What to Know About Trileptal (Oxcarbazepine)

An Anticonvulsant That May Treat Bipolar Disorder

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Trileptal (oxcarbazepine) is an anticonvulsant, or an antiepileptic drug (AED), used to treat seizures. It is sometimes prescribed off-label to treat bipolar disorder. Trileptal is approved by the Food and Drug Administration (FDA) to treat partial seizures in adults and children; however, it is not specifically approved to treat bipolar disorder.

Two brand names of oxcarbazepine are Trileptal and Oxtellar XR. Typically, Trileptal is taken in pill form. It can also be taken in extended-release pill form or liquid form. A doctor will usually prescribe a patient a small dosage initially and increase it over time as needed.

Uses

Trileptal is a medication that is approved by the FDA to treat and prevent partial seizures. Children and adults with epilepsy, for instance, are commonly prescribed this medication. Oxcarbazepine has also been used to treat neuropathic pain; however, studies are limited on its efficacy.

Off-Label Uses

Some doctors prescribe Trileptal 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.

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

Before Taking

It's important to 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 before
  • If you have other psychiatric or medical problems
  • If you take other medications (including over-the-counter and herbal)
  • If you receive any non-medication treatment such as therapy
  • If you're pregnant or breastfeeding
  • If you use alcohol or other substances

These can help your doctor determine whether or not you are a good candidate for Trileptal. In addition, your doctor may perform certain blood tests prior to prescribing an anticonvulsant. They may order a complete blood count as well as measure liver function, electrolytes, kidney function, and pancreatic enzymes.

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

Oxcarbazepine is sometimes used instead of carbamazepine in the treatment of bipolar disorder because it has fewer reported side effects and drug interactions. Tegretol and Epitol are two common brand names for carbamazepine. If you have had difficulty tolerating other bipolar disorder medications, Trileptal might be prescribed to you instead of or in addition to other medications.

No major difference between brand name and generic oxcarbazepine has been reported; however, more studies are needed for conclusive evidence.

Precautions and Contraindications

Trileptal may have adverse effects on certain people. It's best to talk to your doctor if any of the following apply to you.

Sensitivities to Medication

A person with an allergy to oxcarbazepine or to any of its components should not take Triptetal. If you are unsure if you are sensitive to these medications, consult with your doctor and let them know of any other allergies you have to medications.

If you're allergic to Tegretol, you may also be allergic to oxcarbazepine. Let your doctor know if this is the case.

Kidney or Liver Disease

Let your doctor know if you have or have ever had kidney or liver disease. These conditions affect how your body processes medication and should be evaluated by your doctor first.

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 doctor if you are taking hormonal birth control. Trileptal can reduce the effectiveness of hormonal birth control, so you'll need to use other birth control methods to prevent pregnancy.

If you are planning to become pregnant, let your doctor know, as stopping Trileptal while pregnant may result in a significant relapse of your symptoms.

Suicidal Thoughts

Suicidal thoughts are a possible side effect of medications like oxcarbazepine. Be sure to let your doctor know if you have 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 also important to tell your loved ones when you're starting a new medication and to alert them to any serious side effects that may alter your behavior.

Other Anticonvulsants

Oxcarbazepine is closely related to carbamazepine, which is also used as a mood stabilizer in bipolar disorder; a common brand name for carbamazepine is Tegretol.

Though Trileptal and Tegretol are used to treat the same conditions, some studies found that Tegretol is more likely to decrease the impact of other medications taken at the same time.

Dosage

Trileptal is a film-coated tablet that is available in dosages of 150 milligrams (mg), 300 mg, or 600 mg. Typical doses for the treatment of 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, your doctor will probably start you on the smallest dose possible and increase as needed.

Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

Trileptal oral suspension is a liquid form of the drug. Your pharmacy would provide you with a dosing spoon. Shake the bottle before pouring. You can take it from the spoon or mix the dosage in a glass of water and drink it.

If you have trouble swallowing pills, your doctor may prescribe you the liquid form. Children are commonly prescribed the liquid form as well. A doctor will usually determine the best dosage of Trileptal for a child based on their weight.

How to Take and Store

Trileptal can be taken with or without food. You may find it easier to swallow the pill with water. Trileptal in liquid form and pill form should be stored in a cool, dry place—they do not need to be refrigerated.

If you miss a dose of Trileptal, simply take another dose as close as possible to the time you were scheduled to take it. Be sure not to take more than you're prescribed. If you're forgetting many doses or haven't been able to take it at a consistent time each day, discuss this with your health care provider.

If you take more than you are prescribed, you may experience an increase in negative side effects such as dizziness, drowsiness, and/or vomiting. Though overdoses from Trileptal are rare, it's best to contact your doctor if you experience these or other effects.

Side Effects

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

Common

The most common side effects you can expect when taking 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% to 2% of patients.

Severe

Serious side effects of Trileptal 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
  • Intense fatigue or weakness
  • Severe muscle pain
  • Recurring infections or infections that don't go away

If you experience any of these serious side effects, contact your health care 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.

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, or have someone do it for you, 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
  • Thinking 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.

If you or someone you care about 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 in your blood. Symptoms of this condition include headaches, nausea, confusion, tiredness and, if it's really severe, seizures and coma. Contact your doctor if you suspect this may be occurring.

Rare incidents of anaphylaxis and angioedema have been reported in people taking Trileptal, either after their first dose or during later doses. These are both potentially fatal allergic reactions. Symptoms of anaphylaxis are nausea, rash, sweating, and difficulty breathing.

A sign of angioedema is a red-colored rash appearing in a localized area that could spread to other parts of the body. If you show signs of these reactions, contact your doctor. It's best that you discontinue Trileptal and start on an alternative medication.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal skin conditions that Trileptal might trigger. Your doctor may want to perform a blood test before prescribing oxcarbazepine, as some people have a higher genetic predisposition to these conditions.

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

It's also best to avoid alcohol and sedating medications since Trileptal may have a sedative effect and can increase this symptom.

Do not stop taking Trileptal without consulting with your healthcare provider first. If you are stopping Trileptal, you can wean off of it under your doctor's supervision.

Other Medications

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.

While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons.

Specific medications that may interact with Trileptal include:

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

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

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Article Sources
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Additional Reading
  • National Alliance on Mental Illness. Oxcarbazepine. Published June 2019.