Spotlight on Oxcarbazepine in Epilepsy1

Abstract

Oxcarbazepine (Trileptal, Timox) is structurally related to carbamazepine and has anticonvulsant activity. Studies suggest that the anticonvulsant activity of oxcarbazepine is mediated via the blocking of neuronal ion channels. In patients aged <18 years, the efficacy of oxcarbazepine monotherapy was similar to that of phenytoin in children with partial onset or generalised tonic-clonic seizures in a 48-week trial. Additional supporting findings demonstrated that 43-71% of patients with partial onset, generalised or undetermined epilepsy were seizure free after oxcarbazepine monotherapy (mean dosage 27.7-50 mg/kg/day; duration 1-5 years). In contrast, one small nonblind trial showed more patients treated with oxcarbazepine monotherapy than with carbamazepine monotherapy had recurrent seizures during 16 months of therapy (although the conclusions that can be drawn from this trial are limited). As adjunctive therapy, oxcarbazepine was significantly better than placebo at reducing seizure frequency in children and adolescents with refractory partial onset seizures with or without secondary generalisation: the median percentage change in partial onset seizure frequency was 35% versus 9%, respectively, during 16 weeks of therapy. In noncomparative trials of adjunctive oxcarbazepine (mean dosage of 34.5-56.7 mg/kg/day), 7-11% of patients with partial onset or generalised seizures were seizure free during treatment, and 20-54% had seizure reductions of > or =50%. Oxcarbazepine was generally well tolerated during monotherapy and adjunctive therapy; 2.5% and 10% of patients withdrew from well controlled trials of oxcarbazepine monotherapy and adjunctive therapy. Oxcarbazepine monotherapy was better tolerated than phenytoin and events observed in oxcarbazepine-treated patients were transient. Oxcarbazepine metabolism is largely unaffected by induction of the cytochrome (CYP) P450 system. However, oxcarbazepine can inhibit CYP2C19 and induce CYP3A4 and CYP3A5, thereby interfering with the metabolism of other drugs (e.g. phenytoin). In addition, oxcarbazepine decreases plasma levels of oral contraceptives and alternative contraceptive methods should be used. In conclusion, oxcarbazepine (as both monotherapy and adjunctive therapy) has shown efficacy in the treatment of partial onset seizures in children with epilepsy. Nevertheless, the generally favorable tolerability profile and relatively low potential for drug interactions of oxcarbazepine make it a valuable option in the treatment of childhood epilepsy.

A Novel Enantioselective Microassay for the High-Performance Liquid Chromatography Determination of Oxcarbazepine and Its Active Metabolite Monohydroxycarbazepine in Human Plasma

“…Oxcarbazepine is increasingly used for its primary indication in the treatment of partial and generalized tonicclonic seizures in adults and children, 1 and it is also used in other conditions such as bipolar disorder, 32-34 trigeminal neuralgia, 35 and other potential indications. 34,35 Clinical response to oxcarbazepine is primarily dependent on its active metabolite MHD, which in experimental models retains pharmacologic activity similar to the parent drug 4 and is found in human plasma at much higher concentrations.…”

“…1 As a result of the presence of a ketogroup in the 10-11 position of its molecule, oxcarbazepine differs in pharmacokinetic profile from its analog carbamazepine. Unlike carbamazepine, which is extensively oxidized to an active 10,11-epoxide metabolite, oxcarbazepine undergoes rapid reduction of the ketogroup resulting in the formation of the active monohydroxyderivative (MHD), also known as monohydroxycarbazepine or licarbazepine (Fig.…”

Verzögert freigesetztes Oxcarbazepin – Überblick und klinische Erfahrungen

“…OXC und MHD blockieren spannungsabhängige Natriumkanäle [1]. Im Gegensatz zu CBZ beruht die Wirkung auf Kalziumkanäle nicht auf einer direkten Blockade, sondern auf einer Reduktion der spannungs-und gebrauchsabhängigen Aktivität der Aktionspotentiale [39].…”

Unterschiedlicher Effekt von Monotherapien mit Carbamazepin, Oxcarbazepin und Lamotrigin auf klinisch relevante Laborparameter

“…Diese Induktion hat immerhin einen relevanten Einfluss zum Beispiel auf orale Kontrazeptiva und andere Hormone, da deren Plasmakonzentration absinken kann [16].…”

“…Zumindest konnten wir diesbezüglich keine Unterschiede zwischen beiden Substanzen feststellen. Ein bekanntes praktisches Beispiel für diese Auswirkungen ist die reduzierte Sicherheit der hormonellen Kontrazeption unter OXC-Gabe [16]. Zusätzlich wurde darüber berichtet, dass OXC einen wesentlichen Einfluss auf die Clearance von LTG haben kann [28], obwohl dies kontrovers beurteilt wurde [29,30].…”