Oxcarbazepine in the Treatment of Bipolar Disorder: A Review

Bipolar disorder (BD) is a long-term illness with mood swings which are characterized by recurrent episodes of mania/hypomania and depression, with variable interpolations of relatively asymptomatic periods, called euthymic, in which, however, some psychopathological symptoms may persist. Although mood stabilizers, such as lithium, are the first-line treatment for the prevention of new BD episodes, combination therapy has become the standard of care for BD patients. Besides lithium, the use of a mood stabilizer along with an atypical antipsychotic is recommended in many patients. Recently, atypical antipsychotics (quetiapine, olanzapine, risperidone and aripiprazole) and antiepileptic agents (valproate, lamotrigine and oxcarbazepine) are increasingly used as mood stabilizers. To reduce side effects and optimize treatment it is important to perform accurate monitoring of drug blood levels in these patients, who are often treated with multiple drugs. Therapeutic drug monitoring (TDM) is in fact a powerful tool that, starting from clinical-chemical correlation data, allows to tailor-cut treatment to the specific needs of individual patients; hence the need to have reliable analytical methods available for the determination of plasma levels of drugs and their metabolites. Analyses of biological samples are mainly carried out using high-performance liquid chromatography (HPLC) coupled with different detectors, capillary electrophoresis and gas-chromatography. Various procedures are employed to remove biological interferences before analyzing the samples. This review focuses on currently available analytical TDM methods for atypical antipsychotics and antiepileptic agents used in the treatment of patients with bipolar disorder. Advantages and limitations of the various analytical methods will be reviewed and discussed, together with an evaluation of the role of TDM.

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“…The usual daily doses range from 300 to 2700 mg for the treatment of seizures [251] and 600-2400 for BD [252].…”

Section: Oxcarbazepinementioning

confidence: 99%

Antipsychotic and Antiepileptic Drugs in Bipolar Disorder: The Importance of Therapeutic Drug Monitoring

Musenga

Saracino

Sani³

et al. 2009

CMC

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“…In general, OXC is well tolerated [41]. The incidence of adverse effects during OXC therapy was similar to placebo (90 vs 79%) [10,26].…”

Section: Safety and Tolerabilitymentioning

confidence: 80%

“…Hyponatremia has been associated with the use of OXC, more frequently than CBZ. It is more likely to occur in older patients and patients using diuretics (it is rare in children) [41]. The reported incidence ranges from 0 to 31%.…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

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Oxcarbazepine in the treatment of bipolar and schizoaffective disorders

Popova¹,

Leighton²,

Bernabarre³

et al. 2007

Expert Review of Neurotherapeutics

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Oxcarbazepine is an antiepileptic drug that has been approved by the US FDA and is indicated for use as monotherapy or adjunctive therapy in the treatment of partial seizures in adults and children aged over 4 years. The aim of this report is to investigate the results of clinical trials in order to ascertain the efficacy and safety of oxcarbazepine for use in bipolar disorder and schizoaffective disorder. Oxcarbazepine is a keto-congener of carbamazepine with fewer side effects and drug interactions. Orally administrated oxcarbazepine is rapidly and completely absorbed and has a half-life of 9 h. Currently, there is a lack of controlled clinical trials studying the use of oxcarbazepine. In light of controlled and open-label prospective studies, it may be useful for manic symptoms in the treatment of bipolar and schizoaffective patients. Case reports, retrospective and prospective studies suggest that oxcarbazepine might have prophylactic efficacy and long-term benefit for these patients. In addition, owing to its lower propensity for drug interactions and side effects, it may be useful in the treatment of refractory patients with bipolar and schizoaffective disorder. However, most of the trials have relevant methodological shortcomings. The side-effect profile of oxcarbazepine is similar to carbamazepine, but the severity of these effects appears to be slightly less. The symptoms that are most frequently associated with the use of oxcarbazepine are asthenia, headache, dizziness, somnolence, nausea, diplopia and skin rash. Isolated cases of hyponatremic coma have been reported, thus electrolyte abnormalities should be closely monitored. Oxcarbazepine is now a generic drug, but the metabolite licarbazepine and other related compounds, such as eslicarbazepine, are currently being studied under controlled conditions and might become useful therapies for bipolar and schizoaffective disorder in the future.

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“…Although oxcarbazepine does not have the FDA indication for the treatment of bipolar disorder, a recent review reported efficacy in acute mania and that it may be a useful add‐on in treating bipolar depression and bipolar maintenance (Pratoomsri, Yatham, Bond, Lam, & Sohn, 2006). Also, the TIMA (Suppes et al., 2005) guidelines for bipolar mania/hypomania list oxcarbazepine in Stage 3 of the treatment algorithm.…”

Section: Treatmentmentioning

confidence: 99%