oxcarbazepine

CLINICAL USE

Anti-epileptic agent Trigeminal neuralgia (unlicensed indication)

DOSE IN NORMAL RENAL FUNCTION

Epilepsy: 600 mg–2.4 g daily in divided dosesTrigeminal neuralgia: 400–2.4 g in 2–4 divided doses

PHARMACOKINETICS

Molecular weight :252.3

%Protein binding :40–60 (metabolite)

%Excreted unchanged in urine : <1

Volume of distribution (L/kg) :0.7–0.8

half-life – normal/ESRD (hrs) :1.3–2.3 (9 for metabolite)/Unchanged (16–19 for metabolite)

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–50 Dose as in normal renal function 10–30 Dose as in normal renal function. Start with 300 mg daily and titrate slowly

<10 : Dose as in normal renal function. Start with 300 mg daily and titrate slowly

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Unknown dialysability. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR=10–30 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Ciclosporin: metabolism accelerated (reduced ciclosporin concentration)

Antidepressants: antagonism of anticonvulsant effect; avoid concomitant use with MAOIs

Antimalarials: possibly increased risk of convulsions with chloroquine and hydroxychloroquine; anticonvulsant effect antagonised by mefloquine

Antipsychotics: antagonism of anticonvulsant effectOestrogens and progestogens: metabolism accelerated (reduced contraceptive effect)

Tacrolimus: metabolism accelerated (reduced tacrolimus concentration)

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Metabolised to active monohydroxy metabolite
Hyponatraemia is more common with oxcarbazepine than carbamazepine, monitoring is recommendedMaximum plasma concentrations reached after about 1 hour.

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