Trileptal (oxcarbazepine)
uses, side effects, dosage, how to take, how to stop taking, and more

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!

Doctors have been experimenting with my brain chemistry since I was a kid. I’ve been diagnosed and fed a parade of meds to “see what works” . This is the standard of medicine in our day and in our time. Trileptal works for me, but you are the steward of your own health. If you simply hand yourself to someone else to go down a list of drugs and try them all out on you then you can expect to have a difficult experience. I speak of what I know. Head meds have side effects that might do all manner of things and often the patient is not informed enough to ask the right questions. It is important that you or someone close to you be aware of drug interactions and you make full use of that awareness. Trileptal is a powerful Med with mild side effects and after working together with my Dr and removing a different drug or two and playing around with my dosage for around a year Trileptal suddenly brought me out of the fog. Over-medicating had been a problem, misdiagnoses, poor follow up by physicians, all snowballs into years of being treated incorrectly and with little benefit to the patient. Participate. Educate yourself or have someone help you to know what you are taking, why you are taking it, and what are the likely side effects. We’re all test subjects and Trileptal tested good for me.

Doctors have been experimenting with my brain chemistry since I was a kid. I’ve been diagnosed and fed a parade of meds to “see what works” . This is the standard of medicine in our day and in our time. Trileptal works for me, but you are the steward of your own health. If you simply hand yourself to someone else to go down a list of drugs and try them all out on you then you can expect to have a difficult experience. I speak of what I know. Head meds have side effects that might do all manner of things and often the patient is not informed enough to ask the right questions. It is important that you or someone close to you be aware of drug interactions and you make full use of that awareness. Trileptal is a powerful Med with mild side effects and after working together with my Dr and removing a different drug or two and playing around with my dosage for around a year Trileptal suddenly brought me out of the fog. Over-medicating had been a problem, misdiagnoses, poor follow up by physicians, all snowballs into years of being treated incorrectly and with little benefit to the patient. Participate. Educate yourself or have someone help you to know what you are taking, why you are taking it, and what are the likely side effects. We’re all test subjects and Trileptal tested good for me.

Doctors have been experimenting with my brain chemistry since I was a kid. I’ve been diagnosed and fed a parade of meds to “see what works” . This is the standard of medicine in our day and in our time. Trileptal works for me, but you are the steward of your own health. If you simply hand yourself to someone else to go down a list of drugs and try them all out on you then you can expect to have a difficult experience. I speak of what I know. Head meds have side effects that might do all manner of things and often the patient is not informed enough to ask the right questions. It is important that you or someone close to you be aware of drug interactions and you make full use of that awareness. Trileptal is a powerful Med with mild side effects and after working together with my Dr and removing a different drug or two and playing around with my dosage for around a year Trileptal suddenly brought me out of the fog. Over-medicating had been a problem, misdiagnoses, poor follow up by physicians, all snowballs into years of being treated incorrectly and with little benefit to the patient. Participate. Educate yourself or have someone help you to know what you are taking, why you are taking it, and what are the likely side effects. We’re all test subjects and Trileptal tested good for me.

Doctors have been experimenting with my brain chemistry since I was a kid. I’ve been diagnosed and fed a parade of meds to “see what works” . This is the standard of medicine in our day and in our time. Trileptal works for me, but you are the steward of your own health. If you simply hand yourself to someone else to go down a list of drugs and try them all out on you then you can expect to have a difficult experience. I speak of what I know. Head meds have side effects that might do all manner of things and often the patient is not informed enough to ask the right questions. It is important that you or someone close to you be aware of drug interactions and you make full use of that awareness. Trileptal is a powerful Med with mild side effects and after working together with my Dr and removing a different drug or two and playing around with my dosage for around a year Trileptal suddenly brought me out of the fog. Over-medicating had been a problem, misdiagnoses, poor follow up by physicians, all snowballs into years of being treated incorrectly and with little benefit to the patient. Participate. Educate yourself or have someone help you to know what you are taking, why you are taking it, and what are the likely side effects. We’re all test subjects and Trileptal tested good for me.

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 Author: JerodPoore Last edited by: JerodPoore

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² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]