Anticonvulsant Drugs during Pregnancy
“Bert” Bertis Britt Little in 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)
Epilepsy
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Available data on the teratogenic potential are limited to first- and second-generation ASDs, while those of third-generation drugs are yet to be established. First-line therapy consists of monotherapy with either lamotrigine or levetiracetam, irrespective of seizure type. Data from the North American ASD Pregnancy Registry and the International Registry of ASDs in Pregnancy (EURAP) placed lamotrigine and levetiracetam among the AEDs with the lowest rates of major cortical malformations (MCMs) at 2.0–2.9% and 2.4–2.8%, respectively, comparable to rates reported among healthy women on no medications.62,63 Among the other ASDs considered to be safe during pregnancy, oxcarbazepine has a 2.6–3% risks of MCMs,63 while zonisamide can also be considered, but it carries a risk of small-for-gestational-age for the neonate.63,64
Antiepileptic and antiarrhythmic agents
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Carbamazepine and oxcarbazepine have similar dose-dependent adverse effect profiles (see Table 19.2). Gastrointestinal (nausea) and central (dizziness, vertigo, somnolence, fatigue, headache) side effects are common, but apparently less common and less severe with oxcarbazepine.6 Allergic rash is relatively common and includes Stevens-Johnson syndrome and toxic epidermal necrolysis. There is approximately 25 percent allergic crossreactivity between carbamazepine and oxcarbazepine.6, 12 Mild hyponatremia is common, while clinically significant hyponatremia (< 125 mmol/L) prompted discontinuation of the drug in 1 percent of those started on oxcarbazepine.24[II] High doses of both drugs can induce liver enzymes. NNH for all combined adverse effects with carbamazepine is estimated at 3.7 (95 percent CI 2.4, 7.8).19[I] A 12-month open-label follow-up of 594 patients on oxcarbazepine showed reasonably good tolerability with 20 percent withdrawing; serious side effects were rare and mostly dermatological.24[II]
Recently defined epileptic encephalopathy related to WWOX gene mutation: six patients and new mutations
Published in Neurological Research, 2021
Cengiz Havali, Arzu Ekici, Sevil Dorum, Özlem Görükmez, Ali Topak
As reported in the literature, all patients had early-onset epilepsy with frequent seizures. Antiepileptic drug resistance was reported in 95% of patients in the largest case report [5]. The antiepileptic drug response was variable in the present study. Different antiepileptic drugs were administered to patients. Seizure types and EEG findings in our patients were essential factors in determining the antiepileptic treatment. Carbamazepine or oxcarbazepine was administered to patients with focal seizures. Infantile spasms and hypsarrhythmia recorded on EEG were reported in half of the patients. Oral prednisolone, tetracosactide, and vigabatrin were prescribed to patients with hypsarrhythmia. Benzodiazepines were used in all patients. Varying responses to antiepileptic drugs were observed. Patient 1 responded insufficiently to treatment with three drugs and had seizures lasting one or two minutes, once every 1–2 months. Patients 2 and 3 had seizures lasting one minute once every 2–3 months. Two sibling patients (patients 4 and 5) experienced 5–10 s seizures once or twice monthly with treatment with three drugs. Patient 6 was seizure-free for two years with treatment with two drugs. Treatment responses did not show a correlation with the specific antiepileptic drugs used or the types of genetic mutations. Thus, the first five patients were considered to have drug-resistant epilepsy.
Population pharmacokinetics of oxcarbazepine: a systematic review
Published in Expert Review of Clinical Pharmacology, 2021
Yue-Ting Chen, Chen-Yu Wang, Yi-Wei Yin, Zi-Ran Li, Wei-Wei Lin, Min Zhu, Zheng Jiao
There is no obvious ethnic difference in pharmacokinetics of oxcarbazepine.Comparing to adult patients, pediatric patients show a higher clearance per kilogramme which lead to higher doses per kilogramme to maintain the target concentration.Weight and co-administered enzyme inducers are identified as covariates that influence oxcarbazepine pharmacokinetics; but effect of renal function is controversial for adjusting the dosage regimen.Further studies are essential to evaluate oxcarbazepine pharmacokinetics in infants and elders.
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).
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