oxcarbazepine

Mood stabilizer

Brands: Trileptal, Oxtellar XR

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is oxcarbazepine?
Carbamazepine analog used off-label as an alternative mood stabilizer when carbamazepine is effective but poorly tolerated, offering fewer CYP450 interactions yet higher hyponatremia risk.
What is Trileptal?
Trileptal is a brand name for oxcarbazepine (other brands: Oxtellar XR).
What is Trileptal (oxcarbazepine) used for?
Label indications include: Seizure disorders.
What drug class is Trileptal (oxcarbazepine)?
Mood stabilizer.
What is the mechanism of action of Trileptal (oxcarbazepine)?
Voltage-gated sodium channel modulator that decreases glutamatergic excitation; used off-label as a mood stabilizer and antiepileptic.
What strengths does Trileptal (oxcarbazepine) come in?
Immediate-release tablets 150–600 mg, oral suspension 300 mg/5 mL, extended-release tablets 150–600 mg.
Is Trileptal (oxcarbazepine) a controlled substance?
No — it is not scheduled as a controlled substance under U.S. federal law.

Snapshot

Class: Mood stabilizer
Common US brands: Trileptal, Oxtellar XR
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Clinical Highlights

Carbamazepine analog used off-label as an alternative mood stabilizer when carbamazepine is effective but poorly tolerated, offering fewer CYP450 interactions yet higher hyponatremia risk. Guidelines rank oxcarbazepine as third-line for acute mania or adjunctive maintenance, underscoring the need for careful patient selection and monitoring.

Often considered when carbamazepine interactions or hematologic toxicity limit use; sodium monitoring and hyponatremia education often become central follow-up tasks.
The compare view and the Oxcarbazepine evidence feed can help contextualize dosing, interactions, and sodium risk relative to first-line mood stabilizers.
Hyponatremia is the main limiting adverse effect; monitoring plans often include baseline and early follow-up sodium checks, especially when SSRIs or thiazides are co-prescribed.
Seizure disorders (FDA 2000)
Generic: IR formulations available generically; XR remains brand-only (Oxtellar XR®).

Dosing & Formulations

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

Oxtellar XR: initiate 600 mg once nightly with food; titrate by 600 mg weekly to 1,200–2,400 mg nightly.
Cross-taper from carbamazepine at ~1.5× equivalent dose while tapering carbamazepine over one week.
CrCl <30 mL/min: start at half the usual dose (e.g., 150 mg BID IR) and titrate slowly with sodium monitoring.
Taper by ~300 mg/week (or 10%) to discontinue, extending longer if seizure threshold concerns arise.

Monitoring & Risks

Dizziness/somnolence: Frequent during titration; slower dose escalation often improves tolerability. Diplopia/ataxia: Dose-related and reversible.

Nausea/vomiting: Often transient with food and slower titration.
Hyponatremia (Na <125 mEq/L ≈2.5%; asymptomatic decline common) —sodium monitoring often includes baseline and early follow-up checks (e.g., ~2 weeks, ~1 month), and after dose or medication changes.
Dermatologic reactions including SJS/TEN are rare but warrant immediate discontinuation; cross-reactivity in prior carbamazepine rash ≈25%.
Bone density loss possible with chronic use; vitamin D/calcium supplementation and periodic bone health monitoring are commonly discussed.

Drug Interactions

Induces CYP3A4/UGT, reducing efficacy of hormonal contraceptives, some antipsychotics, and antiretrovirals—backup or non-hormonal contraception is commonly discussed. Inhibits CYP2C19, increasing phenytoin concentrations; phenytoin levels may rise, so monitoring and dose adjustment may be needed.

Additive hyponatremia with SSRIs, thiazide diuretics, carbamazepine, or desmopressin; this may warrant closer sodium monitoring.
CNS depressants (alcohol, benzodiazepines) potentiate dizziness and sedation.

Practice Notes

Education typically covers hyponatremia symptoms (fatigue, confusion, seizures) and when urgent evaluation is needed. HLA-B*1502 screening is often discussed for at-risk ancestry, especially with prior carbamazepine reactions.

Pregnancy registry enrollment and folate supplementation are commonly discussed; MHD transfers to breast milk.
Coordinate bipolar follow-up plans with the bipolar disorder hub when oxcarbazepine supports mood stabilization.
Review contraception plans and other sodium-lowering medications during follow-up, since CYP induction and hyponatremia risk can change the overall safety profile.

References

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)Guidelinebipolarclinical
Clinical Review: Oxcarbazepine Induced Hyponatremia — Epilepsy & Behavior (2015)