Can Trileptal (oxcarbazepine) cause nausea and vomiting?

Nausea and Vomiting as Side Effects of Trileptal (Oxcarbazepine)

Yes, Trileptal (oxcarbazepine) can definitely cause nausea and vomiting, which are among the most common side effects of this medication.

Evidence for Nausea and Vomiting with Oxcarbazepine

The FDA drug label for oxcarbazepine specifically lists nausea and vomiting among the most common side effects 1. This is the strongest evidence confirming the direct relationship between oxcarbazepine and these gastrointestinal symptoms.

Multiple research studies have consistently documented these effects:

• A comprehensive review of oxcarbazepine identified that the most common adverse effects are related to both the central nervous system and the gastrointestinal system, with nausea and vomiting specifically mentioned 2

• A 2015 review article specifically examining adverse effects of oxcarbazepine confirmed that digestive system effects including nausea and vomiting are among the most common side effects 3

• In a clinical study of oral loading doses of oxcarbazepine, nausea and vomiting were among the reported adverse events that occurred within hours of administration 4

Incidence and Characteristics

• Gastrointestinal side effects typically occur early in treatment or with dose increases
• Nausea and vomiting may be more pronounced when taking higher doses
• These symptoms often diminish over time as the body adjusts to the medication

Management Options for Oxcarbazepine-Induced Nausea/Vomiting

If experiencing nausea and vomiting while on oxcarbazepine:

1. Timing modification:

   • Take oxcarbazepine with food rather than on an empty stomach
   • Divide the daily dose into smaller, more frequent doses if approved by prescriber

2. Dose adjustment:

   • Consider a temporary dose reduction with gradual titration back up
   • Slower titration schedule when initiating therapy

3. Antiemetic options (if symptoms are severe):

   • Ondansetron 4-8 mg PO/IV every 8 hours 5
   • Prochlorperazine 5-10 mg PO/IV every 6 hours 6, 5
   • Metoclopramide 10-20 mg PO/IV every 4-6 hours 6

Important Considerations and Monitoring

• Monitor for hyponatremia: Oxcarbazepine can cause hyponatremia (low sodium levels), which may itself cause or worsen nausea and vomiting 7

• Watch for other side effects: Patients experiencing nausea and vomiting should also be monitored for other common side effects such as dizziness, drowsiness, diplopia, and headache 1, 2

• Hydration status: Ensure adequate hydration, especially if vomiting is persistent 5

• Drug interactions: Oxcarbazepine has fewer drug interactions than carbamazepine but still requires monitoring 2

When to Seek Medical Attention

Patients should contact their healthcare provider if:

• Nausea/vomiting is severe or persistent
• Unable to keep food or fluids down for more than 24 hours
• Signs of dehydration develop
• Symptoms of hyponatremia appear (confusion, headache, increased seizures)

While nausea and vomiting are common and typically manageable side effects of oxcarbazepine, persistent or severe symptoms should prompt medical evaluation to rule out other causes or complications such as hyponatremia.