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Trileptal (oxcarbazepine) is an anticonvulsant drug used primarily for the treatment of epilepsy. The medication has mood stabilizing effects and has been used as an add-on therapy for bipolar disorder in patients that have failed or are unable to tolerate approved treatments.

Trileptal can be used in patients as young as 2 years old, though for patients aged 2 to 16 a doctor will need to calculate dosage based on weight and other variables.

Getting Started with Trileptal

Treatment with Trileptal can take one of three approaches; it can be used as an adjunctive therapy (with other medications), conversion to monotherapy, or initiated as monotherapy.

When used as an adjunctive therapy:

• The initial adult dose of Trileptal is 300 mg twice a day (600 mg total).
• After at least one week, dosage may be increased to 600 mg twice per day (1200 mg total).
• After at least another week, dosage may be increased again to 1200 mg twice per day (2400 mg total).
• It is rare for dosage to exceed 600 mg twice per day (1200 mg total); most patients cannot tolerate so much of the medication.

In converting or initiating monotherapy:

• The initial adult dose of Trileptal is 300 mg twice a day (600 mg total).
• After at least one week, dosage may be increased to 600 mg twice per day (1200 mg total).
• After at least another week, dosage may be increased again to 1200 mg twice per day (2400 mg total).
• As a monotherapy, higher doses of 1200 mg twice per day (2400 mg total) are fairly normal.

In patients with impaired renal function, initiate Trileptal at one half the usual starting dose and increase slowly to achieve the desired clinical response.

Once an effective dose is established, treatment may continue for as long as the medication provides benefit.

Trileptal for Bipolar Treatment

There's not a whole lot of data regarding Trileptal for bipolar disorder, but, according to some studies, at least, it is as effective as lithium in preventing mania. While there is no reason to stop taking lithium, or any other medication, that is working well in preventing bipolar mania, it may be worth a shot if other medications are not working well.

Treatment typically consists of 600 mg twice per day (1200 mg total) for most patients. Younger patients will, of course, require adjusted doses.

Withdrawal Concerns

As with most antiepileptic drugs, Trileptal should generally be withdrawn gradually because of the risk of increased seizure frequency and status epilepticus. However, if withdrawal is needed because of a serious adverse event, rapid discontinuation can be considered.

Potential Side Effects

Potential effects of Trileptal on a developing fetus or child aren't well understood. If pregnant or breastfeeding, inform a physician before taking Trileptal.

Co-administration with Trileptal may increase the toxicity of other drugs such as:

• Phenytoin
• Citalopram
• Diazepam
• Imipramine
• Omeprazole
• Propranolol
• Amitriptyline
• Progesterone

Trileptal may decrease the effect of certain hormonal contraceptives, rendering them less effective and increasing risk of pregnancy.

The most common side effects reported with Trileptal use are:

• Dizziness
• Blurred or double vision
• Fatigue
• Headache
• Nausea
• Vomiting
• Drowsiness
• Difficulty concentrating
• Sluggishness

The above side effects are not cause for concern unless persistent or severe.

Antiepileptic drugs, including Trileptal, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication, particularly patients under 25 years of age and during the first month of treatment. Patients treated with this medication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior.