AnticonvulsantUS FDA Database Verified

OXcarbazepine (Rx)

Generic: OXcarbazepine

Brand: Oxtellar XR, Trileptal

(ox'kar- baz'uh- peen)

Pregnancy Category: C

Pharmacological Action

May inhibit nerve impulses by limiting influx of sodium ions across cell membrane in motor cortex

Therapeutic outcome: Absence of seizures

Uses

Partial seizures Unlabeled uses: Trigeminal neuralgia, atypical panic disorder, bipolar disorder

Contraindications

Hypersensitivity

Precautions: Pregnancy C, breastfeeding, children < 4 yr, hypersensitivity to carbamazepine, renal disease, fluid restriction, hyponatremia, abrupt discontinuation, suicidal ideation

Dosage & Routes

Seizures adjunctive therapy

Adult: PO 300 mg bid, may be increased by 600 mg/day in divided doses bid at weekly intervals; maintenance 1200 mg/day ; ext rel 600 mg/day× 1 wk, increase weekly in 600 mg/day increments to 1200 - 2400 mg/day Child 4- 16 yr: PO 8 - 10 mg/kg/day divided bid, dose is determined by weight, increase by 5 mg/kg/day q3 days, max doses are weight dependent Conversion to monotherapy in partial seizures

Adult: PO 300 mg bid with reduction in other anticonvulsants, increase OXcarbazepine by 600 mg/day qwk over 2- 4 wk; withdraw other anticonvulsants over 3- 6 wk, max 2400 mg/day Initiation of monotherapy in partial seizures

Adult: PO 300 mg bid, increase by 300 mg/day q3 day to 1200 mg divided bid, max 2400 mg/day Renal dose

Adult: PO CCr< 30 ml/min 150 mg bid and increase slowly

Available forms: Film- coated tabs 150, 300, 600 mg ; oral susp 300 mg/5 ml ; ext rel tab 150, 300, 600 mg

Implementation Store product at room temperature Provide assistance with ambulation during early part of treatment; dizziness may occur Give product with food, milk to decrease GI symptoms Oral susp: shake well, use calibrated oral syringe provided, use or discard within 7 days of opening Ext rel: do not crush, break, or chew

Adverse Effects

CNS: Headache, dizziness, confusion, fatigue, feeling abnormal, ataxia, abnormal gait, tremors, anxiety, agitation, worsening of seizures, suicidal ideation/behavior

CV: Hypotension, chest pain, edema, bradycardia, syncope

EENT: Blurred vision, diplopia, nystagmus, rhinitis, sinusitis

ENDO: Hypothyroidism, hot flashes

GI: Nausea, constipation, diarrhea, anorexia, vomiting, abdominal pain, gastritis

GU: Urinary frequency, hematuria, menses change

INTEG: Purpura, rash, acne

META: Hyponatremia

RESP: Flulike symptoms

SYST: Angioedema, anaphylaxis, Stevens- Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS)

Pharmacokinetics

Absorption: Unknown

Distribution: Unknown

Metabolism: Liver; 95% renal extraction

Excretion: Unknown

Half-life: Unknown

Pharmacodynamics

Onset: Unknown

Peak: 4-6 hr

Duration: Unknown

Interactions

Individual products:

Alcohol: increased CNS depression

CarBAMazepine: decreased carBAMazepine level, decreased Oxcarbazepine levels

Felodipine: decreased effects of felodipine Nisoldipine, ranolazine: do not use concurrently PHENobarbital, valproic acid, verapamil: decreased Oxcarbazepine level

Phenytoin: decreased Oxcarbazepine level

Drug classifications Contraceptives (oral): decreased oral contraceptive level

MAOIs: do not use concurrently

Drug/herb

Ginkgo: increased anticonvulsant effect Ginseng, santonica: decreased anticonvulsant effect

Drug/lab test

Decreased: sodium

Nursing Considerations

Assessment - Assess seizure activity, including frequency, duration, and aura; provide seizure precautions - Assess mental status including mood, sensorium, affect, behavioral changes, suicidal thoughts, behavior; if mental status changes, notify prescriber; usually occurs within the first 3 mo of treatment, but may occur ≤ 1 yr; if this product is being used with other products that decrease sodium, monitor sodium levels - Assess eye problems: ophthalmic examinations (slit lamp, funduscopy, tonometry) are needed before, during, after treatment - Assess patient for hypersensitivity to carBAMazepine - Assess for serious skin reactions: angioedema, anaphylaxis, Stevens- Johnson syndrome -

Pregnancy: lack of seizure control due to MHD, a metabolite of Oxcarbazepine; monitor seizure control - May monitor target serum level 12- 30 mcg/ml to identify compliance/toxicity

Patient/family education Caution patient to avoid driving, other activities that require alertness - Instruct patient to take twice a day at same intervals - Advise patient not to discontinue medication quickly after long- term use, seizures may increase Instruct patient to avoid use of alcohol while taking this medication - Instruct patient to use alternative contraception if using hormonal method, to report if pregnancy is planned or suspected, pregnancy (C) Teach patient to report skin rashes immediately; serious skin reactions can occur - Instruct patient to inform prescriber if allergic to carBAMazepine; multisystem hypersensitivity may occur, to report fever, other allergic symptoms Instruct patient to report suicidal thoughts/behavior immediately

Evaluation Positive therapeutic outcome - Decreased seizure activity TREATMENT OF

OVERDOSE: Activated charcoal, give 0.9% NaCl (hypotensive state), atropine (bradycardia); use benzodiazepines, barbiturates for seizures

Reference

Mosby's Drug Guide; Davis Drug Guide

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