Trileptal

US Brand Name: Trileptal

Other Brand Names: Oxrate (India)
Timox (Germany)
Trileptin (Israel)

Generic Name: oxcarbazepine

Other Form: Oral suspension

What is Trileptal?: Trileptal is an anticonvulsant, specifically an enzyme-inducing anticonvulsant.
Read up on these sections if you haven’t done so already, because they cover a lot of information about multiple medications that I’m not going to repeat on many pages.  I’m just autistic that way about not repeating myself. 

FDA Approved Uses of Trileptal:  For epilepsy – monotherapy (used by itself) or adjunctive  therapy (used with other meds) for adults with partial seizures. Adjunctive therapy only for kids with partial seizures.

Better know partial seizures are:

  • Simple partial seizures – you’re still awake (more or less), with symptoms such as one or two limbs spazzing out or wacky visual or other sensory distortions.  Think Alice in Wonderland, as Lewis Carroll must have had some serious temporal lobe issues.  The fist link will take you to a better explanation.  For a really detailed explanation of what a simple partial seizure is, click here.
  • Complex partial seziures – the people around you think you’re just acting out to get attention.  In reality you have no control over what’s happening.  Again, click there for the basics, click here for what neurologists think about this type of seizure.

Off-Label Uses of Trileptal: Bipolar Disorder.  Schizoaffective Disorder (“…unexpectedly [oxcarbazepine] appeared more efficacious in the treatment of negative symptoms [than avalproate]”).  Neuropathic pain. Augmenting treatment of OCD, Monotherapy for generalized seizures in children, Monotherapy for generalized seizures in adults (compares well withDilantin (phenytonin) and with sodium valproate in another study).  Generalized tonic-clonic is the classic definition of a seizure, when you’re completely flopping all over the place like a fish out of water.  For the neurologist’s view, click here.  Trileptal is also used off-label to treat anxiety and depression (see comments).
Trileptal’s pros and cons:
Pros: Having a much lower side effect profile than Tegretol (carbamazepine USP) and it’s really just as useful for as many things. In time it will be tried for just about everything, not just epilepsy, bipolar disorder and neuropathic pain. Its side effect profile is also lower than Topamax (topiramate), the other temporal lobe-affecting med.

Cons: A lack of US studies or interest by Novartis or something to get this med approved for as many seizure types as its older brother Tegretol (carbamazepine USP) may prevent you from getting it. The jury is still out if it really is as effective for everything as Tegretol (carbamazepine USP). Wacky hyponatremia side effect (not enough salt in your blood – just like the first episode of Star Trek!) could force you to eat potato chips all the time. Hey, wait, maybe that’s a pro!

Trileptal’s Typical Side Effects: Those common for anticonvulsants. Like all meds that hit your temporal lobe, you’ll feel tired, confused, uncoordinated, even somewhat drunk and disoriented. You’ll have problems with your memory, have a hard time thinking and things will just seem really strange. And it figures that a med good for treating headaches will just give people bad headaches. For the most part these will pass, or at least they won’t be so bad, within a couple of weeks. Or a month. And, of course, they’ll come back when your dosage goes up. But they usually won’t be as bad or last as long the next time around. Unless you’re getting way more Trileptal (oxcarbazepine) than you should be. Of the three temporal lobe-affecting meds, Trileptal (oxcarbazepine) seems to have the lowest side effect profile. So these effects are either less likely to hit you or they won’t hit you as badly. If you’re switching from Tegretol (carbamazepine USP) you may not even experience any of these if you’ve dealt with them already.

For tips on how to cope with these side effects, please see our side effects page.
These aren’t all the side effects possible, just the most popular ones.

Trileptal’s Not So Common Side Effects: Hyponatremia – not enough salt in your blood. Time to stock up on potato chips and other salty snacky goodness! Also photosensitivity. While all anticonvulsants and antipsychotics make you more sensitive to sunlight, Tegretol (carbamazepine USP) and Trileptal (oxcarbazepine) are just the worst when it comes to turning you into a vampire.

These may or may not happen to you don’t, so don’t be surprised one way or the other.

Trileptal’s Freaky Rare Side Effects: Crisis in the rotation of the eyeballs and renal calculus (Whenever our kidneys have to do advanced math, it’s a crisis). Mouse’s experience with Trileptal (oxcarbazepine) may have had long-term effects that bother her to this day. She was prescribed it by a less-than-reputable psychiatrist who was not monitoring her reactions like a good doctor should have done, and the Trileptal (oxcarbazepine) caused hypoglycemia, a known side effect. Although she no longer takes Trileptal (oxcarbazepine) her insulin reactions are still completely fucked over. Granted, she has a family history of wacky insulin reactions, but something had to trigger her wacky insulin reaction.

You aren’t going to get these. I promise.

For all side effects read the PI sheet

VisusScan 160×600 msg9

Interesting Stuff Your Doctor Probably Won’t Tell You: Trileptal (oxcarbazepine) works better for boys than girls for bipolar disorder.
Hyponatremia, the significant lowering of sodium in the bloodstream, can be a problem. You may be required to supplement your sodium intake. I’m serious about the potato chips.

The jury is still out if Trileptal (oxcarbazepine) really is as effective as Tegretol (carbamazepine USP), so you may have to take Tegretol (carbamazepine USP) instead.

Trileptal’s Dosage and How to Take Trileptal: I’m just going to deal with adults and monotherapy. For epilepsy and bipolar disorder the standard recommendation has you starting at two 300mg doses a day, increasing by 300mg a day every three days until you hit 1200mg a day. After that it all depends on symptoms. You should find your proper dosage somewhere between 1200 and 2400mg a day.

My recommendation is starting at 300mg a day in two 150mg doses and increasing by 150mg a day every week until you hit 900mg a day. After that you can go up or down 300mg a day, as required, until you find your sweet spot between 900 and 2400mg a day. You have to be seriously seizing or flipping out to want to go up any faster. Take it slow and easy, get used to the med to avoid the worst of the side effects.

Days to Reach a Steady State: Usually two to three days. Although an enzyme-inducing drug Trileptal (oxcarbazepine) has pretty linear pharmacokinetics.

When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long Trileptal Takes to Work: While you’ll probably start feeling something once you hit a steady state, the odds are you won’t really be getting any benefit until you’re at 900mg a day.

Trileptal’s Half-Life & Average Time to Clear Out of Your System: Although enzyme-inducing drug, Trileptal (oxcarbazepine) has pretty linear pharmacokinetics. It does a double metabolism, but they’re both short, two and nine hours. It’s the active metabolite produced that does all the work. Trileptal (oxcarbazepine) is out of your system completely in two to three days.

How to Stop Taking Trileptal: Your doctor should be recommending that you reduce your dosage by 150-300mg a day every three days, based on the 2 and 9 hour half-lives, if not more slowly than that. For more information, please see the page on how to safely stop taking these crazy meds.

Like any anticonvulsant, if you’ve been taking Trileptal (oxcarbazepine) for more than a couple months and you’re up to or above 900mg a day (give or take, depending on other meds you might be taking) you just can’t stop cold turkey if you’re not at the therapeutic dosage for another anticonvulsant that is known to work for you, otherwise you risk partial-complex, absence seizures or even tonic-clonic grand mals, despite your never having had a seizure disorder before! The risk is worse if you’re taking a lithium variant, and/or any antidepressant, especially Wellbutrin (bupropion hydrochloride).

If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.

Comments: Be sure to read the sections on anticonvulsants and enzyme-inducing anti-epileptic drugs if you haven’t done so already.
Approved by the FDA in January of 2000 but in use elsewhere since 1990, Trileptal (oxcarbazepine) is not as manly as its older brother Tegretol (carbamazepine USP), the manliest of the anticonvulsants. It still clobbers the efficacy of oral contraceptives and other estrogen supplements, and really does a number on Lamictal (lamotrigine), the diva of anticonvulsants. It also encourages you to stay inside and watch sports on TV to deal with the side effects of photosensitivity and hyponatremia.

Trileptal is the newish & improved (more or less) version of Tegretol (carbamazepine USP). At least, we think it’s improved. No more blood tests and a much lower side effect profile – those are big improvements, right? But there’s still a question of efficacy for epilepsy, bipolar and all the off-label uses that Tegretol (carbamazepine USP) enjoys. Trileptal (oxcarbazepine) has had plenty of time to get approved for all the things Tegretol (carbamazepine USP) is approved for. What’s the hold up? Is it that there’s just a bigger profit margin in pushing anticonvulsants off-label with a nod and a wink from the pharm reps? Or is it that Trileptal (oxcarbazepine) really isn’t as effective as Tegretol (carbamazepine USP) when it comes to some forms of epilepsy and bipolar disorder? Without real trials, we won’t really know for sure.

Because Tegretol (carbamazepine USP) has long been considered a first-line medication for bipolar disorder Trileptal (oxcarbazepine) is getting an automatic tryout for the disorder. However just as Tegretol (carbamazepine USP) is best suited for certain types of epileptic disorders, the same applies to Trileptal (oxcarbazepine). The key is to look at how it performs in epilepsy. Like Topamax (topiramate) and Tegretol (carbamazepine USP), Trileptal (oxcarbazepine) is best used when applied to problems in the temporal lobes. You don’t have to be epileptic to have problems with your temporal lobes, as your bipolar disorder could be living there as well. I’ll be writing an article about the symptoms of temporal lobe dysfunction and how they apply to bipolar disorder. Still when tested on random bipolar patients (two recent studies, here and here) show that it’s effective about half the time. Not bad! Trileptal (oxcarbazepine) also compares well to Dilantin (phenytoin) for controlling partial to generalized seizures (abstract of review here). But if you were to just take people with temporal lobe issues, then Trileptal (oxcarbazepine), like Topamax (topiramate) and Tegretol (carbamazepine USP), works very well indeed.

Unlike Tegretol (carbamazepine USP), how Trileptal (oxcarbazepine) works in your brain is fairly well understood. It works along the voltage channels of the brain, primarily the sodium channels. Hence the salt thing. That also means if you’re mixing it with blood pressure meds that work along sodium channels in other parts of your body you could be in for a big surprise. Gotta love those drug-drug gotchas. Anyway, Trileptal (oxcarbazepine) pretty much prevents seizures and bipolar hyperactivity by keeping your brain from getting supercharged along its sodium channels. Quite probably its potassium channels as well. Doubtfully its calcium channels, but that hasn’t been proven one way or the other. Otherwise it doesn’t seem to hit any neurotransmitters, thus making it a good add-on for other meds that do affect neurotransmitters.
If Tegretol (carbamazepine USP) is indicated for you, for either epilepsy or bipolar, ask about Trileptal (oxcarbazepine) if it’s available where you live. Because it has a lower side effect profile and it seems to have a better response rate. But that better response rate could just be due to better med compliance as the side effects don’t suck as much donkey dong. The only thing it is known not to work at anywhere near as well as Tegretol (carbamazepine USP) is the neuropathic pain, such as migraines. It does work, and is good for when you have a comorbid condition, like neuropathic pain and bipolar disorder. But when it comes to straightforward pain, if Tegretol (carbamazepine USP) is indicated, try that med first. In any event it’s pretty easy to switch between the two meds. 300mg of Trileptal (oxcarbazepine) = 200mg of Tegretol (carbamazepine USP). The PI sheets are full of information about switching between the two.

Dr. Amen will use Trileptal (oxcarbazepine) for some forms of depression and anxiety that would not normally respond to antidepressants or antipsychotics. He spells it out in his book (see below) when it’s a first-line med to treat those disorders, and not just another horsie to ride on the med-go-round.

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