At Mind Align Psychiatry, we are dedicated to providing comprehensive and effective treatment options for mood disorders. Oxcarbazepine, known by its brand name Trileptal, is one such medication that we prescribe to manage mood dysregulation, particularly in conditions like bipolar disorder and Disruptive Mood Dysregulation Disorder (DMDD).
Oxcarbazepine: A Versatile Mood Stabilizer
Initially developed for seizures, Oxcarbazepine has found its place in psychiatric care. It is FDA-approved for bipolar disorder in adults and used off-label in children and teens for irritability and anger associated with DMDD.
Mechanism of Action
Oxcarbazepine works by slowing down voltage-gated sodium channels in the brain, leading to a mild slowing of cells implicated in mood dysregulation. It also impacts the GABA:Glutamate system, which regulates neuronal speed and other functions.
Key Side Effects and Genetic Testing
- Like lamotrigine, oxcarbazepine can cause a serious inflammatory reaction, including Stevens Johnson Syndrome, so its dosage is increased gradually. Genetic testing is recommended for individuals of Asian descent before starting oxcarbazepine due to a higher risk of this syndrome, linked to the HLA-B 1502 mutation (found in 10% of Asians and rare in other ethnic groups). The HLA-A*31:01 subtype, also associated with increased risk, is more prevalent in Asian, Native American (15%), and African American (5%) populations.
- Regular lab tests are advised after 2 weeks and 2 months of treatment to monitor sodium levels, as oxcarbazepine can lower them.
- Additionally, oxcarbazepine has a lower likelihood of causing weight gain compared to other mood stabilizers.
Dosing Guidelines
- Adults: Starting at 300mg every 12 hours, increasing to a goal dose of 1200mg to 2400mg per day.
- Children: A lower starting dose, often using a liquid preparation, is recommended, gradually increasing based on weight and response.
Medication Interactions
Patients taking Oxcarbazepine should be cautious with oral contraceptives, certain hypertension medications like Verapamil, MAOI antidepressants, and if they have glaucoma.
Pregnancy Considerations
Oxcarbazepine's safety in pregnancy is not fully established, particularly in the first trimester. Women of childbearing age should use additional contraception methods.
Identifying Stevens-Johnson Syndrome
Stevens Johnson Syndrome (SJS) is a serious reaction that can start with flu-like symptoms such as feeling unwell, fever, headaches, joint aches, and sometimes a cough. After one to three days, a distinctive rash appears. This rash typically has red or purple spots, darker in the middle with lighter edges, forming a "target-like" pattern. Unlike typical drug rashes, these spots usually don't itch but can turn into blisters. A key indicator of SJS is that the rash affects not just the skin but also the mucous membranes (inside the mouth, nose, eyes, genital area, and respiratory tract). If such symptoms are noticed, it's crucial to immediately stop the medication causing the reaction and seek emergency medical attention, as SJS can lead to severe skin damage and, in rare cases, can be fatal.
Monitoring Therapy
While serum levels of Oxcarbazepine are not routinely measured, they may be checked in cases where higher doses are not yielding expected results.
At Mind Align Psychiatry, our approach is to tailor treatment to each individual's needs, considering their unique medical history and response to medication. Oxcarbazepine represents a key component in our diverse arsenal of mood stabilization options, helping us provide effective and personalized care.
Discover Wellness with Mind Align Psychiatry:
At Mind Align Psychiatry, we believe in a holistic and personalized approach to mental health care. Amantadine represents just one of the many innovative options we explore to provide effective solutions for conditions like OCD and anxiety. Begin your journey towards a healthier and more balanced life by visiting www.mindalignpsych.com or texting or calling 484-799-9211.
