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Anticonvulsant Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Important note: oxcarbazepine is an anticonvulsant drug closely related to a known human teratogen, carbamazepine. This drug has been part of a polytherapy regimen in most published reports of its use during pregnancy, confounding its possible causal role. Among 248 pregnancies exposed to oxcarbazepine monotherapy during pregnancy, there were six congenital anomalies (2.4 percent), which is similar to that expected in the general population. Among 61 infants whose mothers were given polytherapy that included oxcarbazepine, four birth defects (6.6 percent) occurred (Montouris, 2005), which is greater than that in the general population. Among 372 infants exposed to oxcarbazepine during the first trimester, the frequency of birth defects was not increased (Box 9.13)
Mood Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Madeleine A. Becker, Tal E. Weinberger, Leigh J. Ocker
Data on malformation rates with oxcarbazepine exposure are still limited. The EURAP registry, an international registry of women with epilepsy on AED monotherapy at the time of conception, reports on the largest dataset of oxcarbazepine-exposed pregnancies currently available. In 333 oxcarbazepine-exposed pregnancies, the malformation rate was found to be 3%, which is reassuringly within the commonly accepted general population rate [148, 150]. Oxcarbazepine does not produce the same toxic epoxide metabolite as carbamazepine and thus, authors speculate that oxcarbazepine may be less harmful to the developing fetus [41]. Plasma concentrations of oxcarbazepine may decrease during pregnancy [151], which may necessitate dose adjustment.
Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Most patients can be managed medically. The most effective first-line treatment is carbamazepine, followed by oxcarbazepine, both of which reduce the excitability of neurons by blocking sodium channels. Carbamazepine 400–1200 mg daily in divided doses is effective in about three-quarters of patients.25 A small dose of 50–100 mg nightly is the usual starting dose (to avoid drowsiness), escalating the dose as tolerated until pain relief is achieved (or adverse effects occur). A slow-release preparation can also be used. The dose is continued for weeks to months, and can then be tapered slowly, with reloading if the pain recurs. Most responders will experience about 6–12 months of respite before recurrence. Up to one-third of patients cannot tolerate carbamazepine in the doses required to alleviate the pain due to adverse effects such as rash, nausea, drowsiness, and ataxia. Carbamazepine may also cause hyponatremia, megaloblastic anemia (folate interaction), aplastic anemia, agranulocytosis, hepatotoxicity, and hypersensitivity reactions. Oxcarbazepine (900 mg/day to 1800 mg/day) is generally better tolerated.
Notalgia paresthetica: treatment review and algorithmic approach
Published in Journal of Dermatological Treatment, 2020
Ahmed Ansari, David Weinstein, Naveed Sami
Oxcarbazepine, another antiepileptic medication that is used as a pain modulator and in neuropathies, works by inhibiting voltage-sensitive sodium channels, which stabilizes neural membranes and decreases repetitive neuronal firing (18). One study reported a patient on oxcarbazepine 300 mg twice daily who had decreased pain and pruritus after 1 month of treatment. Further improvement occurred at his 6-month follow-up with symptoms decreasing from an initial 10/10 to 3/10 pain and 5/10 pruritus. The study added an additional 3 patients, 2 of which had noticeable improvements (3/10 pruritus on 600 mg twice daily and 6/10 pruritus on 300 mg twice daily) and one who did not (9/10 pruritus on 900 mg twice daily) after 6 months of oxcarbazepine. Oxcarbazepine was well tolerated except for one patient who had headache and dizziness (18).
Association of small-fiber polyneuropathy with three previously unassociated rare missense SCN9A variants
Published in Canadian Journal of Pain, 2020
Mary A. Kelley, Anne Louise Oaklander
Given his persisting severe confirmed SFN and inflammatory serologies, a trial of immunotherapy for likely autoimmune causality was discussed. Corticosteroids were judged as contraindicated by his mood disorder, so a 3-month trial of IVIg (2 g/kg/4 weeks, the typical initial dose for immune neuropathy40) was undertaken, and when IVIg reduced his pain and disability, treatment was continued. After 12 months of treatment, his sensory loss had improved, and his chronic nausea had resolved. Along with resuming exercise he regained 20 lb of lost weight. His repeat skin biopsy showed marginally improved END to 80 neurites/mm2, still less than first percentile of predicted. As his symptoms improved his IVIg was gradually tapered to 1.4 g/kg/4 weeks, but his clinical gains and END both regressed (to 59 neurites/mm2), so he requested resumption of 2 g/kg/4-week dosing, after which his symptoms again abated. He resisted further suggestions to taper until 36 months, when he agreed to and tolerated slower tapering. After 80 months of IVIg, his skin biopsy showed complete recovery of his END to the normal range (196 neurites/mm2, at the 71.4th percentile of predicted). We continued to search for other potential contributors to his SFN, and whole exome sequencing identified a heterozygous rare SCN9A-A3734G:p.Asp1245Ser variant exon 20, a cytoplasmic domain very near the N-terminus of the loop. The 1245A3734G SNP was a single nucleotide missense variant at a poorly conserved position in the protein, and the allele frequency was estimated at 0.0036 to 0.0055. Additionally, it has received conflicting interpretations of pathogenicity and has been reported in the literature in two individuals with erythromelalgia. Given this finding, mexiletine and oxcarbazepine were trialed but not tolerated.
Utility of oxcarbazepine in the treatment of childhood and adolescent psychiatric symptoms
Published in Baylor University Medical Center Proceedings, 2021
Kyle Morrow, Keith A. Young, Shawn Spencer, Edgar Samuel Medina, Michaela A. Marziale, Alejandro Sanchez, James A. Bourgeois
Oxcarbazepine, a dibenzazepine carboxamide derivative of carbamazepine, is a voltage-gated sodium channel anticonvulsant.1 Common side effects of oxcarbazepine include dizziness, somnolence, syndrome of inappropriate antidiuretic hormone secretion, and nausea.2–4 Rare cutaneous reactions include maculopapular eruption, Stevens-Johnson syndrome, and toxic epidermal necrolysis, which require discontinuation.5 Oxcarbazepine was cited as an effective treatment for treatment-resistant focal epilepsy in adults.6 Oxcarbazepine is also used off label as a psychotropic medication in adults7–13 and for treatment of epilepsy in children and adolescents.14–16 Unlike some other anticonvulsants, oxcarbazepine spares cognition and does not aggravate symptoms of co-occurring attention deficit hyperactivity disorder (ADHD) and epilepsy.17 Oxcarbazepine has been used to treat child and adolescent psychiatric disorders. While recent American Association of Child and Adolescent Psychiatry practice parameters do not include oxcarbazepine as a treatment option for autism spectrum disorder (ASD), oppositional defiant disorder, or depressive disorders, oxcarbazepine has been listed as a fifth-line option for treatment of child and adolescent bipolar disorder.18–21 Negative findings include a double-blind placebo-controlled trial to treat mania in children, which did not find efficacy for oxcarbazepine in this population.22 More recently, oxcarbazepine was found to be effective in reducing irritability and agitation in ASD.23,24 Oxcarbazepine was reported by clinicians to be perceived as one of the best-tolerated treatments for childhood behavioral problems associated with ASD and other conditions.25 To better document clinical impressions of oxcarbazepine in children and adolescents, we performed a retrospective chart review focusing on tolerability and treatment outcomes.