Oxcarbazepine (Trileptal) is a 10-keto analogue of carbamazepine but is not oxidatively metabolized. As a result, there is little, if any, induction of hepatic enzymes and no autoinduction of metabolism, allowing for a more rapid titration to maximum dosage. Its active metabolite is a monohydroxy derivative (MHD) that has a half-life of 10 h, allowing for a bid dosing. It is begun at 20 mg/kg/day and increased to a maximum of 60 mg/kg/day or to tolerance and seizure control. It will probably be approved for use as adjunctive treatment of partial epilepsies. It can be used in combination with any of the existing AEDs, including carbamazepine. Unlike carbamazepine, it has no epoxide metabolites and is not affected by erythromycin.
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