Trileptal (oxcarbazepine)

US Brand Name: Trileptal

generic name: oxcarbazepine

Other Form: Oral suspension

Class: Antiepileptic Drug (AED)/Anticonvulsant (AC)

1.  Other Brand Names

• Oxrate (India)
• Timox (Germany)
• Trileptin (Israel)

2.  FDA Approved Uses of Trileptal

Monotherapy (used by itself) or adjunctive therapy (used with other meds) for adults with partial seizures. Adjunctive therapy only for kids with partial seizures.

3.  Off-Label Uses of Trileptal

• Bipolar Disorder
• Schizoaffective Disorder (“…unexpectedly [oxcarbazepine] appeared more efficacious in the treatment of negative symptoms [than a valproate]”)
• Neuropathic pain
• Monotherapy for generalized seizures in adults (compares well with Dilantin (phenytonin) in that study and with sodium valproate in another study)

4.  Trileptal’s pros and cons

Pros: Having a much lower side effect profile than Tegretol and it’s really just as useful for almost 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.

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 may prevent you from getting it. The jury is still out if it really is as effective for everything as Tegretol. Wacky hyponatremia side effect (not enough salt in your blood - just like the creature from first aired episode of Star Trek!) could force you to eat potato chips all the time. Hey, wait, maybe that’s a pro!

5.  Trileptal’s Side Effects

5.1  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 than you should be. Of the three temporal lobe-affecting meds, Trileptal 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 you may not even experience any of these if you’ve dealt with them already.

5.2  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 and Trileptal are just the worst when it comes to turning you into a vampire.

5.3  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). “Renal calculus” is fancy doctor-speak for kidney stones. Rare, but not all that freaky.

6.  Interesting Stuff Your Doctor Probably Won’t Tell You

• Trileptal works better for boys than girls for bipolar disorder. At least it did in that one small study.
• 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 really is as effective as Tegretol - for whatever you’re taking it for - so you may have to take Tegretol instead.
• As an enzyme-inducing AED, albeit a mild one, Trileptal will sap your body of vitamin D, folic acid, and maybe even calcium. So ask your doctor about tests for vitamin D and calcium levels and supplements. You should probably take 400–1,000mcg of folic acid in any event, but no more than that, otherwise it might interfere with how well Trileptal works.

7.  Trileptal’s Dosage and How to Take Trileptal

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 suggestion for bipolar disorder and as an add-on for partial seizures is starting at 300mg a day in two 150mg doses and increasing by 150mg a day every week until your symptoms stop and/or 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.
If you’re taking Trileptal for generalized seizures or as monotherapy for partial seizures it’s between you and your doctor.

8.  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.

9.  Trileptal’s Half-Life & Average Time to Clear Out of Your System

Although enzyme-inducing drug, Trileptal 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 is out of your system completely in two to three days.

10.  Days to Reach a Steady State

Usually two to three days.

11.  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.

Like any anticonvulsant, if you’ve been taking Trileptal 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 (AKA grand mal) seizures, despite your never having had a seizure disorder before! The risk is worse if you’re taking a lithium variant, and/or most antidepressants, 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 neurological / psychiatric medication. Presuming you have the option of slowly tapering off them.

12.  Comments

Trileptal is the newish & improved (more or less) version of Tegretol. At least, we think it’s improved. It has a much lower side effect profile - although it still encourages you to stay inside and watch sports on TV to deal with the side effects of photosensitivity and hyponatremia - a monthly blood test isn’t required as with Tegretol, Trileptal has much less of an effect on oral contraceptives, other estrogen supplements, and Lamictal; although Lamictal is so temperamental a drug-drug interaction can’t be ruled out. Those are big improvements, right? But there’s still a question of efficacy for epilepsy, bipolar and all the off-label uses that Tegretol enjoys. Trileptal has had plenty of time to get approved for all the things Tegretol 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? Norvartis must have thought so, as they gambled on that, lost, and ended up paying $422.5 million for that mistake. Oops.

If Tegretol is indicated for you, for either epilepsy or bipolar, ask about Trileptal if it’s available where you live. Its better response rate could just be due to better med compliance as the side effects don’t suck as much donkey dong, but that’s still a damn good reason to take Trileptal instead of Tegretol. If it doesn’t work as well as expected it’s pretty easy to switch between the two meds. 300mg of Trileptal = 200mg of Tegretol. The PI sheets are full of information about switching between the two.

But when it comes to straightforward pain, especially the special hells that are glossopharyngeal neuralgia and trigeminal neuralgia Tegretol kicks the asses of all other treatments.

13.  Discussion board

Crazy Meds’ Trileptal discussion board

14.  Your Comments About and Experiences with Trileptal

Tell us what you think about Trileptal

This is the first medication I hAve taken that didn’t cause weight gain 1200 mg a day

can trileptal cause depression ? ‘/

does trileptal cause hyperness

Trileptal sucks, I took it for awhile, it worked but not like other drugs I have taken for bipolar disorder. It made me stoned for like four hours of the day! I will never go back to this drug, and you will have headaches like crazy!

Enter your own Comments & Experiences with Trileptal here.
You must be a registered member of the Crazy Meds Talk forum to post a comment on this page.

16.  Full US PI sheet, Global SPCs & PILs, check for drug-drug interactions

Trileptal Full US Prescribing Information / PI Sheet
UK Summary of Product Characteristics
New Zealand Data Sheet
New Zealand Consumer Medicine Information

Check for drug-drug interactions

17.  Bibliography

Physicians’ Desk Reference Edition 56 Maria Deutsch & Anu Gupta, Drug Information Specialists, et al. © 2002. Published by Medical Economics Company.

Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton

A Primer of Drug Action Robert M. Julien, M.D., Ph. D. © 2001. Ninth Edition.

Partial Seizure Disorders Mitzi Waltz © 2001. Published by O’Reilly & Associates.

Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.

Mosby’s 2004 Drug Guide David Nissen PharmD, Editor.© 2004. An imprint of Elsevier.

Date created 14 Mar 2011 - 17:08 Page Creator: JerodPoore Last edited by:

Page design and explanatory material copyright © 2004 - 2011 Jerod Poore. All rights reserved.

Almost all of the material on this site is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, and 2011 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you.
The information on Crazy Meds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
Know your sources!
Nobody on this site is a doctor, therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication^*. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazy Meds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Firefox.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices or in all dimensions of reality.

^*While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

‘Everything is true, nothing is permitted.’ - Jerod Poore