Recommendations on the clinical use of oxcarbazepine in the treatment of epilepsy: a consensus view

Extensive clinical use and a series of clinical trials have shown that oxca rbazepine is a valuable antiepileptic drug for the treatment of adults and children with partial onset seizures both in initial monotherapy, for conve rsion to monotherapy and as adjunctive therapy. The clinically recommended titration scheme for all forms of therapy in adults is to start with 150 mg /day at night and to increase by 150 mg/day every second day until a target dose of 900-1200 mg/day is reached. If necessary, one can go faster and st art with up to 600 mg/day and titrate with weekly increments of up to 600 m g/day. In children, treatment can be initiated with 8-10 mg/kg/day body wei ght in two to three divided doses. Dosage can be increased by 8-10 mg/kg/da y in weekly increments if necessary for seizure control. Hyponatremia (seru m sodium <125 mmol/l) can develop gradually during the first months of oxca rbazepine therapy in approximately 3% of patients with a previously normal serum sodium. However, there is no need to measure baseline serum sodium co ncentrations unless the patient has renal disease, is taking medication whi ch may lower serum sodium levels (such as diuretics, oral contraceptives or nonsteroidal anti-inflammatory drugs) or-in rare cases-has clinical sympto ms of hyponatremia. During oxcarbazepine maintenance therapy measurement of serum sodium levels should also be considered if medications known to decr ease sodium levels are added or symptoms of hyponatremia develop. Oxcarbaze pine does not appear to have any clinically notable effects on other safety parameters such as renal and liver function or haematological test results . In summary, oxcarbazepine is a safe and well tolerated antiepileptic drug for partial epilepsy.