 3-6wk; taper dose gradually to D/C
- [monotherapy, 4-16 yo, >70 kg]
- Dose: 750-1050 mg PO bid; Start: 8-10 mg/kg/day PO divided bid, incr. by 5 mg/kg/day q3 days if initial monotherapy or by up to 10 mg/kg/day qwk if conversion to monotherapy; Info: consider screening pts of genetically at-risk ancestry (see pkg insert) for HLA-B*1502 allele before initiating tx; D/C concomitant anticonvulsants over 3-6wk; taper dose gradually to D/C
renal dosing
- [adjust dose amount]
- CrCl <30: decr. usual dose by 50%, max start dose 300 mg/24h
- HD: decr. usual dose by 50%, on dialysis days admin. after dialysis; supplement not defined; PD: decr. usual dose by 50%; supplement not defined
hepatic dosing
- [see below]
- mild-moderate impairment: no adjustment; severe impairment: not defined
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to eslicarbazepine acetate
- HLA-B*1502 allele (tx-naive pts)
- abrupt withdrawal
- caution: hypersensitivity to aromatic antiepileptics
- caution: female pts of reproductive potential
- caution: pregnancy
- caution: elderly pts
- caution: Asian pts (incr. prevalence of HLA-B*1502 allele)
- caution: hyponatremia
- caution: CrCl <50 (IR form)
- caution: CrCl <30 (ER form)
- caution: depression
- caution: depression hx
Drug Interactions .
Overview
oxcarbazepine
sodium channel blocker
- CYP3A4 substrate
- UGT1A9 substrate
- UGT2B7 substrate
- CYP2C19 inhibitor, weak
- CYP3A4 inducer, minor
- UGT1A1 inducer
- P-gp inducer
- antiepileptic agent
- CNS depression
- delays atrioventricular conduction
- hyponatremia
Contraindicated
- amifampridine
- bupropion
- cabotegravir
- dalfampridine
- doravirine
- metoclopramide
- rilpivirine
Avoid/Use Alternative
- atazanavir
- atogepant
- bictegravir
- cobicistat
- codeine
- dabigatran
- desogestrel (contraceptive)
- dienogest (contraceptive)
- dolutegravir
- doxylamine
- drospirenone (contraceptive)
- elvitegravir
- eslicarbazepine acetate
- estradiol (contraceptive)
- ethanol
- ethinyl estradiol (contraceptive)
- ethynodiol (contraceptive)
- etonogestrel (contraceptive)
- flibanserin
- fosamprenavir
- futibatinib
- ginkgo
- hydrocodone
- isocarboxazid
- kava
- kratom
- lenacapavir
- letermovir
- levonorgestrel (contraceptive)
- levonorgestrel (post-coital contraceptive)
- lindane topical
- lopinavir/ritonavir
- lumateperone
- mavacamten
- medroxyprogesterone (contraceptive)
- meperidine
- metaxalone
- methadone
- midazolam
- norelgestromin (contraceptive)
- norethindrone (contraceptive)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- oxybate
- phenelzine
- ponesimod
- promethazine
- ranolazine
- ropeginterferon alfa-2b
- sacituzumab govitecan
- segesterone (contraceptive)
- sirolimus albumin-bound
- sofosbuvir
- tenofovir alafenamide
- thalidomide
- tranylcypromine
- trimethobenzamide
- ulipristal (post-coital contraceptive)
- velpatasvir
- voxilaprevir
- zuranolone
Monitor/Modify Tx
- acetazolamide
- aldesleukin
- alfentanil
- alprazolam
- amiloride
- amitriptyline
- amlodipine
- apalutamide
- aripiprazole
- baclofen intrathecal
- brexanolone
- bumetanide
- buprenorphine
- butalbital
- butorphanol
- carbamazepine
- carvedilol
- chlordiazepoxide
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cisplatin
- citalopram
- clobazam
- clomipramine
- clonazepam
- clorazepate
- cyclophosphamide
- cyclosporine
- daridorexant
- deferasirox
- desflurane
- desmopressin
- desvenlafaxine
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- digoxin
- dihydrocodeine
- diltiazem
- dinutuximab
- disopyramide
- droperidol
- duloxetine
- encorafenib
- enzalutamide
- escitalopram
- esketamine
- estazolam
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- everolimus
- fedratinib
- fentanyl
- fluoxetine
- fluphenazine
- fluvoxamine
- fosphenytoin
- furosemide
- gabapentin
- gabapentin enacarbil
- hydrochlorothiazide
- hydrocortisone
- hydromorphone
- hydroxyzine
- ifosfamide
- indapamide
- isoflurane
- isradipine
- ivosidenib
- ketamine
- ketoconazole
- lacosamide
- lemborexant
- levomilnacipran
- levorphanol
- levothyroxine
- linagliptin
- linezolid
- liothyronine
- lorazepam
- lumacaftor/ivacaftor
- magnesium citrate
- mannitol
- methazolamide
- methohexital
- metolazone
- milnacipran
- mirtazapine
- mitapivat
- mitotane
- morphine
- nalbuphine
- nelarabine
- nelfinavir
- nevirapine
- nicardipine
- nilotinib
- nimodipine
- nisoldipine
- olanzapine
- oliceridine
- opicapone
- opium
- oxazepam
- oxybutynin
- oxycodone
- oxymorphone
- oxytocin
- paroxetine
- pentazocine
- pentobarbital
- perampanel
- perphenazine
- phenobarbital
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- posaconazole
- pregabalin
- primidone
- propofol
- quazepam
- quetiapine
- quinidine (antiarrhythmic)
- ramucirumab
- remifentanil
- remimazolam
- rifabutin
- rifampin
- ritonavir
- romidepsin
- selinexor
- sertraline
- sevoflurane
- sirolimus
- spironolactone
- St. John's wort
- sufentanil
- sulfate bowel prep
- suvorexant
- tacrolimus
- tapentadol
- telmisartan
- temazepam
- thioridazine
- thiothixene
- thyroid
- tiagabine
- torsemide
- tramadol
- trazodone
- triamterene
- triazolam
- ubrogepant
- vasopressin
- venlafaxine
- vilazodone
- voriconazole
- vortioxetine
- warfarin
- zaleplon
- ziconotide
- zolpidem
Caution Advised
- 5-HTP
- abemaciclib
- abrocitinib
- acalabrutinib
- acyclovir
- afatinib
- allopurinol
- almotriptan
- amantadine
- aminophylline
- amiodarone
- amoxapine
- amoxicillin
- amphetamine
- ampicillin
- apixaban
- apomorphine
- apraclonidine ophthalmic
- aprepitant
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- artemether/lumefantrine
- asenapine
- atorvastatin
- avacopan
- avapritinib
- axicabtagene ciloleucel
- axitinib
- baclofen
- bazedoxifene
- benzphetamine
- berotralstat
- betamethasone
- bosentan
- bosutinib
- brexpiprazole
- brexucabtagene autoleucel
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- bromocriptine
- brompheniramine
- budesonide
- buspirone
- busulfan
- cabozantinib
- cannabidiol
- cannabis
- capivasertib
- capmatinib
- carbinoxamine
- cariprazine
- carisoprodol
- cefazolin
- cefepime
- cefiderocol
- ceftaroline fosamil
- ceftazidime
- cenobamate
- ceritinib
- cetirizine
- chamomile, German
- chlorambucil
- chloroquine
- chlorpheniramine
- chlorzoxazone
- ciltacabtagene autoleucel
- ciprofloxacin
- cisatracurium
- cladribine oral
- clarithromycin
- clemastine
- clonidine
- clopidogrel
- clozapine
- cobimetinib
- cocaine
- colchicine
- cortisone
- crizotinib
- cyclobenzaprine
- cyproheptadine
- dabrafenib
- dantrolene
- darbepoetin alfa
- darifenacin
- darolutamide
- darunavir
- dasabuvir
- dasatinib
- deflazacort
- delafloxacin
- desipramine
- deutetrabenazine
- dexamethasone
- dexchlorpheniramine
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- dicloxacillin
- diethylpropion
- difelikefalin
- difenoxin
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- domperidone
- donepezil
- doxepin
- doxepin topical
- doxorubicin
- dronabinol
- dronedarone
- edoxaban
- efavirenz
- elacestrant
- elbasvir
- eletriptan
- eliglustat
- elivaldogene autotemcel
- entacapone
- entrectinib
- ephedra
- epoetin alfa
- erdafitinib
- erlotinib
- ertapenem
- erythromycin
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethinyl estradiol (hormone replacement)
- ethosuximide
- etomidate
- etoposide
- etravirine
- exemestane
- felbamate
- felodipine
- fenfluramine
- fesoterodine
- fexofenadine
- finerenone
- fosaprepitant
- foscarnet
- fostamatinib
- frovatriptan
- fruquintinib
- galantamine
- ganaxolone
- ganciclovir
- gepirone
- gilteritinib
- glasdegib
- glecaprevir
- glofitamab
- glycopyrrolate
- goserelin
- grazoprevir
- guanfacine
- haloperidol
- histrelin
- hydroxychloroquine
- hyoscyamine
- ibrutinib
- idecabtagene vicleucel
- idelalisib
- iloperidone
- imatinib
- imipenem
- imipramine
- infigratinib
- iohexol
- iopamidol
- irinotecan
- isavuconazonium
- isoniazid
- istradefylline
- itraconazole
- ivacaftor
- ixazomib
- ketorolac
- lamotrigine
- lapatinib
- larotrectinib
- lasmiditan
- ledipasvir
- lefamulin
- leniolisib
- leuprolide
- levetiracetam
- levocarnitine
- levocetirizine
- levodopa
- levofloxacin
- levoketoconazole
- levonorgestrel intrauterine device (contraceptive)
- lidocaine
- lidocaine topical
- lisdexamfetamine
- lisocabtagene maraleucel
- lithium
- lofexidine
- lonafarnib
- lorlatinib
- loxapine
- lurasidone
- macitentan
- maraviroc
- meclizine
- mefloquine
- melatonin
- meprobamate
- meropenem
- methamphetamine
- methocarbamol
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methsuximide
- methyldopa
- methylphenidate
- metronidazole
- metyrapone
- metyrosine
- mexiletine
- midostaurin
- mobocertinib
- modafinil
- molindone
- mosunetuzumab
- moxifloxacin
- mycophenolate mofetil
- nafarelin
- nafcillin
- naldemedine
- naloxegol
- naltrexone
- naratriptan
- nefazodone
- neratinib
- netupitant
- nifedipine
- nintedanib
- nirmatrelvir
- nirogacestat
- nortriptyline
- ofloxacin
- olaparib
- olutasidenib
- ombitasvir
- orphenadrine
- oxacillin
- pacritinib
- palbociclib
- paliperidone
- paritaprevir
- passion flower
- pemigatinib
- penicillin G
- penicillin V
- pexidartinib
- phendimetrazine
- pheniramine
- phentermine
- pibrentasvir
- pimozide
- piperacillin
- pirtobrutinib
- ponatinib
- pramipexole
- praziquantel
- pretomanid
- procarbazine
- prochlorperazine
- proguanil
- propafenone
- protriptyline
- pyridostigmine
- pyrilamine
- pyrimethamine
- quinidine (CYP2D6 inhibitor)
- quinine
- quizartinib
- raltegravir
- ramelteon
- rasagiline
- regadenoson
- relugolix
- repotrectinib
- ribociclib
- rifapentine
- ripretinib
- risperidone
- rivaroxaban
- rivastigmine
- rizatriptan
- roflumilast
- rolapitant
- ropinirole
- rotigotine transdermal
- rufinamide
- safinamide
- samidorphan
- saquinavir
- scopolamine
- selegiline
- selegiline transdermal
- selpercatinib
- selumetinib
- sildenafil
- simvastatin
- sodium phosphate (bowel prep)
- sodium picosulfate
- solifenacin
- sonidegib
- sotorasib
- stiripentol
- sumatriptan
- sunitinib
- tadalafil
- tamoxifen
- tasimelteon
- teclistamab
- temsirolimus
- terbutaline
- tetrabenazine
- tezacaftor/ivacaftor
- theophylline
- ticagrelor
- tipranavir
- tisagenlecleucel
- tizanidine
- tofacitinib
- tolcapone
- tolterodine
- tolvaptan
- topiramate
- toremifene
- tranexamic acid
- triamcinolone
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- triptorelin
- trospium
- valacyclovir
- valbenazine
- valerian
- valganciclovir
- valproic acid
- varenicline
- venetoclax
- verapamil
- vigabatrin
- viloxazine
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- vonoprazan
- voxelotor
- zanubrutinib
- ziprasidone
- zolmitriptan
- zonisamide
Adverse Reactions .
Serious Reactions
- hyponatremia
- SIADH
- anaphylaxis
- angioedema
- drug rxn w/ eosinophilia and systemic sx
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- erythema multiforme
- acute generalized exanthematous pustulosis
- suicidality
- leukopenia
- thrombocytopenia
- pancytopenia
- agranulocytosis
- aplastic anemia
- pancreatitis
- withdrawal seizures if abrupt D/C
- withdrawal sx if abrupt D/C
Common Reactions
- dizziness
- headache
- nausea
- vomiting
- somnolence
- diplopia
- balance disorder
- fatigue
- asthenia
- tremor
- hyponatremia
- visual disturbance
- nystagmus
- ataxia
- abnormal gait
- abdominal pain
- dyspepsia
- gastritis
- diarrhea
- constipation
- cognitive dysfxn
- impaired concentration
- confusion
- URI sx
- rash
- nervousness
- insomnia
- acne
- photosensitivity
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; Na; s/sx depression, behavior changes, suicidality
Look/Sound-Alike Drug Names
Trileptal confused with: TEGretol
OXcarbazepine confused with: carBAMazepine; OLANZapine; oxaprozin
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; dose adjustment may be needed during pregnancy and/or postpartum; possible risk of teratogenicity based on conflicting human data; risk of teratogenicity and developmental toxicity based on animal data; possible risk of decr. maternal drug levels, efficacy during pregnancy
Pregnancy Registry
encourage pts to enroll in North American Antiepileptic Drug Pregnancy Registry at 1-888-233-2334 or www.aedpregnancyregistry.org
Individuals of Reproductive Potential
avoid pregnancy by using effective non-hormonal contraception during tx in female pts
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; inadequate human data available to assess risk of infant harm; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: none; Info: active metabolite
Excretion: urine 95% (<1% unchanged), feces <4%; Half-life: 2h (parent drug), 7-11h (parent drug, ER form), 9h (metabolite)
Subclass: Bipolar Disorder ; Neuropathy/Neuralgia ; Seizure Disorders
Mechanism of Action
exact mechanism of action unknown; blocks voltage-sensitive Na channels, stabilizes neural membranes, inhibits repetitive firing, and decr. synaptic impulse propagation
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Novartis Pharmaceuticals Corp.
DEA/FDA: Rx
Approximate Retail Price
from http://www.goodrx.com/trileptal
oral tablet:
- 150 mg (60 ea): $302.00
- 300 mg (90 ea): $811.00
- 600 mg (60 ea): $991.00
oral suspension:
- 300 mg/5 mL (2 bottle of oral suspension, 250 mL): $830.00
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