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Re: Bipolar ll: Trileptal vs. Tegretol » Ritch

Posted by ed_uk on January 13, 2005, at 15:23:39

In reply to Re: Bipolar ll: Trileptal vs. Tegretol » ed_uk, posted by Ritch on January 13, 2005, at 12:49:19

Hello Ritch,

>Trileptal is *supposed* to be the *same* as Tegretol without the drug interaction risks.

Trileptal and its active metabolite do inhibit the cytochrome P450 isoenzyme CYP2C19. Trileptal and its metabolite also have the capacity to induce CYP3A4 and CYP3A5. Trileptal induces hepatic enzymes to a lesser extent than Tegretol.

Are you on any drugs which might interact with Tegretol or Trileptal?

>what's the difference in the effects of taking either drug (given an "equivalent" dosage)??

I would expect them to be somewhat similar- although the efficacy of Tegretol in bipolar disorder is better established. A pubmed study said 'The mechanism of action of Trileptal involves mainly blockade of sodium currents but differs from Tegretol by modulating different types of calcium channels.'

>I just wonder if the "Trileptal is the same as Tegretol except it is safer and cleaner" is true for BIPOLAR, or whether that is somewhat mythological.

Some similarities and differences between Tegretol and Trileptal.......

1. Trileptal seems to cause hyponatremia more frequently than Tegretol. Symptoms include lethargy, restlessness and confusion. With Trileptal, hyponatremia is usually mild but 'hyponatraemia occurred in 23% of 350 patients whose serum-sodium concentrations were monitored.' In the rare cases where severe hyponatremia occurs, seizures and coma may result.

2. Hypersensitivity (allergic-type) reactions such as skin rashes occur less frequently with oxcarbazepine (Trileptal) than with carbamazepine(Tegretol). However, cross-sensitivity does occur and about 25 to 30% of patients hypersensitive to carbamazepine may experience such reactions with oxcarbazepine.

3. Trileptal appears to cause leucopenia less frequently than Tegretol. Thrombocytopenia has been reported rarely with Trileptal, as is the case with Tegretol. The risk of serious blood disorders is said to be lower with Trileptal.

4. Hepatitis has been reported rarely with Trileptal, as is the case with Tegretol.

5. Apparantly 'switching from Tegretol to Trileptal normalized Tegretol-associated thyroid and sexual hormone abnormalities and pathological lipid values in small patient samples.'

'Trileptal has been reported to be a preferable antiepileptic drug, when compared to Tegretol with respect to its effects on lipid metabolism, especially cholesterol, high-density lipoproteins, and low-density lipoproteins.'

6. In one study 'More adverse events were self-reported with Tegretol (63%) than the other treatments (Trileptal 12%,, placebo 5%). Tegretol induced the greatest motor slowing (p = 0.002), followed by Trileptal (p = 0.01).'

7. 'The pharmacokinetic profile of Trileptal is less complicated than that of Tegretol, with less metabolism by the cytochrome P450 system, no production of an epoxide metabolite, and lower plasma protein binding.'

8. Cases of Systemic Lupus Erythematosus (SLE / 'Lupus') have been reported with both drugs.

9. A study in 1989 found that 'Trileptal caused significantly fewer (P = 0.04) severe side effects than Tegretol; global evaluation of tolerability demonstrated a trend towards the better tolerability of Trileptal.'


Sorry, can't be sure about the nausea. You'll have to try it!!!

Regards,
Ed.


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URL: http://www.dr-bob.org/babble/20050113/msgs/441702.html