Oxcarbazepine

Pronunciation: ox-car-BAZ-eh-peen.

Generic name
oxcarbazepine
Drug class
Anticonvulsant (antiepileptic drug) -- a keto-analogue of carbamazepine
Form
Film-coated tablet (150 mg, 300 mg, 600 mg) and oral suspension (60 mg/mL)
Route
Oral
Legal status
Prescription-only

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Trileptal (5) · Full directory

What oxcarbazepine is and how it works

Oxcarbazepine is an anticonvulsant (antiepileptic) medicine chemically related to carbamazepine. It is used, alone or together with other antiepileptic medicines, to control partial-onset (focal) seizures, with or without secondary generalisation, in adults and children. (1) (2)

Oxcarbazepine has two safety issues that are especially important to understand before starting: it can lower blood sodium levels (hyponatraemia), and -- rarely -- it can trigger a serious skin reaction (Stevens-Johnson syndrome or toxic epidermal necrolysis). The skin-reaction risk is meaningfully higher in people who carry a specific gene variant (HLA-B*1502) that is much more common in people of Han Chinese, Thai, and some other Southeast Asian ancestries; genetic testing before starting is recommended for people from these backgrounds. If you have ever had an allergic reaction to carbamazepine, tell your clinician, since about a quarter to a third of such patients also react to oxcarbazepine.

Mechanism of action: how oxcarbazepine works

Oxcarbazepine is a keto-analogue of carbamazepine, rapidly and extensively metabolised to its pharmacologically active 10-monohydroxy derivative (MHD). Its antiepileptic effect is believed to arise primarily from blockade of voltage-sensitive sodium channels, stabilising hyperexcited neuronal membranes and reducing repetitive neuronal firing. Oxcarbazepine and MHD are weak inducers of CYP3A4/3A5 and UDP-glucuronyltransferases, and MHD inhibits CYP2C19. (1) (2)

What oxcarbazepine is used for

Partial-onset (focal) seizures -- monotherapy

Used alone to control partial-onset seizures, with or without secondary generalisation, in adults and in children (age thresholds vary slightly by country, generally from around 4-6 years upward). (1) (2)

Partial-onset (focal) seizures -- adjunctive (add-on) therapy

Used together with other antiepileptic medicines when partial-onset seizures are not fully controlled by monotherapy, in both adults and children (from around age 2 in some countries). (1) (2)

Before taking oxcarbazepine

Do not take / not appropriate for

  • Do not take oxcarbazepine if you have a known hypersensitivity to oxcarbazepine, to eslicarbazepine acetate, or to any ingredient in the product. (all countries) (1) (2)
  • Do not restart oxcarbazepine after a genuine hypersensitivity reaction (rash, angioedema, anaphylaxis, or a serious skin reaction) -- rechallenge is not safe. (all countries) (1) (2)

Tell your clinician about

  • Any past allergic/hypersensitivity reaction to carbamazepine -- roughly 25-30% of people who reacted to carbamazepine will also react to oxcarbazepine.
  • Your family background/ancestry, particularly Han Chinese, Thai, or other Southeast Asian ancestry -- your clinician may recommend genetic (HLA-B*1502) testing before you start, because of a higher risk of serious skin reactions in people who carry this gene variant.
  • Any history of low blood sodium, kidney problems, or if you take other medicines that can lower blood sodium (such as certain diuretics).
  • Any history of depression, mood changes, or suicidal thoughts, since antiepileptic medicines as a class carry a small increased risk of suicidal thinking.
  • If you use hormonal contraception -- oxcarbazepine can make it less effective.
  • Any heart rhythm/conduction problems.
  • Whether you are pregnant, planning pregnancy, or breastfeeding.
  • All other medicines you take, especially other antiepileptic drugs, lithium, ciclosporin, or tacrolimus.
(1) (2)

How to take oxcarbazepine

  • Take oxcarbazepine exactly as prescribed, with or without food; tablets can be taken with a small amount of water.
  • Do not stop taking oxcarbazepine suddenly -- it must generally be withdrawn gradually, under your clinician's guidance, because of the risk of increased seizure frequency or status epilepticus.
  • If your dose needs adjusting, this should be done by your clinician, not on your own.
(1) (2)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6)

Missed dose

Contact your prescriber or pharmacist for specific guidance if you miss a dose. Do not double a dose to make up for a missed one without checking first, since correct, steady dosing matters for seizure control.

Overdose

Seek emergency medical attention immediately if too much oxcarbazepine has been taken, or if you notice severe drowsiness, confusion, loss of coordination, uncontrolled eye movements, seizures, or loss of consciousness. There is no specific antidote; treatment is supportive. (2)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Somnolence (sleepiness) and fatigue.

What to notice: Somnolence (sleepiness) and fatigue.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Dizziness and headache.

What to notice: Dizziness and headache.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Double vision (diplopia) and other visual disturbances.

What to notice: Double vision (diplopia) and other visual disturbances.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Nausea and vomiting.

What to notice: Nausea and vomiting.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (2)

Unsteadiness/abnormal gait (ataxia) and tremor.

What to notice: Unsteadiness/abnormal gait (ataxia) and tremor.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Weight increase.

What to notice: Weight increase.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (2)

Serious warnings

Signs of low blood sodium (hyponatraemia) — high caution

Symptoms: Nausea, feeling generally unwell, headache, drowsiness, confusion, or (rarely) seizures.

Action: Contact your clinician promptly for a blood sodium check -- clinically significant hyponatraemia (sodium below about 125 mmol/L) has developed in up to 2.5-2.7% of people taking oxcarbazepine, usually within the first few months. Your clinician will decide whether to adjust or stop treatment. (1) (2)

Signs of a serious skin reaction (Stevens-Johnson syndrome or toxic epidermal necrolysis) — high caution

Symptoms: A spreading rash, blistering or peeling skin, mouth/eye/genital sores, or fever alongside a new rash.

Action: Seek emergency medical help immediately and do not take another dose. This risk is meaningfully higher in people carrying the HLA-B*1502 gene variant, more common in people of Han Chinese, Thai, and some other Southeast Asian ancestries -- genetic testing before starting is recommended for people from these backgrounds. Oxcarbazepine must never be restarted after a reaction like this. (1) (2)

Signs of a serious allergic reaction (including in people with a past reaction to carbamazepine) — emergency

Symptoms: Swelling of the face, lips, tongue, or throat, difficulty breathing, or widespread hives/rash.

Action: Seek emergency medical help immediately. About 25-30% of people who have had a hypersensitivity reaction to carbamazepine will also react to oxcarbazepine -- tell your clinician about any past carbamazepine reaction before starting. (1) (2)

New or worsening mood changes, or thoughts of suicide or self-harm — high caution

Symptoms: New or worsening depression, anxiety, agitation, or thoughts of self-harm, which can appear as early as the first week of treatment.

Action: Contact your clinician promptly, or seek emergency help if there is any immediate risk. Antiepileptic medicines as a class, including oxcarbazepine, carry a small increased risk of suicidal thoughts or behaviour. (1) (2)

Signs of DRESS (multi-organ hypersensitivity) or a serious blood disorder — high caution

Symptoms: Fever with rash, swollen glands, unusual bruising or bleeding, or signs of infection alongside these symptoms.

Action: Contact your clinician urgently for assessment -- rare multi-organ hypersensitivity (DRESS) and rare blood-count problems (including agranulocytosis, aplastic anaemia, and pancytopenia) have been reported. (1) (2)

Interactions

  • May reduce the effectiveness of hormonal contraceptives (the pill, patch, ring, and similar methods) -- discuss additional or alternative non-hormonal contraception with your clinician. (1) (2)
  • Can raise phenytoin levels (especially at oxcarbazepine doses above 1200 mg/day), which may need a phenytoin dose reduction. (1) (2)
  • Other antiepileptic medicines (carbamazepine, phenytoin, phenobarbital) can reduce oxcarbazepine's active metabolite levels, potentially needing a dose adjustment. (1) (2)
  • May reduce blood levels of ciclosporin or tacrolimus (immunosuppressants). (2)
  • Combined use with lamotrigine has been linked to more nausea, somnolence, dizziness, and headache. (2)
  • Theoretical risk of increased neurotoxicity with lithium. (2)
  • Alcohol may add to sedative effects. (2)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

Human data are limited; no clear increase in major congenital malformations has been shown, but a moderate teratogenic risk cannot be completely excluded, and some registry data suggest a higher chance of a smaller-than-expected baby (small-for-gestational-age). Seizures themselves carry real risks to both mother and baby, so treatment should not be stopped abruptly -- discuss the safest plan, folic acid supplementation, and monitoring with your specialist. (1) (2) (3) (4) (5) (6)

Breastfeeding

Oxcarbazepine and its active metabolite pass into breast milk in small amounts; a risk to the breastfed infant cannot be fully excluded. Discuss with your clinician, and watch the baby for drowsiness or poor weight gain if breastfeeding. (1) (2) (3) (4) (5) (6)

Children

Used as monotherapy and adjunctive therapy in children, generally from around age 2-6 years depending on the country and indication, with weight-based dosing set by the prescriber. (1) (2) (3) (4) (5) (6)

Elderly

No specific dose adjustment is required based on age alone, though renal function should be checked, since dosing changes if kidney function is reduced. (1) (2) (3) (4) (5) (6)

Hepatic_impairment

No dose adjustment is generally needed in mild-to-moderate liver impairment; caution is advised in more severe impairment. (1) (2) (3) (4) (5) (6)

Renal_impairment

Starting dose is halved if creatinine clearance is below 30 mL/min, with more gradual titration. (1) (2) (3) (4) (5) (6)

Monitoring

Before starting

  • Baseline serum sodium (especially in those at higher risk)
  • Consideration of HLA-B*1502 genetic testing in patients of Han Chinese, Thai, or other higher-risk ancestry
  • Review of any past carbamazepine hypersensitivity reaction
  • Kidney function

During treatment

  • Serum sodium checked at baseline, around 2 weeks, then monthly for about 3 months in at-risk patients, and whenever symptoms of hyponatraemia appear.
  • Prompt skin/mucosal assessment if any new rash develops.
  • Ongoing monitoring for mood changes or suicidal thoughts, especially early in treatment.
(1) (2)

Storage

Store below 30°C (or as directed on the product packaging), protected from moisture, out of reach of children.

Study the drug class: Antiepileptics

Professional information

Clinician-facing context only, sourced from the current US FDA and UK SmPC labels; verify against the current full label before prescribing.

United States / United Kingdom / European Union / Canada / Australia / New Zealand

Indication: Partial-onset seizures, adults

Dose summary: Initial 600 mg/day in 2 divided doses, titrated by up to 600 mg/day weekly to a therapeutic range of ~600-2,400 mg/day (max 2,400 mg/day); renal impairment (CrCl <30 mL/min): start at half the usual dose.

Renal context: CrCl <30 mL/min: initiate at one-half the usual starting dose (e.g. 300 mg/day) with slower titration. (1) (2)

United States / United Kingdom / European Union / Canada / Australia / New Zealand

Indication: Partial-onset seizures, children

Dose summary: Weight-based dosing, commonly starting around 8-10 mg/kg/day in 2 divided doses, titrated over about 2 weeks to a weight-based maintenance range; country-specific age minimums vary (from age 2 for adjunctive use in some countries, age 4-6 for monotherapy in others).

Renal context: Not separately established in the sources reviewed; use adult renal-impairment principles with specialist judgement. (1) (2) (6)

Mechanism of action

Hepatic guidance

No dose adjustment generally required in mild-to-moderate hepatic impairment; not specifically studied in severe hepatic impairment.

Overdose note

No specific antidote; manage with supportive care, gastric decontamination measures where appropriate, and monitoring of sodium, cardiac conduction (QTc), and neurological status. (1) (2)

Frequently asked questions

Is oxcarbazepine available in the US, UK, Europe, Canada, Australia, and New Zealand?

Yes. It is authorised in all of these regions, marketed as Trileptal (and, in some EU markets, other brand names) plus generic oxcarbazepine products. (1) (2) (3) (4) (5) (6)

Does oxcarbazepine have a boxed warning like some other antiepileptic drugs?

No -- oxcarbazepine does not carry an FDA boxed warning. Its most important safety issues are the risk of low blood sodium (hyponatraemia) and a rare but serious skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis), which is more likely in people carrying a specific gene variant, HLA-B*1502, more common in people of Han Chinese, Thai, and some other Southeast Asian ancestries. (1) (2)

Why might my clinician recommend a genetic test before I start oxcarbazepine?

If you are of Han Chinese, Thai, or certain other Southeast Asian ancestry, your clinician may recommend testing for the HLA-B*1502 gene variant, which is carried much more often in these populations and is linked to a higher risk of serious skin reactions (Stevens-Johnson syndrome/toxic epidermal necrolysis) with oxcarbazepine. (1) (2)

I had an allergic reaction to carbamazepine -- can I take oxcarbazepine?

Tell your clinician first. About 25-30% of people who have had a hypersensitivity reaction to carbamazepine will also react to oxcarbazepine, so this needs careful clinical judgement before starting. (1) (2)

What is the mechanism of action of oxcarbazepine?

Oxcarbazepine is a keto-analogue of carbamazepine, rapidly and extensively metabolised to its pharmacologically active 10-monohydroxy derivative (MHD). Its antiepileptic effect is believed to arise primarily from blockade of voltage-sensitive sodium channels, stabilising hyperexcited neuronal membranes and reducing repetitive neuronal firing. Oxcarbazepine and MHD are weak inducers of CYP3A4/3A5 and UDP-glucuronyltransferases, and MHD inhibits CYP2C19. (1) (2)

What is the generic name of Oxcarbazepine?

The generic name is oxcarbazepine. (1) (2)

What class of drug is oxcarbazepine?

Oxcarbazepine is classed as: Anticonvulsant (antiepileptic drug) -- a keto-analogue of carbamazepine. (1) (2)

References

  1. TRILEPTAL (oxcarbazepine) tablets and oral suspension -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information, Novartis · United States · accessed 2026-07-30 · source 1
  2. Trileptal 300 mg Film-coated Tablets -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom -- Novartis Pharmaceuticals UK Ltd · United Kingdom · accessed 2026-07-30 · source 2
  3. Oxcarbazepine -- list of nationally authorised medicinal products (PSUSA/00002235)European Medicines Agency (EMA) -- PSUSA (periodic safety update report single assessment), list of nationally authorised medicinal products · European Union · accessed 2026-07-30 · source 3
  4. TRILEPTAL 300 MG -- Drug Product Database recordHealth Canada Drug Product Database (DPD) · Canada · accessed 2026-07-30 · source 4
  5. TRILEPTAL oxcarbazepine 150mg/300mg/600mg tablets and 60mg/mL oral suspension -- ARTG entries 76200/76201/76202/81195Therapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-30 · source 5
  6. TRILEPTAL (oxcarbazepine) New Zealand Data Sheet and Consumer Medicine InformationMedsafe (New Zealand regulator) · New Zealand · accessed 2026-07-30 · source 6

Brand names by country

Single-ingredient oxcarbazepine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Trileptal60 mg/mL, 150 mg, 600 mg, 300 mg · novartis pharmaceuticals corporation
  • OXTELLAR XR300 mg, 600 mg, 150 mg · supernus pharmaceuticals, inc.

United Kingdom

  • Trileptal (2)MHRA licensed emc smpc confirmed · 150 mg, 300 mg, 600 mg tablets, 60 mg/mL oral suspension · Novartis Pharmaceuticals UK Ltd

Canada

  • TRILEPTAL

Australia

  • Trileptal (5)TGA ARTG registered confirmed · 150 mg, 300 mg, 600 mg tablets, 60 mg/mL oral suspension · Novartis Pharmaceuticals Australia Pty Ltd

New Zealand

  • Trileptal (6)Medsafe data sheet and CMI confirmed · 150 mg, 600 mg tablets · Novartis New Zealand Limited
View brands in additional countries.

European Union

Timox (example: Germany) (3)

This page provides general reference information about oxcarbazepine and is not a substitute for advice from the prescriber managing your treatment. All dosing and treatment decisions, including any decision to change or stop treatment, should be made with your prescriber.

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