What labs are recommended for long-term use of Oxcarbazepine (Trileptal)?

From the Guidelines

For long-term use of oxcarbazepine, regular laboratory monitoring should include complete blood counts, sodium levels, and liver function tests, as recommended by the most recent guidelines 1. When initiating oxcarbazepine therapy, baseline laboratory assessments should include:

• Complete blood count to monitor for potential blood dyscrasias
• Comprehensive metabolic panel, with particular attention to sodium levels, to assess the risk of hyponatremia
• Liver function tests to evaluate hepatic function During treatment, it is essential to monitor:
• Sodium levels within the first month and then every 3-6 months to detect hyponatremia, a common side effect of oxcarbazepine
• Complete blood counts periodically to identify potential blood dyscrasias, although these are rare
• Liver function tests, especially in the first few months of treatment, to assess hepatic function Additionally, for patients with kidney disease, more frequent monitoring of drug levels and electrolytes may be necessary. It is also crucial to consider monitoring calcium, vitamin D, and bone density in patients on long-term oxcarbazepine therapy due to the potential risk of osteoporosis, as suggested by the guidelines for other medications with similar side effect profiles 1. These monitoring recommendations are based on the most recent and highest quality study available 1, and they help ensure the safe long-term use of oxcarbazepine by detecting potential adverse effects early and allowing for appropriate dose adjustments or interventions.

From the FDA Drug Label

Laboratory Abnormality: gamma-GT increased, hyperglycemia, hypocalcemia, hypoglycemia, hypokalemia, liver enzymes elevated, serum transaminase increased. Laboratory Tests Serum sodium levels below 125 mmol/L have been observed in patients treated with Oxcarbazepine [see Warnings and Precautions (5. 1)]. Laboratory data from clinical trials suggest that Oxcarbazepine use was associated with decreases in T4, without changes in T3 or TSH.

Key laboratory tests for long-term use of oxcarbazepine include:

• Serum sodium levels
• Liver enzymes (e.g., gamma-GT, serum transaminase)
• Electrolyte panels (e.g., potassium, calcium)
• Thyroid function tests (e.g., T4, T3, TSH)
• Complete blood counts (to monitor for potential hematologic effects) 2

From the Research

Labs for Long Term Use of Oxcarbazepine

• Serum sodium levels should be monitored in patients taking oxcarbazepine for long periods, as hyponatremia is a common adverse effect 3, 4, 5, 6, 7
• The frequency of hyponatremia increases with the duration of oxcarbazepine treatment, with each year of therapy increasing the risk of hyponatremia by 1.3 times 3
• Electrolyte balance should be evaluated before starting oxcarbazepine and during treatment, especially in patients with a history of hyponatremia or those taking other medications that may increase the risk of hyponatremia 5, 7
• Oxcarbazepine-induced hyponatremia is not solely attributable to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), but may also involve a direct effect on the renal collecting tubules or an enhancement of their responsiveness to circulating antidiuretic hormone 7
• Patients taking oxcarbazepine should be monitored for signs and symptoms of hyponatremia, including headache, nausea, vomiting, and seizures, and serum sodium levels should be checked regularly to prevent severe hyponatremia 3, 4, 5, 6