Trileptal (Oxcarbazepine) Bipolar Treatment: Uses, Effectiveness, & More

What Is Trileptal?

Trileptal, also known by its generic name oxcarbazepine, is a medication that is FDA-approved in the treatment of seizures. There is another brand of oxcarbazepine called Oxtellar XR, which is an extended-release medication as opposed to Trileptal’s immediate-release formulation. This article will focus on Trileptal. Also known as an anticonvulsant or antiepileptic drug, Trileptal helps to suppress excessive rapid firing of the nerves, preventing or treating seizures. Other than seizure control, Trileptal may be used off-label as a treatment for bipolar disorder.^{1, 2}

Can Trileptal be Used to Treat Bipolar Disorder?

Trileptal can be used in the treatment of bipolar disorder, but this is an off-label indication. It is one of many possible medications used for bipolar disorder. This medication is typically used after the first-line options are exhausted or if there are complications that prevent someone from taking those medications. It has been suggested that Trileptal may be useful in controlling acute manic episodes in patients with bipolar disorder, although more data is needed to determine if it is effective for maintenance treatment.³

The difference between FDA-approved and off-label use is that a medication with FDA approval has gone through a formal process to determine that medication is safe and effective for that use. Off-label use is when a medication has not undergone the FDA approval process but may be used as a treatment for some conditions.^{1, 2}

Which Is Better, Lamictal or Trileptal?

Both medications are effective for the reasons they are prescribed. Lamictal is approved as a treatment for seizures and bipolar disorder, unlike Trileptal, which is used off-label for bipolar disorder.⁴ When treating bipolar disorder, Lamictal can treat both mania and depression but tends to be more effective with depression symptoms. Trileptal is thought to be better suited for mania. ^{5, 6} The right medication for you depends on your condition as well as personal factors you can discuss with your doctor.

Is Trileptal Similar to Gabapentin?

Trileptal and gabapentin are similar in that they are both anticonvulsants used to treat seizures, but they differ in how gabapentin is used as only an add-on therapy for certain types of seizures. Gabapentin is approved for use in nerve pain, including pain caused by the herpes zoster virus, known as shingles.⁷ There are overlapping uses, but the specifics of their mode of action and approved uses make them different.

How Does Trileptal Work for Bipolar Disorder?

Trileptal works by keeping nerves from firing too rapidly by interfering with the body’s electrical activity. This change in the nervous system helps to control the cause of seizures. It is unknown how Trileptal works as a mood stabilizer and the exact mechanisms when used in bipolar disorder.

Side Effects of Trileptal for Bipolar Disorder

All medications have a potential for side effects. Trileptal’s side effects can cause side effects across the entire body, affecting the digestive system, eyes, skin, and other areas. Some may be mild, while others require medical intervention, such as those listed as serious side effects. Mild reactions may go away as your body adjusts to medication, but if you experience new or worsening side effects, speak with a doctor.

It’s important to note that side effects reported for Trileptal came from clinical trials when it was used to treat seizures. There may be different side effects when used for bipolar disorder. Your doctor can help to answer questions about how Trileptal may work for your condition.

Common side effects of Trileptal for bipolar disorder include*:^{1, 2}

• Dizziness
• Drowsiness
• Fatigue
• Abnormal vision, such as blurred or double vision
• Nausea
• Vomiting
• Abnormal gait/lack of coordination
• Headache
• Tremors

*All medications, including Trileptal, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious side effects of Trileptal for bipolar disorder that require immediate medical attention include*:^{1, 2}

• Allergic reaction and swelling of the throat, lips, and eyelids
• Serious skin reactions
• Nausea, headache, lack of energy, confusion, or seizures that last longer or happen more often than in the past
• Low sodium levels
• Suicidal ideation and behavior
• Issues with blood cells

*All medications, including Trileptal, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

What Are the Long-term Side Effects of Trileptal?

Decreased bone mineral density, osteoporosis, and fractures have been reported in patients taking Trileptal long-term. It is unknown if Trileptal has caused this reaction or how prevalent this side effect is.² Most side effects of Trileptal are mild and improve over time as the body adapts to the medication. Side effects that do not get better with consistent use of Trileptal usually resolve when Trileptal is stopped, or the dosage is decreased.

Does Trileptal Make You Gain Weight?

There is a potential that Trileptal can cause weight gain, but it is not a common reaction according to clinical studies. At most, 2% of adults treated with Trileptal experienced weight gain compared to the 1% in the placebo group. A possible side effect of Trileptal is increased appetite, which could contribute to weight gain, but it is unknown if the increased appetite is due to Trileptal or some other factor.²

Weight gain seems to be uncommon in adults, but there is a potential that children being treated with Trileptal for epilepsy may experience a significant increase in body weight, according to one study.⁸

How Does Trileptal Make You Feel?

You may not notice Trileptal working if you are taking it for mood disorders. It is used to stabilize your moods, so it can be hard to notice a difference. In some circumstances, you may experience some side effects. Examples of common side effects are headaches, fatigue, abnormal vision, and dizziness.

Trileptal for Bipolar Disorder Dosage

Since using Trileptal for the purpose of treating bipolar disorder is an off-label indication, there are no established dosage range recommendations. Dosages may differ from person to person, depending on several factors, and it is not dependent on how severe your symptoms are. ^{1, 2}

How Fast Does Trileptal Work for Bipolar Disorder?

It can take several weeks for you to see the full effects of Trileptal. It is important to stay on track with your medications and to keep taking the medication, even if you feel better. It is important to tell your doctor if you are experiencing any side effects while on Trileptal, especially if they become worse or if they impact your lifestyle.⁹

How Long Does Trileptal Stay in Your System?

Trileptal’s half-life, the amount of time it takes for the body to reduce the amount of drug by half, is about 2 hours. Metabolites are the chemicals that remain after a substance is broken down in the body. Trileptal’s metabolite has a half-life of 9 hours ^{1, 2} A drug is typically considered eliminated after 4 to 5 half-lives from the body, meaning that Trileptal should leave the body in about 36 to 45 hours. This length of time can vary depending on each individual person.

Can You Overdose on Trileptal?

It is possible to overdose on Trileptal. If you have taken too much Trileptal, call poison control’s free helpline at 1-800-222-1222. If the victim collapses, has a seizure, has trouble breathing, or won’t wake, then immediately call 911 and seek emergency care.²

How to Get a Prescription for Trileptal for Bipolar Disorder

To obtain a prescription for Trileptal, you must visit a licensed physician or use an online psychiatry service. They will determine if Trileptal is an appropriate therapy for you based on personal factors as well as your current treatments and the status of your condition. Since bipolar disorder is an off-label treatment, the doctor will have to decide if Trileptal will bring you more benefits over risks. Once approved, a prescription for Trileptal will be sent to a pharmacy of your choice.

Questions to Ask Your Healthcare Provider About Trileptal for Bipolar Disorder

Trileptal is often not the first medication considered when treating bipolar disorder. If you are prescribed this medication as a treatment option, then it is possible you and your doctor or psychiatrist, have tried other medications to treat your condition. When considering the use of Trileptal, you should ask about how it might work for you, what are the side effects, and how it interacts with other medications you might be on.

Questions to ask your care team when considering the side effects of Trileptal may include:

• Can I use Trileptal along with therapy to treat bipolar disorder?
• How long will it take for me to adjust to taking Trileptal?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• Are there drugs I am taking that could have negative interactions?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• Is Trileptal similar to any medications I have used for bipolar disorder?