What to Know About Trileptal (Oxcarbazepine)

Trileptal (oxcarbazepine) is an anticonvulsant (also known as an antiepileptic drug) used to treat seizures. It is sometimes prescribed off-label to treat bipolar disorder.

Oxcarbazepine is available under the brand names Trileptal and Oxtellar XR. No major differences between brand name and generic oxcarbazepine have been reported; however, more studies are needed for conclusive evidence.

What Is Trileptal Used For?

Trileptal is approved by the Food and Drug Administration (FDA) to treat partial seizures in adults and children. Children and adults with epilepsy are commonly prescribed this medication. Oxcarbazepine has also been used to treat neuropathic pain; however, studies are limited on its efficacy.

Before Taking Trileptal

Tell your doctor about any of the following before taking Trileptal:

• If you have thoughts of suicide
• If you've had adverse effects or allergies to medications
• If you have other psychiatric or medical problems
• If you take other medications (including over-the-counter and herbal preparations)
• If you receive any non-medication treatment, such as therapy
• If you're pregnant or breastfeeding or have plans to become pregnant
• If you use alcohol or other substances

These can help your doctor determine whether you are a good candidate for Trileptal.

Before prescribing it, your doctor may perform blood tests to assess liver function, electrolytes, kidney function, pancreatic enzymes, and a complete blood count.

Your kidneys play a major role in processing medication. Because of this, your doctor will make sure your kidneys are fully functioning. In some cases, your doctor can decrease your dosage of Trileptal so that your kidneys can better process it.

Side Effects of Trileptal

There are many potential side effects of Trileptal. Be sure to monitor your symptoms after starting Trileptal and discuss concerns with your doctor.

Common Side Effects

The most common side effects of Trileptal include:

• Abdominal pain
• Abnormal vision
• Acid reflux (dyspepsia)
• Appetite loss
• Constipation
• Diarrhea
• Difficulty concentrating
• Dizziness
• Double vision (diplopia)
• Drowsiness
• Fast, uncontrollable eye movements
• Fatigue
• Thirst
• Forgetfulness
• Headache
• Nausea and vomiting
• Slower thoughts
• Taste changes
• Tremor
• Unsteadiness on your feet (ataxia)

Only 1% to 2% of patients experience weight gain.

Severe Side Effects

Serious side effects of Trileptal include:

• Blistering or peeling skin
• Intense fatigue or weakness
• Painful sores in your mouth or near your eyes
• Recurring infections or infections that don't go away
• Severe muscle pain
• Signs of an allergic reaction, such as difficulty breathing or swallowing, hives, itchy skin, rash, or swelling in your arms, legs, or face
• Signs of an infection such as fever, sore throat, chills, or swollen glands
• Unusual bleeding or bruising
• Yellowish skin or eyes

Oxcarbazepine treatment, like other anticonvulsants, carries a warning about an increased risk of suicidal thoughts or behaviors.

Trileptal Dosage

Trileptal is available as 150, 300, and 600 mg film-coated tablets. A typical dose to treat partial seizures might start at 300 mg twice a day and increase over several weeks.

The dosage for treating bipolar disorder may be similar. However, doctors often start on the smallest dose possible and increase as needed.

Check your prescription and talk to your prescribing doctor to make sure you are following the dosage regimen that's right for you.

Modifications

Trileptal oral suspension is the liquid form of the drug, which may be prescribed for people who have trouble swallowing pills. Children are commonly prescribed the liquid form, too.

How to Take and Store

Typically, Trileptal is taken in pill form. You also can take it as an extended-release pill or liquid. All forms should be stored in a cool, dry place; no refrigeration is necessary.

If you're prescribed the liquid, shake the bottle before pouring. Take the medicine from the spoon your pharmacy provides, or mix it into a glass of water and drink it.

You can take Trileptal with or without food. You may find it easier to swallow the pill with water.

If you miss a dose of Trileptal, take another dose as close as possible to the time you were scheduled to take it. If you're forgetting many doses or haven't been able to take your medication at a consistent time each day, discuss this with a healthcare provider.

Precautions and Contraindications

Trileptal may have adverse effects on certain people. Talk to a healthcare provider if any of the following apply to you.

Sensitivities to Medication

If you have an allergy to oxcarbazepine or to any of its components, you should not take Trileptal. If you're unsure, consult your prescribing doctor and discuss any other allergies you have to medications, especially if you have known allergies to Tegretol (carbamazepine).

Kidney or Liver Disease

Tell your doctor if you have or have had kidney or liver disease. These conditions affect how your body processes medication and should be evaluated before taking new medications.

Pregnant or Breastfeeding

If you're pregnant or become pregnant while taking Trileptal, let your doctor know. This medication has been associated with craniofacial and heart deformities in some infants. Trileptal also passes into breast milk, so you shouldn't breastfeed while taking it.

Tell your prescribing doctor if you are taking hormonal birth control. Trileptal can reduce its effectiveness, so you'll need to use additional birth control methods to prevent pregnancy.

Tell your prescribing doctor if you're planning to become pregnant; stopping Trileptal while pregnant can cause a significant relapse of your symptoms.

Suicidal Thoughts

Suicidal thoughts are a possible side effect of medications such as oxcarbazepine. Tell your doctor if you've had suicidal thoughts in the past. Your doctor may work with you directly or refer you to a mental health professional who can help monitor your symptoms as you take the medication.

It's important that you, your family members, and loved ones recognize this risk with Trileptal before beginning treatment and watch for any signs of it while you are taking the drug.

Contact a healthcare provider immediately, or have someone do it for you if you experience any of these symptoms, especially if they are new, worrisome, or become worse:

• Acting out dangerous impulses
• Aggressive, angry, or violent behavior
• Agitation or restlessness
  
• Giving away prized possessions
• Insomnia
• Mania, which involves a notable increase in your activity level
• New or worsening irritability, anxiety, or depression
• Panic attacks
• Preoccupation with death and dying
• Thoughts or talk of harming or killing yourself
• Withdrawal from friends and family

Tell your doctor about any other unusual changes in behavior or mood.

Other Anticonvulsants

Trileptal (oxcarbazepine) is closely related to Tegretol (carbamazepine), which is also used as a mood stabilizer in bipolar disorder.

Although Trileptal and Tegretol are used to treat the same conditions, Tegretol was found to be more likely to decrease the impact of other medications taken at the same time.

See your healthcare provider for all your follow-up appointments, and take Trileptal precisely as directed.

Warnings and Interactions

A fairly rare but dangerous side effect is hyponatremia, which is low sodium levels in your blood. Symptoms include headaches, nausea, confusion, tiredness, and, in severe cases, seizures and coma. Contact your doctor if you suspect this.

One sign of angioedema is a red rash in a localized area, which might spread to other parts of the body. If you show signs of these reactions, contact your doctor; they might decide to discontinue Trileptal and start you on an alternative medication.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal skin conditions that can be triggered by Trileptal. Your prescribing doctor might perform a blood test before prescribing oxcarbazepine because some people have a higher genetic predisposition to these conditions.

Don't drive or operate heavy machinery until you have gauged your response to Trileptal. Some people have experienced decreased motor coordination, slower speech, and fatigue as a result of taking Trileptal.

Do not stop taking Trileptal without consulting with a healthcare provider first. When stopping Trileptal, you must wean off of it under medical supervision.

Other Medications

To guard against interactions, make sure your prescribing doctor knows about all the prescription and over-the-counter medications you're taking, including supplements, vitamins, and herbal products.

While some drugs pose minor interaction risks, others might preclude use altogether or prompt careful consideration of the risks and benefits.

Medications that can interact with Trileptal include calcium channel blockers, other anticonvulsants, diuretics, proton-pump inhibitors, selective serotonin reuptake inhibitors (SSRIs), and some other medications, specifically:

• Cardene (nicardipine)
• Cardizem, Dilacor, Tiazac (diltiazem)
• Celexa (citalopram), Cymbalta (duloxetine), Zoloft (sertraline), and other SSRIs
• Cordarone (amiodarone)
• DynaCirc (isradipine)
• Elavil (amitriptyline)
• Norvasc (amlodipine) or other calcium channel blockers
• Plendil (felodipine)
• Procardia (nifedipine)

Your doctor can tell you if these or any other medications you take may interfere with Trileptal.