Oxcarbazepine Suspension

Generic name:

Oxcarbazepine

Drug class:

Dibenzazepine anticonvulsant; antiepileptic

Dosage form:

Oral suspension (e.g., 300 mg/5 mL)

Root of administration:

Oral

Dose:

• Adults: initial 300 mg twice daily; increase by 300 mg every 3 days to 1200–2400 mg/day in divided doses
• Children (4–16 years): 8–10 mg/kg/day initial; titrate by 5 mg/kg every week up to ~30 mg/kg/day
• Geriatric: start low; adjust based on renal function and tolerability
• Renal impairment: dose reduction recommended; monitor renal function

Mechanism of action:

Prodrug converted to 10-monohydroxy metabolite; blocks voltage-gated sodium channels, stabilizes hyperexcitable neuronal membranes, inhibits repetitive neuronal firing, and reduces synaptic impulse propagation.

Drug usage cases:

• Partial seizures (monotherapy and adjunctive therapy) in adults and children ≥2 years
• Trigeminal neuralgia (off-label)
• Bipolar disorder (adjunctive/off-label)
• Generalized tonic-clonic seizures (off-label)
• Neuropathic pain (off-label)

Drug contra indications:

• Hypersensitivity to oxcarbazepine, eslicarbazepine, or related compounds
• History of severe cutaneous adverse reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis)
• Presence of HLA-B*1502 allele (increased risk of SJS/TEN) unless benefits outweigh risks

Side effects:

• CNS: dizziness, somnolence, headache, ataxia, nystagmus, tremor, fatigue
• Gastrointestinal: nausea, vomiting, dyspepsia
• Electrolyte: hyponatremia, SIADH
• Dermatologic: rash, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis
• Hematologic: leukopenia, neutropenia, agranulocytosis, thrombocytopenia
• Hepatic: elevated transaminases, hepatic dysfunction
• Psychiatric: agitation, behavioral changes, depression, suicidal ideation
• Endocrine: hypothyroidism (rare)
• Others: weight gain, peripheral edema, xerostomia

Warnings:

• Risk of serious dermatologic reactions; screen for HLA-B*1502 in at-risk populations
• Hyponatremia and SIADH; monitor serum sodium regularly
• Suicidal thoughts and behaviors; monitor mood changes
• CNS depression; caution with other sedatives
• Blood dyscrasias; periodic blood counts recommended
• Hypersensitivity reactions; discontinue if severe rash or organ involvement
• Withdrawal seizures; taper gradually

Use during pregnancy or breastfeeding:

Pregnancy: Category C. May increase risk of congenital malformations (e.g., neural tube defects). Use only if benefits justify risks. Monitor maternal folate levels.

Breastfeeding: Excreted in breast milk; potential for adverse effects in neonates. Use caution; monitor infant for sedation and feeding difficulties.