What is the dosage and usage of Trileptal (oxcarbazepine) for treating seizures?

Trileptal (Oxcarbazepine) Dosage and Usage for Seizures

For treating seizures in adults, start oxcarbazepine (Trileptal) at 600 mg/day divided twice daily, with gradual titration up to 1,200-2,400 mg/day depending on clinical response and tolerability. 1

Adult Dosing

Adjunctive Therapy

• Initial dose: 600 mg/day (divided twice daily)
• Titration: Increase by maximum of 600 mg/day at approximately weekly intervals
• Maximum recommended dose: 1,200 mg/day (though doses up to 2,400 mg/day may provide greater efficacy but with more side effects) 1

Conversion to Monotherapy

• Initial dose: 600 mg/day (divided twice daily)
• Simultaneously begin reducing concomitant antiepileptic drugs (AEDs)
• Titration: Increase by maximum of 600 mg/day at approximately weekly intervals
• Target dose: 2,400 mg/day
• Complete withdrawal of concomitant AEDs over 3-6 weeks 1

Initiation of Monotherapy

• Initial dose: 600 mg/day (divided twice daily)
• Titration: Increase by 300 mg/day every third day
• Target dose: 1,200 mg/day (though 2,400 mg/day has shown effectiveness) 1

Pediatric Dosing

Children 4-16 years

• Initial dose: 8-10 mg/kg/day (generally not exceeding 600 mg/day), divided twice daily
• Target maintenance doses (to be achieved over 2 weeks):
  • 20-29 kg: 900 mg/day
  • 29.1-39 kg: 1,200 mg/day

  • 39 kg: 1,800 mg/day 1

Children 2-4 years

• Initial dose: 8-10 mg/kg/day (generally not exceeding 600 mg/day), divided twice daily
• For children <20 kg: Consider 16-20 mg/kg/day initially
• Maximum maintenance dose: 60 mg/kg/day in a twice-daily regimen (to be achieved over 2-4 weeks) 1

Pediatric Monotherapy (4-16 years)

• Initial dose: 8-10 mg/kg/day divided twice daily
• Titration: Increase by 5 mg/kg/day every third day
• Target dose: Based on weight (see FDA label for specific weight-based dosing) 1

Clinical Considerations

Efficacy

• Oxcarbazepine is effective for partial seizures with or without secondary generalization in both adults and children 2
• More than 85% of patients with paroxysmal kinesigenic dyskinesia can achieve complete remission with low-dose oxcarbazepine (75-300 mg/day) 3

Metabolism and Drug Interactions

• Oxcarbazepine undergoes reductive metabolism to form MHD (monohydroxy derivative), which is then glucuronidated and excreted in urine 2
• Minimal involvement of hepatic cytochrome P450 enzymes, resulting in fewer drug interactions compared to carbamazepine 2
• However, oxcarbazepine can:
  • Inhibit CYP2C19
  • Induce CYP3A4 and CYP3A5
  • Decrease plasma levels of oral contraceptives (alternative contraception recommended) 4, 5

Monitoring and Safety

• Monitor serum sodium levels in patients:
  • With renal disease
  • Taking medications that may lower sodium (diuretics, oral contraceptives, NSAIDs)
  • Developing symptoms of hyponatremia 6
• Hyponatremia occurs in approximately 3% of patients, typically developing gradually during the first months of therapy 6
• In Han Chinese populations, consider HLA-B*15:02 screening before initiating treatment to reduce risk of Stevens-Johnson syndrome/toxic epidermal necrolysis 3

Special Populations

• For pregnant women with mild seizures, consider discontinuing therapy due to potential fetal risks 3
• For women of childbearing potential, consider alternative AEDs like lamotrigine or levetiracetam 7

Practical Administration Tips

• For better tolerability, administer at bedtime to minimize dizziness 3
• If faster titration is needed, can start with up to 600 mg/day and increase by weekly increments of up to 600 mg/day 6
• For patients who cannot tolerate carbamazepine or experience dizziness/drowsiness with oxcarbazepine, consider alternative sodium channel blockers like lamotrigine, topiramate, or phenytoin 3

Oxcarbazepine offers advantages over carbamazepine including better tolerability, fewer rashes, and fewer drug interactions, making it a valuable option for treating seizures in both adults and children 2.