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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Chris A. on July 27, 2000, at 17:20:53
My pDoc is suggesting we try this apparently newly FDA approved relative of carbamazepine (Tegretol). It is supposed to have fewer side effects and less potential for drug interactions. Does anyone know anything practical about this anticonvulsant med - like the trade name, what company makes it, and the biggie - what is it's potential for causing weight gain? What I've found on medline doesn't answer these questions. Has any efficacy been shown in treatment resistant bipolar disorder? Would it stabilize one in a down mood or a bit farther up on the scale? Supposedly it can actually improve cognition and memory, which is the only thing that makes me want to consider it. It is a newbie for my pDoc. I have been his willing guinea pig for over five years now.
Thanks for any insight,
Chris A.
Posted by medlib on July 27, 2000, at 18:23:15
In reply to Info on oxcarbazepine - Scott, Cam, anyone??, posted by Chris A. on July 27, 2000, at 17:20:53
> My pDoc is suggesting we try this apparently newly FDA approved relative of carbamazepine (Tegretol). It is supposed to have fewer side effects and less potential for drug interactions. Does anyone know anything practical about this anticonvulsant med - like the trade name, what company makes it, and the biggie - what is it's potential for causing weight gain? What I've found on medline doesn't answer these questions. Has any efficacy been shown in treatment resistant bipolar disorder? Would it stabilize one in a down mood or a bit farther up on the scale? Supposedly it can actually improve cognition and memory, which is the only thing that makes me want to consider it. It is a newbie for my pDoc. I have been his willing guinea pig for over five years now.
>
> Thanks for any insight,
>
> Chris A.----------------------------
Chris--
Oxcarbazine's trade name is Trileptal, made by Novartis, available in 150, 300 and 600 mg. tabs. Drug info is available at:
www.lexi.com/html/chapter/mono/hf095150.htm
I found no mention of weight gain, just mainly somnolence, N&V, etc. I also found no mention of use for BD--just treatment-refractive epilepsy, facial neuralgia; but, this was just a quick-and-dirty first-pass search. Others may be able to provide more pertinent details.
I know you've been through an awful lot; did you find reference to cognitive enhancement for this drug? I ask because the drug lit mentions cognitive dificulties (I presume, similar to Tegretol).
Anyway, hope this helps a little, and that the drug does, too; your deserve a break!
Well wishes--medlib
Posted by Sunnely on July 27, 2000, at 21:15:36
In reply to Info on oxcarbazepine - Scott, Cam, anyone??, posted by Chris A. on July 27, 2000, at 17:20:53
> My pDoc is suggesting we try this apparently newly FDA approved relative of carbamazepine (Tegretol). It is supposed to have fewer side effects and less potential for drug interactions. Does anyone know anything practical about this anticonvulsant med - like the trade name, what company makes it, and the biggie - what is it's potential for causing weight gain?
Oxcarbazepine (Trleptal), related to carbamazepine (Tegretol) in chemical structure, received US FDA approval in January, 2000 as a treatment of partial seizures with or without secondary generalization.
In the US, Trileptal is not indicated for use in the treatment of mania and bipolar disorder. However, it has been used and found effective for this condition in some European countries. During the European studies comparing carbamazepine (Tegeretol; Tegretal in Germany) and oxcarbazepine as treatment for bipolar disorder and schizoaffective disorder, both were found to have pharmacologically similar profile of action. However, oxcarbazepine was better tolerated than carbamazepine in equivalent dosages. It was suggested that the known adverse effects of carbamazepine are closer related to the its main metabolite called carbamazepine-10,11-Epoxide than its parent compound (carbamazepine). Oxcarbazepine is not metabolized to this compound but a different one. Because of its better tolerability, it has an advantage over carbamazepine in the treatment of acute mania, where relatively high dosages should be reached as soon as possible. (Minor advantage during prophylactic treatment of manic symptoms.) Majority of the patients with manic symptoms during the European studies appeared to respond to oxcarbazepine in dose range of 1200-3000 mg/day.
Trileptal appears to have similar side effect profile as Tegretol. During clinical trials as an anti-epileptic, the following symptoms were experienced by patients at least 5% more frequent than placebo: dizziness, sleepiness, double vision, tiredness, nausea, vomiting, unsteadiness, abnormal vision, abdominal pain, tremor, and dyspepsia. For patients who have not previously been treated with other anti-epileptics, using Trileptal alone, most common symptoms that led to discontinuation of treatment were: dizziness, nausea, rash, headache. Increase in weight was seen in 1% of patients on Trileptal at 600 mg/day; 2% on doses 1200-2400 mg/day; 1% on placebo.
In 14 controlled epilepsy studies, Trileptal caused clinically significant drop in blood sodium level (hyponatremia) in 2.5% of the patients (38 of 1524). Patients whose treatment with Trileptal was discontinued due to hyponatremia experienced normalization of blood sodium within a few days without additional treatment.
Trileptal can inhibit and stimulate the action of certain liver enzymes leading to significant interactions with other drugs. For female patients of childbearing age, the concurrent use of Trileptal with hormonal contraceptives may render this method of contraception less effective. Additional non-hormonal forms of contraception are recommended when using Trileptal. Other anti-epileptics which strongly stimulate liver enzymes have been shown to decrease the blood level of Trileptal. Repeated dosing with Trileptal has been shown to lower the blood level of certain calcium channel blockers (e.g., felodipine). On the other hand, verapamil produced a decrease in the blood level of Trileptal's active metabolite, 10-monohydroxy (MHD). Cimetidine (Tagamet), erythromycin, and dextropropoxyphene had no effect on the metabolism of MHD. No evidence of interaction noted with warfarin (Coumadin, blood thinner) with either single or repeated dosing of Trileptal. Alcohol can cause possible additive sedative effect with Trileptal. There are no known interactions of Trileptal with commonly used laboratory tests. Unlike Tegretol, no autoinduction has been observed with Trileptal (i.e., Trileptal does not induce its own metabolism).
Patients who have allergic reactions to Tegretol have approximately 25%-30% chance of developing allergic reactions with Trileptal.
Trileptal is a Pregnancy Category C drug.
Good Luck.
Posted by Chris A. on July 27, 2000, at 23:49:27
In reply to Re: Info on oxcarbazepine - Scott, Cam, anyone??, posted by medlib on July 27, 2000, at 18:23:15
> did you find reference to cognitive enhancement for this drug?One UK study, (Eur J Clin Pharmocol 1993;44(6):529-33), which appeared to have face validity, indicated that OXCZ improved performance (compared to placebo) on a focused attention task and increased manual writing. Subjective ratings showed that it increased feelings of alertness, clear headedness and quickwittedness. The researchers concluded that it has a slightly stimulant effect on some aspects of psychomotor functioning.
Another Brazilian study suggested a potential AD effect. (Eur J Pharmacol 1998 Apr 17;347(1):23-7).
>I ask because the drug lit mentions cognitive difficulties (I presume, similar to Tegretol).
I'm praying that the results of the above studies apply to me! We're jumping through all sorts of hoops to try to enhance and perserve cognitive functioning. My neurons have had enough and feel like they're about 1,000 years old.
> Anyway, hope this helps a little,
Yes, this does help. Thanks a bunch. Following a lot of ECT I've found I've had to relearn lots of details, and one of them is how to search. My therapist showed me where the control is for the emergency flashers is on my car yesterday. I've been driving around for six months without a clue. Talk about feeling dumb!
How are < you > doing??
Blessings,
Chris A.
Posted by Chris A. on July 28, 2000, at 0:26:02
In reply to Re: Info on oxcarbazepine - Scott, Cam, anyone??, posted by Sunnely on July 27, 2000, at 21:15:36
> Increase in weight was seen in 1% of patients on Trileptal at 600 mg/day; 2% on doses 1200-2400 mg/day; 1% on placebo.
That info. sounds hopeful. There aren't many mood stabilizers out there that don't cause one to balloon up. Thanks for taking the time and effort to send it. I've printed it out for my file to help in making an informed treatment decision.
May the sun shine upon you,
Chris A.
Posted by medlib on July 29, 2000, at 2:03:15
In reply to Re: Info on oxcarbazepine - Thanks! » medlib, posted by Chris A. on July 27, 2000, at 23:49:27
Chris--
Thanks for the citations and for inquiring about me! I really can relate to "tired neurons" and am sorry that I didn't take time to preview my post to you--2 errors in the same post are embarrassing! I've just come from the funeral of a friend who was 6 years younger that I am; her sudden, unexpected death (heart attack) is sobering; I have many risk factors for an MI--she had none (that we knew). Sorta makes my suffering through drug trials seem trivial. I'm on Effexor and Ritalin and am trying to add Remeron (pdoc thinks Effexor+Remeron is an especially potent combo), but the daily severe migraines that Remeron causes are wearing. I'm sure that your post-ECT or my son's past post-ictal headaches must be worse; but, any severe headache makes thinking pretty tough. Sometimes, it's difficult to gauge which causes more "cognitive difficulties"--depression, or its various treatments.
I was interested in the drug you mentioned because my son's been on Tegretol for 20+ years (epilepsy). One brief drug-free period long ago let us see how much Tegretol "costs" him mentally (particularly, short-term memory) for its seizure-free insurance. Huge difference. He has managed, nevertheless, to acquire a grad degree (4.0) and succeed at a memory-intensive profession. Guess I'm feeling guilty for allowing myself to become so impaired by depression.
The information Sunnely provided (she is incredibly knowledgeable and thorough!) that Oxcz yields an active metabolite different from carbamazebine is hopeful, as is the info on weight gain. I'd be quite interested in your experience with it--hope it works out for you.
Well wishes--medlib
>
> > did you find reference to cognitive enhancement for this drug?
>
> One UK study, (Eur J Clin Pharmocol 1993;44a6):529-33), which appeared to have face validity, indicated that OXCZ improved performance (compared to placebo) on a focused attention task and increased manual writing. Subjective ratings showed that it increased feelings of alertness, clear headedness and quickwittedness. The researchers concluded that it has a slightly stimulant effect on some aspects of psychomotor functioning.
>
> Another Brazilian study suggested a potential AD effect. (Eur J Pharmacol 1998 Apr 17;347(1):23-7).
>
> >I ask because the drug lit mentions cognitive difficulties (I presume, similar to Tegretol).
>
> I'm praying that the results of the above studies apply to me! We're jumping through all sorts of hoops to try to enhance and perserve cognitive functioning. My neurons have had enough and feel like they're about 1,000 years old.
>
> > Anyway, hope this helps a little,
>
> Yes, this does help. Thanks a bunch. Following a lot of ECT I've found I've had to relearn lots of details, and one of them is how to search. My therapist showed me where the control is for the emergency flashers is on my car yesterday. I've been driving around for six months without a clue. Talk about feeling dumb!
>
> How are < you > doing??
>
> Blessings,
>
> Chris A.
Posted by 2sense on April 20, 2002, at 17:15:10
In reply to Re: Info on oxcarbazepine - Thanks! » Chris A., posted by medlib on July 29, 2000, at 2:03:15
What amount of Tegretol was your son on? Did he gain weight, sexual dysfunction (though you may not know this and it would be understandable) -- I will be on 600 mg and had a grand mal due to w/drawal from Klonopin (long story started it for sleep but the tolerance drove it up and I didn't like the side effects and wanted out)...
thank you for any information -- 2sense
Posted by medlib on April 23, 2002, at 1:51:00
In reply to Re: Info on oxcarbazepine - Thanks! » medlib, posted by 2sense on April 20, 2002, at 17:15:10
Hi 2sense--
My son has been on Tegretol since he was 14, when he experienced his first grand mal seizure. He's been taking 1200mg. (300mg. 4x/d) for many years with no major problems. He's had no sexual dysfunction, but weight gain is a continuing struggle. It's not the inevitability that it is on Paxil or Zyprexa; it *is* controllable by exercise, but vigilance is necessary to avoid the insidious creep upward. For him, the worst side effects are serious difficulties with short-term memory and overall alertness. He gives a whole new meaning to the term "absent minded," and it frustrates him as much as those he deals with. It's my impression that the side effects are pretty much dose-dependent. Other meds have not been as effective for him, so he's had to adjust to the one that works. And he's done that well; he completed his B.S. and Masters with 4.0s, has a good job he likes, is happily married and just presented me with my first grandchild! Best of all, he didn't inherit my Aspergers or double depression.
The minimum therapeutic dose of Tegretol for epilepsy in adults generally is considered to be 800mg/day (or used to be). I believe very strongly that epilepsy should be managed by a neurologist who specializes in it--an epileptologist. Your seizure sounds like it could be a one-time event; not all docs prescribe ACs after a single seizure (particulary a "situational" one). But, if you *do* need to go on an AC, the need for meds probably should be reevaluated in 6 mo-1 yr. I urge you to consider getting a second opinion from the best epileptologist you can find before starting (or continuing) an AC.
Hope things go well, and please keep us updated!---medlib
Posted by medlib on April 23, 2002, at 2:44:07
In reply to Re: Info on oxcarbazepine - Thanks! » medlib, posted by 2sense on April 20, 2002, at 17:15:10
Hi again 2sense--
First, please let me apologize for my delay in replying to your post; I don't read PB as often as I did pre-grandchild (I'm now a nanny 2-3 days a week).
Second, I'm sorry, I didn't even notice the lengthy thread below; I just came to a screaching halt when I saw my name. My capacity to overlook the obvious is legendary.
Third, although ACs are useful mood stabilizers particularly helpful in bipolar cases, IMHO, Tegretol is not a great first-line choice for that purpose. Certainly, other alternatives have more benign side effect profiles (and don't require regular liver function blood tests, as Tegretol does).
I don't want to offend or sound dogmatic, but I just don't consider a pdoc qualified to prescribe ACs for seizure disorders--they lack the appropriate clinical database. (Nor would I be willing to have an epileptologist prescribe for a bipolar disorder, not that they would.)
Now that my foot's once more firmly in my mouth, I'd better get down off my soap box before I trip over it. Well wishes---medlib
Posted by Chris A. on April 23, 2002, at 11:20:17
In reply to Re: Info on oxcarbazepine - Scott, Cam, anyone??, posted by Sunnely on July 27, 2000, at 21:15:36
I still keep oxcarbazepine around as a fire extinguisher. When I find myself not sleeping as much, feeling very strongly about issues, talking a bit faster, getting agitated, getting racing thoughts and posting to Babble, it is time to put those warning flames out with the addition of Trileptal to my cocktail. It only involves taking a very small dose at night, along with my p.m. dose of 100 mg of Lamictal and .25 of Klonopin. Even samll doses make me drowsy during the day. I have been overly-sensitive to to drowsiness/fogginess on all ACs except Lamictal. So, after two years, Trileptal is a keeper in my medicine cabinet because it works.
I considered taking it last night. We will see how the rest of the day goes, and I'll possibly add some back in tonight.Here's to a 5 1/2 on a scale of one to ten,
Chris A.
Posted by Binger on February 9, 2004, at 13:08:03
In reply to Re: Info on oxcarbazepine - Thanks!, posted by medlib on April 23, 2002, at 2:44:07
Just wanted to throw a little info in--I've done a bit of research on Trileptal lately. First, It IS Tegretal with an extra oxygen molecule added. The Tegratol I would be very cautious about starting, one thing I've read about is it really likes to kill white blood cells, your infection fighting cells(Think HIV). The oxygen attached to Trileptal seems to prevent this. The biggest reason I've read about for stopping Trileptal is rash, but there are a lot of other effects. Some people have none, or problems like dizzines, naseau, clumsiness, stuttering--but a lot of times they go away after a week or two. My starting dose-300 mg- had no side effects, but after increasing it to 600 mg I felt a very strange intoxification, naseau, memory problems,and probably clumsiness--I don't know cause I can't remember before--all I know is I have a lot less dishes lately. Keep in mind that this is a very light dose, 600 mg is usually as low as they go, but I have a milder case of epilepsy. I have to say though, most side effects have gone away from medicinal use of an herbal anti-naseau-anti-convulsant, yeah you know the one. One site that had good info was www.psycheducation.org/depression/meds/trileptal.htm -----------------ignore the extra the--it won't go away. the .
This is the end of the thread.
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