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Oxcarbazepine / Trileptal

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1 Oxcarbazepine / Trileptal on Wed Sep 30, 2009 10:51 am

TJW

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Trileptal (try-LEP-tal) is the brand name for the seizure medicine oxcarbazepine (ox-car-BAZ-eh-peen). Trileptal is available in many countries, including the United States, Canada, the UK, Australia, and the countries of the European Union.

Although Trileptal has been used in the United States just since 2000, it has been used in other countries since 1990 and has been studied in thousands of patients around the world.

Forms
Trileptal is marketed in the United States by Novartis Pharmaceuticals. The name or appearance may differ in other places. The dose (measured in milligrams, abbreviated "mg") will usually be the same.

Tablets
Trileptal tablets are available in three sizes:
150-mg (pale gray-green, scored)
300-mg (yellow, scored)
600-mg (light pink, scored)


Suspension
300 mg/5 mL suspension: off-white to slightly brown or slightly red liquid

The generic form of Trileptal, called oxcarbazepine, is available in the United States and some other countries.

Follow your doctor's directions. Call if you have any questions. Trileptal (oxcarbazepine) is generally taken twice a day, so many people help themselves to remember by taking it with breakfast and dinner. It's OK to take it either with food or without food. Ask the doctor what to do if you forget to take a dose.

To use the suspension, start by shaking the bottle well. Then immediately measure the prescribed amount, taking it from the bottle using the "dosing syringe" that was supplied with the medicine. This medicine can be swallowed directly from the syringe, or you can mix it in a small glass of water. After each use, close the bottle, rinse the syringe with warm water, and allow it to dry thoroughly.

Be careful if the doctor writes a new prescription using a different kind of pill. For example, if you've been using 150-mg tablets and the new prescription is for 300-mg tablets, be careful to use the correct number. Don't automatically continue to use the same number of pills as before. This kind of mistake may be especially easy to make with Trileptal, since all the tablets are the same color and shape in some countries. Make sure you know what size tablet has been prescribed.

Store all forms of Trileptal at room temperature. Keep the liquid suspension in its original container. Store both the liquid and tablets where children cannot see or reach them. The suspension should be used within 7 weeks of first opening the bottle.

Be sure to use only the amount of Trileptal that your doctor prescribes. If you think you've taken one or two extra tablets, call your doctor for advice. For a larger overdose, call your local poison control center or emergency room right away.

Don't stop taking Trileptal or change the amount you take without talking to your doctor first. Stopping any seizure medicine all at once can cause a serious problem called status epilepticus.

If you forget a dose, take it as soon as you remember. If it is almost time for the next dose, delay that dose for a few hours instead of taking two doses very close together. Then go back to the regular schedule.

Do your best to follow the doctor's directions. If you forget doses often, it may be a good idea to get a special pillbox or watch with an alarm to remind you.

Taking the right amount of seizure medicine on time every single day is the most important step in preventing seizures!

Trileptal (oxcarbazepine) is a highly effective antiepileptic medication. It is related to carbamazepine (Tegretol, Carbatrol), a widely used seizure medicine, and is used in similar situations. These include treating simple and complex partial seizures (with or without secondary generalization) and primary generalized tonic-clonic seizures. Comparisons of Trileptal and Tegretol have found them to be equally effective for these uses. Trileptal does not control absence seizures.

Many of the side effects commonly seen with Tegretol also are seen with Trileptal. In many people, Trileptal causes fewer and milder side effects than Tegretol or Carbatrol, however, so it may be substituted for those medications if side effects are a problem. Trileptal is much more expensive than Tegretol.

Some studies have compared Trileptal with other seizure medicines for treatment of newly diagnosed epilepsy. For instance, studies in both children and adults have compared Trileptal (used alone) with phenytoin (Dilantin, Phenytek) have found them to be about equally effective overall in controlling partial seizures and primary generalized tonic-clonic seizures. (About 60% of patients were seizure-free during the treatment period.) The patients who took Trileptal had fewer problems with side effects.

A similar study comparing Trileptal with Depakote (valproate) in adults found little difference between the two medications.

Trileptal also can be used as add-on therapy for patients whose seizures are not well controlled by one or two other medications. A summary of studies in which Trileptal was used in this way for partial seizures reported that 41% of adults who took Trileptal had their seizures reduced in frequency by at least half, compared to 13% of those who added a placebo to their previous medications.

A comparable study of add-on therapy for children also found that 41% of those who took Trileptal had at least a 50% decrease in seizure frequency. Of those who took a placebo, 22% had a similar reduction.

No single combination of medications is perfect for everyone. Sometimes, a series of combinations must be tried before finding what is best for the individual patient. If Trileptal is added to standard medications such as Tegretol or Depakote, usually no adjustment of the previous dosages of those medicines will be necessary. However, the dose of Dilantin (or Phenytek) may need to be decreased if Trileptal is added.

Since Trileptal (oxcarbazepine) is related to carbamazepine (Tegretol, Carbatrol), it causes many of the same side effects. About 25% of people who get a rash from carbamazepine will also get one from Trileptal. On the whole, however, many people find that side effects are less of a problem with Trileptal than with Tegretol. Sometimes their seizures can be controlled better because they can take a higher dose with fewer side effects.

The side effects of Trileptal are usually mild or moderate. The most common side effects are:

dizziness
headache
tiredness
drowsiness
double vision
stomach upset
loss of coordination
If you notice problems like any of these while you are taking Trileptal, it's probably a good idea to discuss them with your doctor or nurse. You shouldn't stop taking Trileptal or any other seizure medicine without your doctor's advice.

In some patients, especially those taking higher doses of Trileptal, the level of sodium in the blood may become low (hyponatremia). Usually this is not serious, but occasionally it may increase seizure frequency or cause other problems such as tiredness or dizziness. Your doctor may want to check your blood to see if this is happening to you, especially if you are having nausea, a vaguely "unwell" feeling, headache, listlessness, or confusion.

As with many other seizure medicines, you may feel sleepy or less alert when taking Trileptal. Some patients who change from Tegretol to Trileptal report feeling more alert, but it's uncertain how much difference there is between these two medicines in this regard. Until you know how Trileptal affects you, you should be careful about activities that might be dangerous. You should also be very cautious about drinking alcohol, because with Trileptal the neurologic effects of alcohol (such as tiredness, slurred speech, or unsteadiness) may be increased.

Allergic reactions
A small percentage of people taking Trileptal develop a rash within the first few weeks of taking it. If this happens, tell the doctor or nurse right away, to be sure that it's not the beginning of a serious problem. It's rare for the rash to be serious, but don't ignore it. It's often necessary to switch to a different seizure medicine.

Like Tegretol or Carbatrol, Trileptal also can be used to treat a type of facial pain called trigeminal neuralgia (tic douloureux) and to stabilize mood in patients with bipolar (manic-depressive) disorder.

Sometimes one kind of medicine changes the way another kind of medicine works in the body. If two kinds of medicine affect each other, the doctor may prescribe something else or change the amount to be taken.

Trileptal has very few problems of this kind. The way Trileptal works is not affected by other medicines and Trileptal does not affect the most other medicines. (See below for some exceptions.) This means that Trileptal can be taken with most other medicines without difficulty.

One exception is that Trileptal can make oral contraceptives and Depo-Provera less effective. To prevent pregnancy, you may need to use a different type of birth control or raise the dosage of the contraceptive. Talk to your doctor about this problem. Trileptal does not affect barrier types of birth control, like condoms, IUDs, and diaphragms.

Trileptal can cause the level of the seizure medicines Dilantin or Phenytek (phenytoin) to go higher, so adjustments may be necessary if these medicines are used together.

The dose for children is calculated based on the child's body weight. Usually the doctor will prescribe 8 to 10 milligrams (mg) of Trileptal per kilogram (2.2 pounds) of weight to start, divided into two doses per day. This dose will be increased over about 2 weeks, up to a dosage of 10-50 mg/kg per day.

Children’s bodies break down Trileptal faster than adults’ bodies do. This means that young children need to take a larger amount, relative to their weight, than adults. They also may need to take the medication more often. By the time children reach their early teens, however, their bodies absorb, digest, and excrete medicines more like adults do, so they may need to take less than before.

If the liquid suspension is used, it is very important to shake the bottle thoroughly immediately before measuring. A child who gets a dose from a bottle that has not just been well shaken may get too much or too little medication.

Pregnancy Category C. This indicates that caution is advised, but the benefits of the medication may outweigh the potential risks. There have been no well-controlled studies in women, but studies in animals have shown some harm to the fetus.

In general, the risk of defects is higher for women who take more than one AED and for women with a family history of birth defects.

Women who are capable of becoming pregnant should take at least 400 mcg (0.4 mg) of folic acid (folate) daily to help prevent a type of birth defect called a neural tube defect. (The best-known of these is spina bifida, in which the spinal cord is not completely enclosed.) Women at high risk, such as those with a history of this kind of defect in a previous pregnancy, should take 4000 mcg (4 mg) daily, beginning before they become pregnant.

About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones or changes in how their seizure medicine is handled by the body. The doctor may recommend checking the level of medication in the blood regularly during pregnancy so that the dosage can be adjusted as needed.

No studies have been performed to demonstrate the effect of specific seizure medicines during labor and delivery.

Possible causes of seizures include:

failure or inability to take medication
sleep deprivation
hyperventilation
stress
pain

Some Trileptal is passed through breast milk. If you want to breastfeed your baby, check with your doctor about what seizure medicine would be best for you.

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