From the FDA Drug Label
- 3 Initiation of Monotherapy for Adults Patients not currently being treated with AEDs may have monotherapy initiated with oxcarbazepine. In these patients, initiate oxcarbazepine at a dose of 600 mg/day (given a twice-a-day); the dose should be increased by 300 mg/day every third day to a dose of 1,200 mg/day
To start oxcarbazepine in suspected bipolar, initiate oxcarbazepine at a dose of 600 mg/day, given in a twice-a-day regimen, and increase the dose by 300 mg/day every third day to a dose of 1,200 mg/day 1.
From the Research
To start oxcarbazepine for suspected bipolar disorder, begin with a low dose of 300 mg twice daily and gradually increase by 300 mg every 3-7 days as tolerated, typically to a target dose of 1200-2400 mg per day divided into two doses. When initiating treatment, it is crucial to obtain baseline sodium levels, complete blood count, liver function tests, and assess renal function 2. Regular monitoring of sodium levels is essential, especially during the first three months, as hyponatremia is a common side effect 3. Patients should be informed about potential side effects including dizziness, drowsiness, nausea, vomiting, and allergic reactions. Oxcarbazepine works by stabilizing neuronal membranes through blockade of voltage-sensitive sodium channels and modulation of calcium channels, which helps regulate mood 4. It's particularly useful for treating manic or mixed episodes in bipolar disorder and may be used as monotherapy or adjunctively with other mood stabilizers 5. Avoid abrupt discontinuation; when stopping, taper the dose gradually over at least 1-2 weeks to prevent withdrawal symptoms or seizures in patients with comorbid epilepsy. Some key points to consider when using oxcarbazepine include:
- Monitoring for signs of hyponatremia, such as headache, nausea, and fatigue 3
- Regular assessment of renal function and liver enzymes 4
- Adjusting the dose based on patient response and tolerability 5
- Considering combination therapy with other mood stabilizers or antipsychotics for optimal treatment outcomes 2