From the Guidelines
Aptiom (eslicarbazepine acetate) is not the first-line treatment for trigeminal neuralgia, and carbamazepine remains the primary drug of choice, as suggested by international guidelines and Cochrane reviews 1.
Key Considerations
- The most recent and highest quality study suggests that carbamazepine is the most effective treatment for trigeminal neuralgia, with 70% of patients showing partial or complete pain relief 1.
- Aptiom may be considered as an off-label treatment for trigeminal neuralgia when patients cannot tolerate or have inadequate response to first-line options, but its use should be carefully monitored due to potential side effects such as dizziness, fatigue, headache, nausea, and hyponatremia.
- The diagnosis and management of trigeminal neuralgia should be guided by the clinical features and guidelines outlined in Table 2 of the British Journal of Anaesthesia study 1, which highlights the importance of accurate diagnosis and treatment to improve quality of life.
Treatment Approach
- Typical starting doses of carbamazepine are 200 mg at night, gradually increased by 200 mg every 7 days to a final dose of 400–1200 mg, divided in 2–3 doses per day 1.
- Patients should be monitored for side effects and response to treatment, and the dose should be adjusted accordingly.
- Surgical interventions, such as microvascular decompression, may be considered in patients who do not respond to medical treatment or have intolerable side effects 1.
From the Research
Treatment Options for Trigeminal Neuralgia
- Trigeminal neuralgia is a rare condition characterized by sudden, brief, and excruciating facial pain attacks in one or more of the branches of the trigeminal nerve 2.
- The antiepileptic drugs carbamazepine and oxcarbazepine are the first-line pharmacological treatment for trigeminal neuralgia, with a mechanism of action that modulates voltage-gated sodium channels, leading to a decrease in neuronal activity 2.
- Other drugs that may be useful for pain control in trigeminal neuralgia include gabapentin, pregabalin, lamotrigine, phenytoin, baclofen, and botulinum toxin type A, which can be coadministered with carbamazepine or oxcarbazepine for a synergistic approach 2.
Eslicarbazepine Acetate (Aptiom) for Trigeminal Neuralgia
- Eslicarbazepine acetate, also known as Aptiom, is a third-generation antiepileptic drug that has been evaluated for the treatment of trigeminal neuralgia 3.
- A study found that eslicarbazepine acetate was effective, safe, and well-tolerated in patients with trigeminal neuralgia, with a responder rate of 88.9% and 44.4% of patients becoming asymptomatic after treatment 3.
- Eslicarbazepine acetate has a distinctive mechanism of action and tolerability profile compared to other antiepileptic drugs, and has been approved as adjunctive therapy in adults with refractory partial-onset seizures 4.
Comparison of Treatment Options
- Carbamazepine and oxcarbazepine are effective in most patients with trigeminal neuralgia, but side effects are still a major issue, particularly in patients with secondary and idiopathic trigeminal neuralgia 5.
- Eslicarbazepine acetate may be a viable alternative for patients who do not respond to or cannot tolerate carbamazepine or oxcarbazepine, due to its efficacy and safety profile 3.
- Further studies are needed to corroborate the results of eslicarbazepine acetate in the treatment of trigeminal neuralgia and to explore its potential as a first-line treatment option 3.