Oxcarbazepine

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 12, 2023

Warnings

Oxcarbazepine (Trileptal) Risks, Warnings, and Complications

Oxcarbazepine can cause or worsen health problems in some people. Talk to your doctor or pharmacist about other treatments for partial-onset seizures if you are at an increased risk of adverse reactions or complications from this medication. Some of the risks of taking oxcarbazepine include:

HYPONATREMIA: People taking oxcarbazepine can develop clinically significant hyponatremia (low serum sodium concentrations). Clinical studies have found that this generally occurs during the first three months of treatment, but it can develop even a year or more after starting oxcarbazepine therapy. Most patients who develop hyponatremia don’t have any symptoms, but some may need to have their sodium levels monitored frequently, especially if they are taking other medications that can affect sodium levels. Your provider may reduce your dose of oxcarbazepine, discontinue the medicine, or ask you to restrict fluid intake if you develop hyponatremia. Discontinuing the medicine usually results in the normalization of serum sodium levels within a few days. Tell your doctor right away if you develop signs and symptoms such as nausea, tiredness, headache, lack of energy, confusion, or increased seizure frequency or severity.
SERIOUS ALLERGIC REACTIONS: Rarely, oxcarbazepine can cause anaphylaxis (throat closing) or angioedema (swelling of the eyelids, lips, or throat). Swelling of the throat can be life-threatening. Seek emergency medical attention if you develop any such reaction after taking oxcarbazepine. Tell your doctor if you have a history of an allergic reaction to carbamazepine because this increases your risk of a hypersensitivity reaction to oxcarbazepine.
SEVERE SKIN REACTIONS: In a small number of adults and children, oxcarbazepine can lead to a serious drug reaction such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Such adverse reactions can be life-threatening and may require treatment in the hospital. Get emergency medical care if you develop skin rash, hives, itching, blistering, peeling, or shedding. Your doctor will discontinue oxcarbazepine and prescribe another antiepileptic drug.
SUICIDAL THOUGHTS AND BEHAVIOR: People taking antiepileptic medicines, including oxcarbazepine, have an increased risk of suicidal thoughts or behavior. Tell your doctor right away if you notice any changes in mood or behavior, including new or worsening depression and suicidal thoughts or behavior. These effects can occur as early as one week after starting treatment and persist for the duration of the treatment. Family members should be alert for any unusual mood or behavior changes and should know how to contact your healthcare provider if you are unable to do so yourself.
WITHDRAWAL SEIZURES: Oxcarbazepine and other antiepileptic medicines should be withdrawn gradually to minimize the risk of increased seizures. Follow your doctor’s instructions, and do not stop taking oxcarbazepine without your doctor’s approval.
NEUROCOGNITIVE EFFECTS: Use of oxcarbazepine is associated with adverse events involving the central nervous system, including cognitive symptoms, slowed movements, difficulty concentrating, speech problems, sleepiness, fatigue, coordination difficulties, and problems with walking. Tell your doctor if you develop any such signs and symptoms.
MULTI-ORGAN HYPERSENSITIVITY: Taking oxcarbazepine has been linked to multi-organ hypersensitivity in adult and pediatric patients, including serious cases requiring hospitalization. Signs and symptoms can be varied, including fever, rash, unusual bruising or bleeding, infections, liver function abnormalities, kidney dysfunction, muscle and joint involvement, and respiratory symptoms. If you develop these serious reactions, your healthcare provider will discontinue oxcarbazepine and start alternative treatment.
USE DURING PREGNANCY: Due to physiologic changes during pregnancy, there can be a gradual decrease in the blood levels of the active metabolite of oxcarbazepine. Your doctor will monitor you carefully during pregnancy and the postpartum period to keep an eye on drug levels and seizure control.

Precautions Before Starting Oxcarbazepine (Trileptal)

Tell your doctor if you have ever had an allergic reaction to oxcarbazepine, any of the active or inactive ingredients in oxcarbazepine formulations, other antiepileptic drugs, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions between oxcarbazepine and your other medications.

Give your doctor a complete medical history. Oxcarbazepine may not be right for people with certain medical conditions. Tell your doctor if you have kidney disease or liver disease.

Also, tell your doctor if you are of Asian descent (Chinese, Korean, Thai, Malaysian, Filipino, or Indian). People of Asian descent have a genetic susceptibility to develop serious skin reactions with oxcarbazepine use. Your provider will carefully weigh the risks versus benefits before prescribing this seizure medicine to you.

Tell your health care professional if you are pregnant, could be pregnant, plan to get pregnant, or are breast feeding. You should be aware that hormonal birth control may not work properly while on oxcarbazepine and therefore you will need an additional method of contraception while on this medicine. Talk to your doctor about the types of birth control that can work for you.

Precautions During Use of Oxcarbazepine (Trileptal)

Keep all your healthcare appointments during oxcarbazepine treatment. Your doctor will likely start you on a low dose of oxcarbazepine and gradually increase the dose. Follow your doctor’s instructions for dose adjustment carefully. Tell your doctor if your seizures are not well controlled. Do not perform a dosage adjustment yourself without your doctor’s approval.

Taking oxcarbazepine can make you drowsy and dizzy. Do not drive or do any activity that requires your full alertness until you know how this medicine affects you. Alcohol can make these side effects worse, so avoid drinking while you are on oxcarbazepine.

Call your doctor right away if you develop any changes in mood or behavior, including suicidal thoughts and behaviors.

Tell your doctor if you become pregnant while on this medication.

Tell all your healthcare providers you are on oxcarbazepine, especially before any procedure, including dental procedures.

Oxcarbazepine (Trileptal) Drug Interactions

Other drugs may affect how oxcarbazepine works. Possible interactions with certain medications can increase the risk of severe adverse effects. Some of the medications that can have interactions with oxcarbazepine include:

Drugs used to treat heart rhythm abnormalities, such as amiodarone (Cordarone)
Tricyclic antidepressants such as amitriptyline (Elavil) and clomipramine (Anafranil)
Antidepressants (selective serotonin reuptake inhibitors or SSRIs) such as duloxetine (Cymbalta), escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), fluvoxamine (Luvox), and sertraline (Zoloft)
Benzodiazepines such as diazepam (Valium)
Calcium channel blockers such as nifedipine (Procardia), diltiazem (Cardizem, Dilacor, Tiazac), verapamil (Calan, Covera, Isoptin, Verelan), nicardipine (Cardene), felodipine (Plendil), amlodipine (Norvasc), isradipine (DynaCirc), nisoldipine (Sular), and nimodipine (Nimotop)
Antipsychotics such as chlorpromazine (Thorazine)
Cancer medications such as cyclophosphamide (Cytoxan, Neosar)
Medications used to treat diabetes insipidus (water diabetes) such as desmopressin (DDAVP, Minirin, Stimate)
Diuretics or water pills such as indapamide (Natrilix)
Proton-pump inhibitors for acid reflux such as omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Protonix)
Other anticonvulsant medications such as phenytoin (Dilantin), phenobarbital, valproic acid (Depakene, Depakote), and carbamazepine (Carbatrol, Equetro, Epitol, Tegretol)
Asthma and COPD medications such as theophylline (Theo-Dur)

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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