oxcarbazepine

Mood stabilizer • Brands: Trileptal, Oxtellar XR

Last reviewed: 2025-12-29

General information

Class: Mood stabilizer
Common US brands: Trileptal, Oxtellar XR
Typical dose range: Acute mania: start 300 mg twice daily (IR); increase by 300 mg/day every 3–4 days to 900–1,200 mg/day, with experience limited above 1,800 mg/day in psychiatric populations.
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Dosing & forms

Forms/strengths: Immediate-release tablets 150–600 mg, oral suspension 300 mg/5 mL, extended-release tablets 150–600 mg.
Frequency: Acute mania: start 300 mg twice daily (IR); increase by 300 mg/day every 3–4 days to 900–1,200 mg/day, with experience limited above 1,800 mg/day in psychiatric populations.
Food: Take with food.
Typical range: Acute mania: start 300 mg twice daily (IR); increase by 300 mg/day every 3–4 days to 900–1,200 mg/day, with experience limited above 1,800 mg/day in psychiatric populations.

Mechanism (brief)

Voltage-gated sodium channel modulator that decreases glutamatergic excitation; used off-label as a mood stabilizer and antiepileptic.

Metabolism & Half‑life

Metabolism: cytosolic reduction to MHD
Half‑life: Single-dose mean 9 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

View labelExact

Monitoring highlights

Serum sodium at baseline and during titration (and after dose or medication changes), given high hyponatremia risk.
Neurologic tolerability (dizziness, diplopia, ataxia) during titration; these symptoms often appear before clinically significant hyponatremia.
Medication review for additive sodium-lowering agents (SSRIs, thiazides, desmopressin) and for contraceptive efficacy given CYP3A4/UGT induction.
Rash or mucosal symptoms during early therapy; cross-reactivity with prior carbamazepine rash can occur and warrants heightened vigilance.
Bone health for long-term therapy (vitamin D, calcium, and fall risk), especially in older adults or when other enzyme-inducing medications are used.

Sources

TRILEPTAL (oxcarbazepine) prescribing information — DailyMed (2025)
Oxtellar XR prescribing information — DailyMed (2025)
The CANMAT and ISBD Guidelines for the Management of Patients With Bipolar Disorder: 2021 Update — Bipolar Disorders (2021)
Clinical review: Oxcarbazepine-induced hyponatremia — Epilepsy & Behavior (2015)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)

General information

Class: Mood stabilizer

Common US brands: Trileptal, Oxtellar XR

Typical dose range: Acute mania: start 300 mg twice daily (IR); increase by 300 mg/day every 3–4 days to 900–1,200 mg/day, with experience limited above 1,800 mg/day in psychiatric populations.

Therapeutic drug monitoring not routinely recommended.

Last reviewed: 2025-12-29

Dosing & forms

Forms/strengths: Immediate-release tablets 150–600 mg, oral suspension 300 mg/5 mL, extended-release tablets 150–600 mg.

Frequency: Acute mania: start 300 mg twice daily (IR); increase by 300 mg/day every 3–4 days to 900–1,200 mg/day, with experience limited above 1,800 mg/day in psychiatric populations.

Food: Take with food.

Typical range: Acute mania: start 300 mg twice daily (IR); increase by 300 mg/day every 3–4 days to 900–1,200 mg/day, with experience limited above 1,800 mg/day in psychiatric populations.

Monitoring highlights

Serum sodium at baseline and during titration (and after dose or medication changes), given high hyponatremia risk.

Neurologic tolerability (dizziness, diplopia, ataxia) during titration; these symptoms often appear before clinically significant hyponatremia.

Medication review for additive sodium-lowering agents (SSRIs, thiazides, desmopressin) and for contraceptive efficacy given CYP3A4/UGT induction.

Rash or mucosal symptoms during early therapy; cross-reactivity with prior carbamazepine rash can occur and warrants heightened vigilance.

Bone health for long-term therapy (vitamin D, calcium, and fall risk), especially in older adults or when other enzyme-inducing medications are used.