Oxcarbazepine is a new
antiepileptic drug (AED) that has been registered in more than 50 countries worldwide since 1990 and recently received approval in the United States and the European Union.
Oxcarbazepine is a keto analog of
carbamazepine and has a more favorable pharmacokinetic profile. It is rapidly absorbed after
oral administration and undergoes rapid and almost complete reductive metabolism to form the pharmacologically active 10-monohydroxy derivative.
Oxcarbazepine exhibits linear pharmacokinetics, no autoinduction, and minimal interaction with other AEDs. Ten controlled trials demonstrated that
oxcarbazepine is safe and efficacious in the treatment of
partial seizures across a wide range of ages (children to adults), situations (recent onset to treatment-resistant
epilepsy), and uses (monotherapy and adjunctive
therapy). The most common treatment-emergent adverse events are related to the central nervous system. Treatment-emergent
hyponatremia (defined as serum
sodium level < 125 mEq/L) occurred in 3% of patients treated with
oxcarbazepine in clinical trials. According to the efficacy and safety profile established in the controlled trials,
oxcarbazepine represents an important new treatment option indicated for monotherapy and adjunctive
therapy in adults with
partial seizures and as adjunctive
therapy in children aged 4 years or older with
partial seizures. Although structurally similar to
carbamazepine, significant differences exist in the pharmacokinetics, drug interaction potential, adverse-effect profile, and dosage and titration between these two agents, and they should be considered distinct therapeutic agents.