From the Guidelines
Trileptal, also known as oxcarbazepine, is recommended as a first-line treatment for partial seizures in adults and children with epilepsy, with a typical starting dose of 75 mg daily, as it has been shown to provide complete or partial relief of attacks in more than 85% of patients 1.
Key Points
- Trileptal works by blocking sodium channels in the brain, which helps prevent the abnormal electrical activity that causes seizures.
- The dosage should be flexible, as the extent of satisfaction with the treatment is subjective and individualized, and patients may tolerate auras without attacks or require complete relief of symptoms.
- For patients who cannot tolerate the dizziness or drowsiness of carbamazepine, or who harbor HLA-B*15:02, other voltage-gated sodium channel blockers, including lamotrigine, topiramate, and phenytoin sodium, are recommended as second-line treatment 1.
- Regular monitoring of sodium levels is important, especially when starting treatment, as Trileptal may cause hyponatremia (low sodium levels).
- Patients should take Trileptal consistently with or without food and should not stop taking it abruptly as this could trigger seizures.
Considerations
- Trileptal may interact with other medications, particularly hormonal contraceptives, which may become less effective, so additional birth control methods may be necessary.
- The use of Trileptal in combination with other medications, such as carbamazepine, should be avoided due to the potential for increased risk of adverse effects, such as agranulocytosis 1.
- Weekly blood cell counts are not typically required for Trileptal, but regular monitoring of sodium levels and other potential side effects is important.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Trileptal Overview
- Trileptal, also known as oxcarbazepine, is an antiepileptic drug used for the treatment of partial seizures with or without secondary generalization in adults and children over 6 years of age 2.
- It is available for both mono- and adjunctive therapy, and its mechanism of action mainly involves the blockage of sodium currents 2.
Dosage and Titration
- The recommended daily starting dose of oxcarbazepine for both mono- and adjunctive treatment is 8-10 mg/kg (600 mg/day for adults) in two doses, which can be titrated according to clinical benefit up to 2400 mg/day 2.
- In adults, the clinically recommended titration scheme is to start with 150 mg/day at night and increase by 150 mg/day every second day until a target dose of 900-1200 mg/day is reached 3.
- In children, treatment can be initiated with 8-10 mg/kg/day body weight in two to three divided doses, with dosage increases of 8-10 mg/kg/day in weekly increments if necessary for seizure control 3.
Efficacy and Safety
- Oxcarbazepine has been shown to be effective and well-tolerated in the treatment of partial epilepsy, with a low potential for drug interactions and a rash rate of less than 5% 4.
- It has been compared favorably to other antiepileptic drugs, including carbamazepine, sodium valproate, and phenytoin, in terms of efficacy and tolerability 2, 4.
- However, oxcarbazepine can cause hyponatremia (serum sodium <125 mmol/l) in approximately 3% of patients, and monitoring of serum sodium levels is recommended in patients with risk factors or symptoms of hyponatremia 3, 5.
Use in Children
- Oxcarbazepine has been shown to be effective and well-tolerated in children with partial onset seizures, with a similar efficacy profile to phenytoin and a better tolerability profile 6.
- The recommended dosage for children is 8-10 mg/kg/day in two or three divided doses, with increases of 10 mg/kg/day in weekly intervals if necessary for seizure control 4, 6.