Side Effects to Discuss When Prescribing Trileptal (Oxcarbazepine) for Bipolar Disorder
When prescribing Trileptal (oxcarbazepine) at 600 mg at bedtime to a bipolar patient, you should discuss hyponatremia, dizziness, somnolence, headache, nausea, and the risk of rash as the most important side effects.
Primary Side Effects to Discuss
According to the FDA drug label for oxcarbazepine 1, the following side effects should be discussed with patients:
Hyponatremia (Low Sodium)
- Most serious and specific concern with oxcarbazepine
- Symptoms include:
- Nausea
- Tiredness/fatigue
- Headache
- Confusion
- Worsening of seizures or mood symptoms
- Regular blood tests may be needed to monitor sodium levels
Neurological Effects
- Dizziness
- Drowsiness/somnolence
- Headache
- Fatigue
- Coordination problems
Gastrointestinal Effects
- Nausea
- Vomiting
- Abdominal pain
Skin Reactions
- Risk of rash (particularly important as patients allergic to carbamazepine may also be allergic to oxcarbazepine)
- Severe skin reactions (rare but serious)
Additional Important Side Effects
Allergic Reactions
- Signs to watch for 1:
- Swelling of face, eyes, lips, or tongue
- Trouble swallowing or breathing
- Skin rash or hives
- Fever, swollen glands
- Painful sores in mouth or around eyes
Psychiatric Effects
- Risk of suicidal thoughts or behaviors (common to many mood stabilizers)
- Patients should report any new or worsening depression, anxiety, irritability, or unusual changes in mood 1
Medication Management Considerations
Dosing Considerations
- The 600 mg bedtime dosing is appropriate for initiating treatment
- Taking with food may help reduce gastrointestinal side effects
- Do not stop taking the medication abruptly without consulting a healthcare provider 1
Drug Interactions
- May reduce effectiveness of hormonal contraceptives
- Inform patients to discuss all medications they are taking with their provider 1
Monitoring Requirements
- Sodium levels should be monitored, especially in the first few months
- Follow-up visits are important to assess medication effectiveness and side effects
Special Populations
Pregnancy and Breastfeeding
- Discuss potential risks if the patient is pregnant or planning pregnancy
- Oxcarbazepine passes into breast milk - discuss breastfeeding plans 1
Practical Advice for Patients
- Take the medication consistently at bedtime
- Report any concerning side effects promptly, especially signs of hyponatremia
- Avoid driving or operating machinery until effects on alertness are known
- Ensure adequate hydration, especially in hot weather or during exercise
Oxcarbazepine is generally well-tolerated in bipolar disorder with studies showing it can be effective as an add-on treatment 2. The side effect profile is often more favorable than some other mood stabilizers, with fewer metabolic effects than many atypical antipsychotics 3.