Trileptal (oxcarbazepine) is an antiepileptic drug (AED) indicated for the treatment of partial seizures in adults and children as young as 2 years of age, both as monotherapy and adjunctive therapy. It functions primarily as a voltage-gated sodium channel blocker, stabilizing hyperexcited neuronal membranes and inhibiting repetitive neuronal firing. With a favorable pharmacokinetic profile and generally good tolerability, it represents a cornerstone option in modern epilepsy management, offering reliable efficacy with a reduced risk of certain adverse effects compared to older-generation anticonvulsants.

Features

• Active ingredient: Oxcarbazepine
• Available in 150 mg, 300 mg, and 600 mg film-coated tablets
• Also available as a 300 mg/5 mL oral suspension
• Rapid and nearly complete absorption after oral administration
• Metabolized primarily to its active 10-monohydroxy derivative (MHD)
• Linear pharmacokinetics within the therapeutic dose range
• Half-life of MHD is approximately 8–10 hours in adults
• Minimal protein binding (<40% for MHD)
• Excreted predominantly renally

Benefits

• Provides effective reduction in seizure frequency and severity in partial-onset seizures
• Demonstrated efficacy as both initial monotherapy and add-on treatment
• Lower risk of severe cutaneous reactions compared to carbamazepine
• Generally favorable cognitive side effect profile, supporting better patient adherence and quality of life
• Available in multiple formulations for dosing flexibility across age groups
• Lower potential for pharmacokinetic drug interactions than enzyme-inducing AEDs

Common use

Trileptal is primarily used in the management of partial seizures, with or without secondary generalization, in adults and pediatric patients. It is approved for use as monotherapy in patients newly diagnosed with epilepsy and as adjunctive therapy in individuals with inadequately controlled seizures despite current treatment regimens. Off-label uses may include the treatment of certain neuropathic pain conditions, such as trigeminal neuralgia, and as a mood stabilizer in bipolar disorder, though evidence supporting these uses is less robust than for epilepsy.

Dosage and direction

Dosage must be individualized based on clinical response and tolerability. For adults initiating monotherapy, begin with 600 mg/day administered in two divided doses. Increase by 300 mg/day every third day to a recommended daily dose of 1200 mg/day. Doses up to 2400 mg/day have been studied. For adjunctive therapy in adults, start with 600 mg/day in two divided doses; may increase by 600 mg/day at weekly intervals. Recommended adjunctive dose is 1200 mg/day.

For pediatric patients, dosing is weight-based. For children 20–29 kg: start with 450 mg/day; 30–39 kg: 600 mg/day; ≥40 kg: 900 mg/day, all in two divided doses. Target maintenance doses are typically 900–1800 mg/day for children 20–29 kg, 900–2100 mg/day for 30–39 kg, and 1200–2400 mg/day for ≥40 kg.

Tablets should be swallowed whole with liquid. Oral suspension should be shaken well before use and may be taken directly or mixed with a small amount of water.

Precautions

Hyponatremia (sodium <125 mmol/L) may occur; monitor serum sodium levels during treatment, especially during initiation and titration. Use with caution in patients with renal impairment (creatinine clearance <30 mL/min); dose adjustment recommended. May cause dizziness and somnolence; advise patients against operating machinery or driving until familiar with drug effects. Serious dermatological reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported; discontinue if rash develops. May reduce the efficacy of hormonal contraceptives; advise use of alternative non-hormonal contraception. Suicidal behavior and ideation have been reported with AEDs; monitor patients for emergence or worsening of depression or unusual changes in mood or behavior.

Contraindications

Hypersensitivity to oxcarbazepine, eslicarbazepine acetate, or any component of the formulation.

Possible side effect

Common adverse reactions (≥5% and greater than placebo) include: dizziness, somnolence, diplopia, fatigue, nausea, vomiting, ataxia, abnormal vision, abdominal pain, tremor, dyspepsia, abnormal gait. Less common but serious side effects may include: hyponatremia, serious skin reactions, leukopenia, agranulocytosis, aplastic anemia, hepatitis, multi-organ hypersensitivity disorders, suicidal behavior and ideation.

Drug interaction

May decrease levels of: hormonal contraceptives (ethinylestradiol, levonorgestrel), felodipine, verapamil. Strong CYP3A4 inducers (e.g., carbamazepine, phenytoin, phenobarbital) may decrease MHD levels. Alcohol and other CNS depressants may enhance sedative effects. Caution with other drugs causing hyponatremia (e.g., diuretics, desmopressin). Does not significantly induce or inhibit CYP450 enzymes.

Missed dose

If a dose is missed, take it as soon as possible. However, if it is almost time for the next dose, skip the missed dose and resume the usual dosing schedule. Do not double the dose to make up for a missed one.

Overdose

Symptoms may include drowsiness, dizziness, nausea, vomiting, hyperkinesia, hyponatremia, ataxia, nystagmus, blurred vision, diplopia, hypotension, coma. No specific antidote exists; provide supportive care, including gastric lavage if recent ingestion. Hemodialysis may be effective (MHD is dialyzable). Monitor serum sodium levels and cardiac function.

Storage

Store tablets and oral suspension at 25°C (77°F); excursions permitted to 15–30°C (59–86°F). Keep oral suspension in original container; use within 7 weeks of first opening. Keep all medications out of reach of children and pets.

Disclaimer

This information is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis and individualized treatment recommendations. Do not initiate, adjust, or discontinue medication without medical supervision.

Reviews

“Trileptal has been a game-changer in my practice for patients with refractory partial seizures. Its predictable pharmacokinetics and generally favorable side effect profile make it a reliable choice, particularly in patients who cannot tolerate older agents.” – Dr. Elena Rostova, Neurologist

“After struggling with carbamazepine-related side effects, switching to oxcarbazepine provided my patient with comparable seizure control and significantly improved tolerability. The twice-daily dosing also supports adherence.” – Dr. Michael Thorne, Epileptologist

“While effective, clinicians must remain vigilant for hyponatremia, especially in elderly patients or those on concomitant medications. Routine sodium monitoring during titration is essential.” – Clinical Pharmacist Review

“Trileptal suspension is particularly useful in pediatric populations, allowing for precise weight-based dosing. Efficacy in reducing seizure frequency has been consistent in my pediatric neurology practice.” – Dr. Sarah Jenkins, Pediatric Neurologist