Trileptal for Bipolar Disorder

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Trileptal (oxcarbazepine) is an anticonvulsant medication used to treat epilepsy, but it's also sometimes prescribed off-label to treat bipolar disorder. Trileptal is approved by the U.S. Food and Drug Administration (FDA) to treat partial seizures in adults and children. It's closely related to carbamazepine, which has a variety of brand names, including Tegretol. Carbamazepine is also used as a mood stabilizer in bipolar disorder.

Effectiveness

Although some healthcare professionals prescribe Trileptal to treat bipolar disorder, research hasn't shown definitively that it's effective. A 2011 Cochrane review of the medical literature concluded that the drug doesn't work well to treat bipolar disorder in children and adolescents, and works about as well as other bipolar disorder medications in adults. The authors said better studies are needed to determine whether Trileptal is truly effective in treating bipolar disorder.

Warnings

Trileptal can reduce the effectiveness of hormonal birth control, so you'll need to use other birth control methods as well to prevent pregnancy.

If you're pregnant, are planning to become pregnant, or become pregnant while taking Trileptal, let your doctor know since this medication can harm an unborn baby. Trileptal also passes into breast milk, so you shouldn't breastfeed while taking it.

Let your doctor know if you have or have ever had kidney or liver disease.

Be careful with alcohol and sedating medications, since Trileptal may have a sedative effect and these can make it worse. Don't drive or operate heavy machinery until you have gauged your response to this drug.

Trileptal may interact with certain drugs such as calcium channel blockers, other anticonvulsants, diuretics, proton-pump inhibitors, and selective serotonin reuptake inhibitors (SSRIs), as well as other medications. To guard against these types of interactions, always make sure your doctor knows about all the prescription and over-the-counter medications you're taking, including supplements, vitamins, and herbal products.

Trileptal can change your mental health, so you and your loved ones will need to be aware of any differences that might occur.

You should never suddenly stop taking Trileptal. If you want to discontinue using it, talk to your doctor about gradually tapering your dose.

Common Side Effects

The most common side effects of Trileptal include:

  • Dizziness
  • Drowsiness
  • Fast, uncontrollable eye movements
  • Diarrhea
  • Constipation
  • Appetite loss
  • Double vision (diplopia)
  • Fatigue
  • Nausea and vomiting
  • Headache
  • Feeling thirsty
  • Abdominal pain
  • Unsteadiness on your feet (ataxia)
  • Abnormal vision
  • Tremor
  • Forgetfulness
  • Slower thoughts
  • Difficulty concentrating
  • Acid reflux (dyspepsia)
  • Taste changes

Weight gain with Trileptal isn't common—it's only experienced by about 1 percent to 2 percent of patients.

Serious Side Effects

A fairly rare, but dangerous, side effect is hyponatremia, which is low sodium in your blood. Symptoms of this condition include not passing much urine, headache, nausea, confusion, tiredness and, if it's really severe, seizures and coma, so contact your doctor if you suspect this may be beginning.

Other serious side effects include:

  • Signs of an allergic reaction like itchy skin, hives, rash, difficulty breathing or swallowing, and swelling in your arms, legs, or face
  • Blistering or peeling skin
  • Signs of an infection such as fever, sore throat, chills, or swollen glands
  • Yellowish skin or eyes
  • Painful sores in your mouth or near your eyes
  • Unusual bleeding or bruising
  • Fatigue or weakness that's severe
  • Severe muscle pain
  • Recurring infections or infections that don't go away

If you're allergic to Tegretol (carbamazepine), you're likely going to be allergic to oxcarbazepine. Let your doctor know if this is the case.

Call your healthcare provider immediately if you experience any of these serious side effects.

Suicide Risk

Oxcarbazepine treatment, like other anticonvulsants, carries a risk of suicidal ideation, which is an increase in suicidal thoughts and behavior. About one in every 500 people—both children and adults—who were treated with Trileptal for various conditions, including epilepsy and mental disorders, during various clinical studies of the drug became suicidal during treatment. Some people developed suicidal thoughts and behaviors within one week of beginning the medication.

It's important that both you and your family members or loved ones recognize this risk with Trileptal before beginning treatment, and watch for any signs of it while you are taking the drug. Contact your doctor immediately and ask your family to call your doctor immediately if you experience any of these symptoms, especially if they are new, worrisome, or become worse:

  • Panic attacks
  • Agitation or restlessness
  • New or worsening irritability, anxiety, or depression
  • Acting out dangerous impulses
  • Insomnia
  • Aggressive, angry, or violent behavior
  • Mania, which involves a notable increase in your activity level and talking
  • Thinking about or talking about harming or killing yourself
  • Withdrawing from friends and family
  • Preoccupation with death and dying
  • Giving away prized possessions
  • Any other unusual changes in behavior or mood

Make sure you see your healthcare provider for all of your follow-up appointments and that you take Trileptal exactly as directed.

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Article Sources
  • MedlinePlus. Oxcarbazepine. The American Society of Health-System Pharmacists, Inc. National Institutes of Health. U.S. National Library of Medicine. Updated July 30, 2018. https://medlineplus.gov/druginfo/meds/a601245.html

  • Vasudev A, Macritchie K, Vasudev K, Watson S, Geddes J, Young AH. Oxcarbazepine for Acute Affective Episodes in Bipolar Disorder. The Cochrane Database of Systematic Reviews. 2011 Dec 7;(12):CD004857. doi:10.1002/14651858.CD004857.pub2.

  • U.S. Food and Drug Administration (FDA). Medication Guide: Trileptal (Oxcarbazepine). Updated March 2017. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021014s036lbl.pdf