Research News . . . .

Oxcarbazepine (continued)

  Five recent studies^4-8 suggest positive effects of open-label OXC in bipolar and related disorders, primarily as an adjunctive medication (see table). Together, these 18 studies and case reports have generated interest in using OXC in those patients who have adverse side effect reactions to CBZ.

III. Does OXC Have Any Adverse Side Effects?

  Common adverse side effects reported with OXC are skin eruption (rash), hyponatremia (decrease in sodium levels), dizziness, vertigo, sleepiness, headache, ataxia (unsteadiness), and vomiting. Unlike CBZ, OXC is not a potent inducer of the cytochrome P450 family and does not cause interactions with many other drugs such as anticoagulants, thyroid hormones, and antibiotics; it does, however, induce the metabolism of estrogen which necessitates the use of high dosage forms of oral contraceptives. OXC levels do not rise markedly when combined with verapamil or erythromycin, as they do when combined with CBZ.

IV. What About OXC Dosages?

  The equivalent dose of OXC to CBZ is approximately 1.5 times that of CBZ. OXC is more expensive than CBZ. OXC is available as 150 mg, 300 mg, and 600 mg tablets, and as a 300 mg oral suspension. It is eliminated from the body rather quickly, but OXC can be administered twice daily.

  For the variety of reasons given above, OXC may come to play a role in the treatment of bipolar disorders in the future. We hope to see further controlled trials of OXC in the literature.

⁴ Alvarez G, Marsh W, Camacho IA, Gracia SL (2003). Effectiveness and tolerability of carbamazepine vs. oxcarbazepine as mood stabilizers. Clin Res Reg Affairs 20: 365-372.

⁵ Benedetti A, Lattanzi L, Pini S, Musetti L, Dell'Osso L, Cassano GB (2004). Oxcarbazepine as add-on treatment in patients with bipolar manic, mixed or depressive episode. J Affect.Disord 79: 273-277.

⁶ Centorrino F, Albert MJ, Berry JM, Kelleher JP, Fellman V, Line G, Koukopoulos AE, Kidwell JE, Fogarty KV, Baldessarini RJ (2003). Oxcarbazepine: clinical experience with hospitalized psychiatric patients. Bipolar Disord 5: 370-374.

⁷ Ghaemi SN, Berv DA, Klugman J, Rosenquist KJ, Hsu DJ (2003). Oxcarbazepine treatment of bipolar disorder. J Clin Psychiatry 64: 943-945.

⁸ Raja M, Azzoni A (2003). Oxcarbazepine vs. valproate in the treatment of mood and schizoaffective disorders. Int J Neuropsychopharmacol 6: 409-414.

The following report was compiled by Mr. Chris Gavin.

Revised 07/01/04

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Topiramate in Bipolar Disorder