Oxcarbazepine: Side effects and toxicity
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The bottom line
Oxcarbazepine is used for partial onset seizures. Common side effects include drowsiness, dizziness, confusion, headache, incoordination, and difficulty with memory. Gastrointestinal symptoms, double vision, dystonia, and low sodium levels can occur. Serious skin and allergic reactions are possible. Drug interactions occur when taken with central nervous system depressants, hormonal contraceptives, and diuretics.
Prevention Tips
Store oxcarbazepine up, away, and out of reach of children.
Take as prescribed.
Do not take more than prescribed or more often than prescribed.
Shake liquid suspension well before each use.
Use the suspension within 7 weeks of opening the bottle.
Do not double your doses if you miss a dose.
Store at room temperature, away from heat and moisture. Do not put in direct sunlight.
Discuss possibility of drug interactions with your doctor or pharmacist.
Contact your doctor immediately if you develop rashes.
Contact your doctor if you have headache, confusion, or nausea which may mean that your sodium levels are low.
Do not stop this medication suddenly since this may cause your seizures to return.
This Really Happened
A 31-year-old man with a history of multiple psychiatric disorders ingested 75 oxcarbazepine tablets in a suicide attempt. His family found him unresponsive and took him to the emergency department. He was very drowsy; crackling sounds were heard in his lungs and his chest x-ray was abnormal. The rest of his physical examination was normal. His blood alcohol level was high; serum sodium was low and serum oxcarbazepine level was high. Electrocardiogram (ECG) was abnormal with high heart rate and conduction disturbance. He had a generalized tonic-clonic seizure which was treated with lorazepam and then levetiracetam was administered.. Other treatments included intravenous fluids, thiamine, and folic acid. There were abnormal findings on electroencephalogram and MRI of the head. His mental status and ECGs improved. Serum sodium decreased, and analysis of blood and urine suggested syndrome of inappropriate anti-diuretic hormone and he was started on fluid restriction. Serum sodium gradually increased to normal. He was medically discharged and then transferred to psychiatry unit.
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What is oxcarbazepine prescribed for?
Oxcarbazepine is prescribed for treatment of epilepsy in adults and children 2 years of age and older. It is used alone or with other anticonvulsants for the treatment of partial onset seizures (also called focal seizures). It may be prescribed off-label (not FDA-approved) as a mood stabilizer for bipolar disorder as well as treatment for nerve pain and trigeminal neuralgia.
How does oxcarbazepine work?
Oxcarbazepine is converted in the liver to a monohydroxy metabolite (MHD) which then decreases abnormal electrical activity in the brain by blocking voltage-gated sodium and modulating calcium channels. It also decreases release of glutamate (an excitatory neurotransmitter).
What are the side effects of oxcarbazepine?
Common side effects include drowsiness, dizziness, headache, wobbly gait, tremor, confusion, incoordination, trouble concentrating, and difficulty with memory or finding words. People can experience nausea, diarrhea, constipation, abdominal pain, and decreased appetite. Double vision or involuntary, rapid eye movements can occur. More serious effects include severe skin reactions, severe allergic reactions (such as swelling of the face or throat), low serum sodium levels, and low white cell counts. There is also a risk of depression and suicidal thoughts.
Is oxcarbazepine a controlled substance?
No, it is not a controlled substance but is available by prescription only. It is available as oral tablets, extended-release tablets, and oral suspension. The brand name for the tablets and suspension is Trileptal, while the brand name for the extended-release tablet is Oxtellar XR; generic formulations are also available.
What should I avoid while taking oxcarbazepine?
You should avoid alcohol and other central nervous system (CNS) depressants such as sleep aids (Ambien, Lunesta) because of the increased risk of drowsiness and dizziness. Oxcarbazepine interacts with CNS depressants, hormonal contraceptives (oxcarbazepine can decrease their effectiveness), and diuretics (can worsen decreased serum sodium level seen with oxcarbazepine). Also avoid driving or doing anything dangerous until you determine how this medication affects your coordination. Avoid becoming dehydrated or overheated. You should also avoid stopping oxcarbazepine abruptly since this may cause seizures to return.
What should I do if someone accidentally takes oxcarbazepine or takes too much oxcarbazepine?
If someone accidentally takes a dose of someone else’s oxcarbazepine or takes a double dose of their own oxcarbazepine, severe toxicity is unlikely, although there is increased risk of drowsiness and dizziness. Seek medical advice, especially if symptoms are present. Overdoses of oxcarbazepine can cause more serious toxicity including drowsiness, dizziness, tremors, headache, fatigue, double vision, ringing in ears, abnormal gait, dystonia (uncontrollable movements), low heart rate, and low blood pressure. Immediate medical attention is needed.
If someone swallows oxcarbazepine or if you have a question about using oxcarbazepine safely, use the webPOISONCONTROL® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.
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