Oxcarbazepine in the treatment of epilepsy

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 analo g of carbamazepine and has a more favorable pharmacokinetic profile. It is rapidly absorbed after oral administration and undergoes rapid and almost c omplete reductive metabolism to form the pharmacologically active 10-monohy droxy derivative. Oxcarbazepine exhibits linear pharmacokinetics, no autoin duction, and minimal interaction with other AEDs. Ten controlled trials dem onstrated that oxcarbazepine is safe and efficacious in the treatment of pa rtial 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 (def ined 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 the rapy 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, dr ug interaction potential, adverse-effect profile, and dosage and titration between these two agents, and they should be considered distinct therapeuti c agents.