Oxcarbazepine, a medication primarily used to treat seizures, can have varying effects on weight, with some individuals experiencing weight gain while others do not. This article aims to provide a comprehensive overview of the relationship between oxcarbazepine and weight changes, considering different patient populations and potential contributing factors.
What is Oxcarbazepine?
Oxcarbazepine is a generic prescription anticonvulsant and the active ingredient in the brand-name prescription drugs Trileptal and Oxtellar XR (extended-release tablets). It is an anticonvulsant medication used to treat partial-onset seizures. It is also used off-label as a mood stabilizer for the treatment of bipolar disorder. Related to the widely-used anti-seizure medication, carbamazepine, oxcarbazepine keeps nerves from firing quickly and repeatedly by interfering with the ability of nerves to build up an electric charge. In this way, oxcarbazepine prevents seizures from spreading throughout the brain. Oxtellar XR and Trileptal are two prescription medications that both contain the same active ingredient called oxcarbazepine. Both medications are taken by mouth and used in the treatment of partial-onset seizures, but they are made by different companies and come in different forms.
Approved for use in 2000, oxcarbazepine has since become a widely utilized agent in seizure management due to favorable efficacy and tolerability in many patient populations.
Oxcarbazepine is a 10-keto derivative of carbamazepine, which became available to the public in 2000. Oxcarbazepine is FDA-approved for partial seizures in adults with epilepsy or partial seizures in children with epilepsy aged 4 to 16. This medication is helpful as monotherapy or adjunctive to another drug for managing seizures. Oxcarbazepine is also an option for bipolar disorder; however, this medication is not yet FDA-approved for bipolar disorder. Many worldwide treatment guidelines list oxcarbazepine as a first-line or second-line treatment for focal-onset epilepsy and primary generalized tonic-clonic seizures. Oxcarbazepine is a first-line choice for treating focal-onset epilepsy in several countries, including the USA. Oxcarbazepine is used off-label to treat trigeminal neuralgia in patients with multiple sclerosis.
Oxcarbazepine binds to sodium channels and inhibits high-frequency repetitive neuronal firing. Oxcarbazepine also inhibits the release of glutamate. This medication gets metabolized by the liver and excreted by the kidneys. Oxcarbazepine is rapidly converted to licarbazepine, its active metabolite (monohydroxy metabolite or MHD). Licarbazepine is responsible for the antiseizure activity of oxcarbazepine. The half-life of oxcarbazepine is 1 to 3.7 hours, while the half-life of licarbazepine is 8 to 10 hours. Oxcarbazepine has not been shown to autoinduce its metabolism, unlike carbamazepine.Oxcarbazepine is known to be a weak inducer of the CYP3A4, which plays a role in estrogen metabolism. Thus, oxcarbazepine can reduce the efficacy of oral contraceptives when used in high doses. Oxcarbazepine is also a weak inhibitor of CYP2C19 and can cause an increase in phenytoin concentrations when used in very high doses. Oxcarbazepine itself is not affected by CYP3A4 inhibitors, as with carbamazepine.Patient body weight and drug metabolism inducers can affect the pharmacokinetics of oxcarbazepine. Pediatric patients have a higher clearance rate than adults and may require a higher dose per kilogram of body weight. Drug metabolism inducers increase oxcarbazepine clearance and, therefore, might require a higher dose to maintain a therapeutic concentration of oxcarbazepine.
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Oxcarbazepine and Weight Gain
While weight gain is not a universally experienced side effect of oxcarbazepine, it has been reported in some patients. Trileptal (oxcarbazepine) can cause weight gain in patient with partial onset-seizures. Significant weight gain has also been observed in children with epilepsy treated with oxcarbazepine in one small study. The study enrolled children aged from 3.7 to 15.9 years of age. A total of 26 children in the study were treated with oxcarbazepine.
Evidence from Studies
At least one study has shown that children taking oxcarbazepine can experience significant increases in body weight. Weight gain in adults, however, seems to be less common. In clinical studies, people taking oxcarbazepine gained weight at just a slightly higher percentage than people taking a placebo. Adults also experienced weight loss on oxcarbazepine. Weight gain, then, seems to be uncommon among adults taking oxcarbazepine. For children, though, it is important to keep an eye on body weight when they’re on oxcarbazepine.
Garoufi A, Vartzelis G, Tsentidis C, et al. reported weight gain in children on oxcarbazepine monotherapy. Epilepsy Res. 2016;122:110-113. doi:10.1016/j.eplepsyres.2016.03.004.
Potential Mechanisms
Several factors could contribute to weight gain in individuals taking oxcarbazepine:
- Increased Appetite: Other side effects of Trileptal include increased appetite which can all affect body weight.
- Fluid Retention: Other side effects of Trileptal include leg edema (swelling) which can all affect body weight.
- Digestive Changes: Other side effects of Trileptal include digestive changes such as constipation, which can all affect body weight.
Oxcarbazepine and Weight Loss
Adults also experienced weight loss on oxcarbazepine.
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Other Common Side Effects of Oxcarbazepine
The most common side effects of oxcarbazepine are dizziness, double vision, and sleepiness. Many of the most common side effects of oxcarbazepine occur early in treatment. These include sleepiness, dizziness, headache, nausea, vomiting, vision problems, and problems with thinking or concentrating. Many of the milder adverse effects of oxcarbazepine improve over time as the body adapts to the drug. Some of the nervous system problems, such as drowsiness, may never go away completely, but they’ll become easier to manage. Oxcarbazepine is intended for long-term use-years, if possible.
Oxcarbazepine can lead to central nervous system (CNS) side effects due to its blockade of voltage-sensitive sodium channels. Some common side effects that patients experience when taking oxcarbazepine are sedation, dizziness, abnormal gait, headache, ataxia, fatigue, confusion, nausea, vomiting, abdominal pain, or rash. Hyponatremia and increased suicidal ideation are among the most dangerous and life-threatening side effects patients may experience while taking oxcarbazepine. Weight gain and sedation can occur as well in a minority of patients.
Precautions and Monitoring
It is very important that your doctor check you or your child's progress at regular visits. This is to make sure the medicine is working properly and to allow for changes in your dose. Blood tests will also be needed to check for unwanted effects. Tell your doctor if you become pregnant while using this medicine. Your doctor may need you to be monitored carefully during your pregnancy and after giving birth.
Do not stop using this medicine suddenly without talking first to your doctor. You may need to slowly decrease your dose before stopping it completely. This medicine may cause some people to become dizzy, drowsy, lightheaded, clumsy, unsteady, or less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
This medicine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you think you or your child have a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
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Drug Interactions
Most of the drug interactions related to oxcarbazepine involve a liver enzyme that breaks down some medications. In some cases, oxcarbazepine speeds up the breakdown of other drugs, making them less effective. These include some AIDS/HIV drugs, some antibiotics, some hepatitis C treatments, some blood thinners, some heart rhythm drugs, and hormonal contraceptives. Women taking birth control pills will be advised that they are at a higher risk for pregnancy if they also take oxcarbazepine.
Other drugs do the opposite: they speed up the body’s breakdown of oxcarbazepine, making it less effective. These include carbamazepine, the anti-seizure medication phenytoin, the tuberculosis treatment rifampin, and other drugs. This list also includes the popular herbal supplement, St. Some drugs make seizures more likely. They are used cautiously in anyone taking drugs like oxcarbazepine to control seizures.
Special Populations
Oxcarbazepine is considered a risk during pregnancy, so it is prescribed cautiously and only if the benefits outweigh the risks. There is not only a risk for birth defects, but pregnant women on oxcarbazepine may see an increase in the number of seizures when pregnant. Oxcarbazepine is prescribed cautiously in women who are breastfeeding. Adults older than 65 may not be able to eliminate the drug as quickly as young adults. This slower clearance puts seniors at a higher risk of side effects, so healthcare professionals will usually start with a low dose of oxcarbazepine at the onset and try to keep the dose as low as possible. Seniors are also more vulnerable to falls, accidents, and injuries if they experience side effects like dizziness and unsteadiness.
Important Considerations for Patients
- The first rule is to make sure the prescriber knows about all medical conditions past and present.
- Taking too much oxcarbazepine raises the risk of adverse effects. Follow the instructions to the letter. Do not take more than the prescribed dose or take it more often than prescribed. A missed dose can be taken when remembered, but skip it if it’s almost time for the next dose.
- Oxcarbazepine can cause serious impairment, so it’s wise to not drive, operate machinery, or engage in risky activities or sports for a few days. Once the effects of oxcarbazepine are understood, then it’s okay to go back to driving if impairment is not too severe. Mild side effects can usually be handled at home. However, if they persist or get worse, get medical advice from the prescribing healthcare provider. Some serious side effects, however, will require immediate medical attention. Thinking about suicide or showing signs of suicidality will require immediate medical attention.
Other serious side effects
Low sodium is a common side effect of oxcarbazepine. A temporary and small dip in sodium levels can be resolved by eating more salt. The real problem arises if sodium gets too low. Oxcarbazepine can poison the liver. Like carbamazepine, oxcarbazepine can cause blood problems. They are all considered serious side effects including reduced white blood cell counts, red blood cell counts, and reduced numbers of blood clot-forming cells called platelets. Each of these problems will have different symptoms. Potentially life-threatening drug reactions usually affect the skin. An allergic reaction to oxcarbazepine could swiftly evolve into a serious problem.
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