What to Know About Trileptal (Oxcarbazepine)

An Anticonvulsant That May Treat Bipolar Disorder

Man examining prescription bottles

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What Is Trileptal?

Trileptal (oxcarbazepine) is an anticonvulsant (also known as an antiepileptic drug) used to treat seizures. It is sometimes prescribed off-label to treat bipolar disorder.

Oxcarbazepine is available under the brand names Trileptal and Oxtellar XR. No major differences between brand name and generic oxcarbazepine have been reported; however, more studies are needed for conclusive evidence.

What Is Trileptal Used For?

Trileptal is approved by the Food and Drug Administration (FDA) to treat partial seizures in adults and children. Children and adults with epilepsy are commonly prescribed this medication. Oxcarbazepine has also been used to treat neuropathic pain; however, studies are limited on its efficacy.

Off-Label Uses

Oxcarbazepine is not specifically approved to treat bipolar disorder, but it is sometimes used off-label to treat the condition instead of carbamazepine because it has fewer reported side effects and drug interactions.

Some doctors prescribe it to people with bipolar disorder because it may be an effective mood stabilizer. Mood stabilizers have been found to reduce common symptoms of mania in bipolar disorder, including hyperactivity, agitation, and restlessness. Likewise, if you have had difficulty tolerating other bipolar disorder medications, Trileptal might be prescribed to you instead of or in addition to other medications.

Researchers say that better studies are needed to determine whether Trileptal is truly effective in treating bipolar disorder.

Before Taking Trileptal

Tell your doctor about any of the following before taking Trileptal:

  • If you have thoughts of suicide
  • If you've had adverse effects or allergies to medications
  • If you have other psychiatric or medical problems
  • If you take other medications (including over-the-counter and herbal preparations)
  • If you receive any non-medication treatment such as therapy
  • If you're pregnant or breastfeeding or have plans to become pregnant
  • If you use alcohol or other substances

These can help your doctor determine whether you are a good candidate for Trileptal.

Before prescribing it, your doctor may perform blood tests to assess liver function, electrolytes, kidney function, and pancreatic enzymes, along with a complete blood count.

Your kidneys play a major role in processing medication, so your doctor will make sure your kidneys are fully functioning. In some cases, your doctor can decrease your dosage of Trileptal so that your kidneys are better able to process it.

Side Effects of Trileptal

There are many potential side effects of Trileptal. Be sure to monitor your symptoms after starting Trileptal and discuss concerns with your doctor.

Common Side Effects

The most common side effects of Trileptal include:

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

Only 1% to 2% of patients experience weight gain.

Severe Side Effects

Serious side effects of Trileptal include:

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

If you experience any of these serious side effects, contact your healthcare provider immediately or go to the emergency room.

Oxcarbazepine treatment, like other anticonvulsants, carries a warning about an increased risk of suicidal thoughts or behaviors.

Dosage

Trileptal is available as 150, 300, and 600 mg film-coated tablets. A typical dose to treat partial seizures might start at 300 mg twice a day and increase over several weeks.

The dosage for treating bipolar disorder may be similar. However, doctors often start on the smallest dose possible and increase as needed.

Check your prescription and talk to your prescribing doctor to make sure you are following the dosage regimen that's right for you.

Modifications

Trileptal oral suspension is the liquid form of the drug, which may be prescribed for people who have trouble swallowing pills. Children are commonly prescribed the liquid form, too.

How to Take and Store

Typically, Trileptal is taken in pill form. You also can take it as an extended-release pill or liquid. All forms should be stored in a cool, dry place; no refrigeration is necessary.

If you're prescribed the liquid, shake the bottle before pouring. Take the medicine from the spoon your pharmacy provides, or mix it into a glass of water and drink it.

You can take Trileptal with or without food. You may find it easier to swallow the pill with water.

If you miss a dose of Trileptal, simply take another dose as close as possible to the time you were scheduled to take it. If you're forgetting many doses or haven't been able to take it at a consistent time each day, discuss this with a healthcare provider.

Don't take more than prescribed. If you do, you may experience side effects such as dizziness, drowsiness, and/or vomiting. Though overdoses from Trileptal are rare, it's best to contact a healthcare provider if you experience these or other effects.

Precautions and Contraindications

Trileptal may have adverse effects on certain people. Talk to a healthcare provider if any of the following apply to you.

Sensitivities to Medication

If you have an allergy to oxcarbazepine or to any of its components, you should not take Trileptal. If you're unsure, consult your prescribing doctor and discuss any other allergies you have to medications, especially if you have known allergies to Tegretol (carbamazepine).

Kidney or Liver Disease

Tell your doctor if you have or have had kidney or liver disease. These conditions affect how your body processes medication and should be evaluated before taking new medications.

Pregnant or Breastfeeding

If you're pregnant or become pregnant while taking Trileptal, let your doctor know. This medication has been associated with craniofacial and heart deformities in some infants. Trileptal also passes into breast milk, so you shouldn't breastfeed while taking it.

Tell your prescribing doctor if you are taking hormonal birth control. Trileptal can reduce its effectiveness, so you'll need to use additional birth control methods to prevent pregnancy.

Tell your prescribing doctor if you're planning to become pregnant; stopping Trileptal while pregnant can cause a significant relapse of your symptoms.

Suicidal Thoughts

Suicidal thoughts are a possible side effect of medications such as oxcarbazepine. Tell your doctor if you've had suicidal thoughts in the past. Your doctor may work with you directly or refer you to a mental health professional who can help monitor your symptoms as you take the medication.

It's important that you, your family members, and loved ones recognize this risk with Trileptal before beginning treatment, and watch for any signs of it while you are taking the drug.

Contact a healthcare provider immediately, or have someone do it for you, if you experience any of these symptoms, especially if they are new, worrisome, or become worse:

  • Acting out dangerous impulses
  • Aggressive, angry, or violent behavior
  • Agitation or restlessness
  • Giving away of prized possessions
  • Insomnia
  • Mania, which involves a notable increase in your activity level
  • New or worsening irritability, anxiety, or depression
  • Panic attacks
  • Preoccupation with death and dying
  • Thoughts or talk of harming or killing yourself
  • Withdrawal from friends and family

Tell your doctor about any other unusual changes in behavior or mood.

Tell your loved ones when you're starting a new medication and alert them to any side effects that may affect your behavior.

Other Anticonvulsants

Trileptal (oxcarbazepine) is closely related to Tegretol (carbamazepine), which is also used as a mood stabilizer in bipolar disorder.

Although Trileptal and Tegretol are used to treat the same conditions, Tegretol was found to be more likely to decrease the impact of other medications taken at the same time.

See your healthcare provider for all of your follow-up appointments, and take Trileptal exactly as directed.

If you or someone you know is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database.

Warnings and Interactions

A fairly rare but dangerous side effect is hyponatremia, which is low sodium levels in your blood. Symptoms include headaches, nausea, confusion, tiredness, and, in severe cases, seizures and coma. Contact your doctor if you suspect this.

Rare incidents of anaphylaxis and angioedema have been reported in people taking Trileptal. These are both potentially fatal allergic reactions. Symptoms of anaphylaxis are nausea, rash, sweating, and difficulty breathing.

One sign of angioedema is a red rash in a localized area, which might spread to other parts of the body. If you show signs of these reactions, contact your doctor; they might decide to discontinue Trileptal and start you on an alternative medication.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal skin conditions that can be triggered by Trileptal. Your prescribing doctor might perform a blood test before prescribing oxcarbazepine because some people have a higher genetic predisposition to these conditions.

Don't drive or operate heavy machinery until you have gauged your response to Trileptal. Some people have experienced decreased motor coordination, slower speech, and fatigue as a result of taking Trileptal.

Trileptal may have a sedative effect and can increase the effects of alcohol and sedating medications, so it's best to avoid these substances while taking oxcarbazepine.

Do not stop taking Trileptal without consulting with a healthcare provider first. When stopping Trileptal, you must wean off of it under medical supervision.

Other Medications

To guard against interactions, make sure your prescribing doctor knows about all the prescription and over-the-counter medications you're taking, including supplements, vitamins, and herbal products.

While some drugs pose minor interaction risks, others might preclude use altogether or prompt careful consideration of the risks and benefits.

Medications that can interact with Trileptal include calcium channel blockers, other anticonvulsants, diuretics, proton-pump inhibitors, selective serotonin reuptake inhibitors (SSRIs), and some other medications, specifically:

  • Cardene (nicardipine)
  • Cardizem, Dilacor, Tiazac (diltiazem)
  • Celexa (citalopram), Cymbalta (duloxetine), Zoloft (sertraline), and other SSRIs
  • Cordarone (amiodarone)
  • DynaCirc (isradipine)
  • Elavil (amitriptyline)
  • Norvasc (amlodipine) or other calcium channel blockers
  • Plendil (felodipine)
  • Procardia (nifedipine)

Your doctor can tell you if these or any other medications you're currently taking may interfere with Trileptal.

Frequently Asked Questions

  • What is Trileptal used for?

    Clinicians prescribe Trileptal mainly to treat partial seizures. Given its structural similarity to carbamazepine, it's sometimes prescribed for bipolar disorder in people who can't tolerate carbamazepine. Despite lacking evidence of efficacy, it's sometimes used to treat neuropathic pain, too.

  • How long does it take for Trileptal to work?

    Symptoms of mania may improve in one to two weeks when treated with Trileptal. For epilepsy, you may see improvement within two to four days.

  • Can you overdose on Trileptal?

    Yes, although overdose is rare. If you take too much Trileptal, you can experience dizziness, sleepiness, low blood pressure, hyponatremia, seizures, coma, and even death. If you've overdosed, call 911 or the Poison Help Line at 1-800-222-1222 immediately.

  • How long does Trileptal stay in your system?

    The half-life of Trileptal averages about two hours but can range between one and five.

  • What are the long-term side effects of Trileptal?

    Most people tolerate long-term treatment with Trileptal well and experience only mild to moderate side effects. People tend to experience the most side effects early in treatment, as the dosage is titrated up.

  • How does Trileptal make you feel?

    The most commonly reported side effects are dizziness, drowsiness, changes in eyesight, upset stomach, tiredness, shaking, and headache. They're more apt to occur early in treatment.

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