Posted by Sunnely on July 27, 2000, at 21:15:36
In reply to Info on oxcarbazepine - Scott, Cam, anyone??, posted by Chris A. on July 27, 2000, at 17:20:53
> My pDoc is suggesting we try this apparently newly FDA approved relative of carbamazepine (Tegretol). It is supposed to have fewer side effects and less potential for drug interactions. Does anyone know anything practical about this anticonvulsant med - like the trade name, what company makes it, and the biggie - what is it's potential for causing weight gain?
Oxcarbazepine (Trleptal), related to carbamazepine (Tegretol) in chemical structure, received US FDA approval in January, 2000 as a treatment of partial seizures with or without secondary generalization.
In the US, Trileptal is not indicated for use in the treatment of mania and bipolar disorder. However, it has been used and found effective for this condition in some European countries. During the European studies comparing carbamazepine (Tegeretol; Tegretal in Germany) and oxcarbazepine as treatment for bipolar disorder and schizoaffective disorder, both were found to have pharmacologically similar profile of action. However, oxcarbazepine was better tolerated than carbamazepine in equivalent dosages. It was suggested that the known adverse effects of carbamazepine are closer related to the its main metabolite called carbamazepine-10,11-Epoxide than its parent compound (carbamazepine). Oxcarbazepine is not metabolized to this compound but a different one. Because of its better tolerability, it has an advantage over carbamazepine in the treatment of acute mania, where relatively high dosages should be reached as soon as possible. (Minor advantage during prophylactic treatment of manic symptoms.) Majority of the patients with manic symptoms during the European studies appeared to respond to oxcarbazepine in dose range of 1200-3000 mg/day.
Trileptal appears to have similar side effect profile as Tegretol. During clinical trials as an anti-epileptic, the following symptoms were experienced by patients at least 5% more frequent than placebo: dizziness, sleepiness, double vision, tiredness, nausea, vomiting, unsteadiness, abnormal vision, abdominal pain, tremor, and dyspepsia. For patients who have not previously been treated with other anti-epileptics, using Trileptal alone, most common symptoms that led to discontinuation of treatment were: dizziness, nausea, rash, headache. Increase in weight was seen in 1% of patients on Trileptal at 600 mg/day; 2% on doses 1200-2400 mg/day; 1% on placebo.
In 14 controlled epilepsy studies, Trileptal caused clinically significant drop in blood sodium level (hyponatremia) in 2.5% of the patients (38 of 1524). Patients whose treatment with Trileptal was discontinued due to hyponatremia experienced normalization of blood sodium within a few days without additional treatment.
Trileptal can inhibit and stimulate the action of certain liver enzymes leading to significant interactions with other drugs. For female patients of childbearing age, the concurrent use of Trileptal with hormonal contraceptives may render this method of contraception less effective. Additional non-hormonal forms of contraception are recommended when using Trileptal. Other anti-epileptics which strongly stimulate liver enzymes have been shown to decrease the blood level of Trileptal. Repeated dosing with Trileptal has been shown to lower the blood level of certain calcium channel blockers (e.g., felodipine). On the other hand, verapamil produced a decrease in the blood level of Trileptal's active metabolite, 10-monohydroxy (MHD). Cimetidine (Tagamet), erythromycin, and dextropropoxyphene had no effect on the metabolism of MHD. No evidence of interaction noted with warfarin (Coumadin, blood thinner) with either single or repeated dosing of Trileptal. Alcohol can cause possible additive sedative effect with Trileptal. There are no known interactions of Trileptal with commonly used laboratory tests. Unlike Tegretol, no autoinduction has been observed with Trileptal (i.e., Trileptal does not induce its own metabolism).
Patients who have allergic reactions to Tegretol have approximately 25%-30% chance of developing allergic reactions with Trileptal.
Trileptal is a Pregnancy Category C drug.
Good Luck.
poster:Sunnely
thread:41526
URL: http://www.dr-bob.org/babble/20000717/msgs/41536.html