Bipolar Beat

Bipolar Medication Spotlight: Trileptal (Oxcarbazepine)

By Candida Fink MD
September 12, 2008

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on Trileptal (oxcarbazepine) – an anti-seizure medication that has been increasingly used to treat bipolar disorder. Following are some facts about Trileptal:

  • Few well designed studies strongly support the use of Trileptal to treat bipolar disorder, but some data suggest that it could be beneficial in the maintenance treatment of bipolar – reducing frequency of cycling – in conjunction with more traditional medications, specifically lithium.
  • Possibly anti-manic, although the studies so far are inconclusive.
  • It has gained a lot of attention because it is so closely related to Tegretol, which is well established as an effective treatment in bipolar disorder, but Trileptal is considered much safer than Tegretol.
  • It does not require all of the blood levels that Tegretol does.
  • It does not interfere with as many other medications as Tegretol.
  • It is thought to be less toxic to the white blood cells and liver than Tegretol.
  • It does not typically cause weight gain.

I have used Trileptal sparingly because of the lack of data supporting its use. I have not found it to be particularly effective when I have used it, but it has been well tolerated and hasn’t caused weight gain. One young man found it very helpful and has stayed on a low dose of Trileptal for a long time, so it certainly can be beneficial in some individuals.

In general, Trileptal should be reserved for use in individuals who have not been able to tolerate therapeutic doses of more well studied medicines or have not had good effects from the more standard treatments.

Although most people tolerate Trileptal, it does have some drawbacks and negative side effects, including the following:

  • Can reduce effectiveness of oral contraceptives and other medications, so tell your doctor about all the medications you are currently taking.
  • Can decrease a person’s sodium level.
  • Can cause headache, nausea, vomiting, diarrhea, stomach pain, and indigestion.
  • Can cause dizziness, sedation, clumsiness, blurred or double vision, and poor coordination.
  • Like all anti-seizure medications, if Trileptal is stopped too rapidly, seizures can occur.

A decrease in sodium level may not produce noticeable symptoms but may cause nausea, drowsiness, impaired thinking, and confusion.

Less common side effects include memory impairment, concentration difficulties, rash, and weight gain.

Rare side effects include rashes and severe reactions exhibiting swelling of the face, eyes, lips, or tongue; impaired breathing; or difficulty swallowing. In very rare cases, Trileptal has been linked to Stevens-Johnson Syndrome, a serious skin reaction.

Caution: Never stop taking any medication cold turkey, especially an anti-seizure medication. Withdrawing an anti-seizure medication too quickly can actually cause seizures. Always consult your doctor before you stop or decrease your medication.

If you’ve taken Trileptal for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.


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Links to This Article

From Psych Central's :
Mood Stabilizers for Bipolar Disorder - Psych Central (January 14, 2009)

21 Comments to
“Bipolar Medication Spotlight: Trileptal (Oxcarbazepine)”

I’m currently taking 900 mg of trileptal and 25 mg zoloft for Bipolar II (I’m 95 lbs). The only other bipolar med I tried was lamictal - which worked incredibly, but sadly I had a terrible allergic reaction. The trileptal has a very small but noticable effect. Mainly, it dulls my emotions. I am just a little bit calmer than I would be without it. At times it is easier to get exhausted, and because of this I could not take a higher dose. It seems to do much for the anxiety and energeticness of mania, and helps with mixed episodes (keeping the panic out of my depression), but does nothing for depression alone. Thus I am on the antidepressant as well, which keeps me feeling a little more human without having extreme emotion and energy burst.

I’ve noticed I will get nauseous if I am not careful with eating well. It helps me fall and stay asleep. When I first started taking it, I was dizzy for about 30 minutes after taking a dose, but that has passed. All in all, it is certainly not a great drug for me, at least compared to Lamictal which did wonders, but it is helpful.

600mg worked well at first but after 2 months i need something else it does not work for mr anymore. I panic alot and get very upset . I never seem to be calm.

I am bipolar. This is one of several meds I am on. The big thing is the anti-manic effects. It works so well that I can sit and cry over an intense cartoon with my kids. I am only taking 450 mg. I want to try something else.
I also take
Clonazepam 1 to .5 mg, once a day
Lamotrigine 250mg, once a day
Provigil 100mg, once a day

I took abilify for two months and I gained 25 pounds. My doc just put me on Geodon. I also take zoloft and lamictal. Do I have to take Geodon and just take trileptal instead? I’m sick of all the side effects and I used to take trileptal years ago and nothing bad happened. I just don’t want to take any antipsychotic meds due to all the side effects. Anyone have any suggestions?

Michelle, when you find the answer to that one let me know. Lithium I had kidney malfunction with; Geodon made me fall asleep while driving & incredibly dizzy so I had to lie down on the floor at work as the room was spinning so badly (very professional); Abilify (still on, but trying to reduce dosage) have gained 50 lbs. in 8 years; Lamictal seems to not have any side effects; also take Provigil, Trazodone, klonopin & trying Topamax to see if it will help with weight loss & maybe can replace the Abilify…

Meanwhile, with the weight gain I have now high blood pressure & cholesterol & now have tested in the diabetic range in blood sugar so taking meds for those conditions…

I was diagnosed with bipolar II 3 or 4 years ago and was put on lithium which I found I could not tolerate. Went through a lot of meds and now am on 300 mg of Lamictal, 5-10 mg of Zyprexa (and have gained 30 lbs.), 75 mg of Zoloft, and 12.5 mg of Ambien. Lately, my dr. prescribed 300-600mg of Trileptal to help with the anger/rage that will erupt. I find though that it makes me feel like a zombie and have not been all that compliant taking it. If I force my way through with it, will that side-effect ease up?

I take 300mg of Trileptal 2X daily for bipolar 2 disorder. It has been my miracle drug. After I first started taking it there was such a huge difference. I almost cried when I realized this is now ‘normal’ people feel. It was like a huge weight was lifted off of me or like i took off sunglasses to see how bright the world really was. This, to me, is proof that Trileptal is indeed effective in treating some people with bipolar disorder. I never had any side effects whatsoever… not even minor ones.

I was just wondering. I have bipolar..I am currently taking 50mg of topamax. I have really bad anxiety…controling my freaking life basically. My doctor wont give me something because of my “substance abuse history”. I was thinking of klonopin. Mind you I was only smoking weed. Is klonopin and Topamax a good combination? I want to go to my doctor prepared and informed. I cant handle this anxiety crap much longer…please help. Thanks.

Holls -
It seems like your is your target symptom right now - and it will certainly be best to discuss this with your doc and to be clear about the type of anxiety, frequency and severity of it and how it impacts your life. That can help her make treatment decisions more effectively.
there are other choices for anxiety besides klonopin or other tranquilizers. It will be worth reviewing those options with your doc in detail. Topamax doesn’t do much for anxiety - but can be used in combination with many of the medications used to treat anxiety.
you didn’t say the status of your mood disorder and this will also play a role in the treatment decisions surrounding your anxiety - so again you want to give the doc as much info as you can about your mood states and cycles. Keeping a calendar with brief notes of the mood quality of each day can be really helpful.

Candida Fink MD

My husband was diagnosed with bipolar 1 in August. Previously he had been diagnosed with cyclothymia. He was hospitalized for 10 days when he was diagnosed and put on Trileptal (300mg 3x per day). A week after getting out of the hospital, he got a really bad migraine and cut his dosage to 2x per day without consulting the nurse in charge of his case. Initially she told me that dosage would never get him stable but after seeing him again said that was enough. Since then it seems to me that he is superficially stable, but still not fully stable especially in relation to our son and me. He says he is concerned about not allowing the meds to make him lose the good things he got from his full-blown mania such as greater clarity. Any thoughts on whether the Trileptal is right for him? Thanks.

Trato depressão há cerca de 6 anos .Inicialmente com Fluoxetina 20 mg/dia e posteriormente com Paroxetina 20 mg.Há um mes , não havia melhora da depressão; pelo contrário, piorou, com muitos episódios de choro fácil, desanimo intenso ,etc. A paroxetina foi trocada pelo Trileptal(oxcarbazepina)300mg, 1 cp ao dia; a sensaçaõ de desanimo melhorou ,mas a qualidade de sono piorou muito: pesadelos e insonia;falta de concentraçaõ e a pressão subiu (normalmente é 11x 7 e foi para 15×9 . Ao falar com meu médico pediu para diminuir a dose para 150 mg/dia .Tenho 55 anos,em uso de estandron -P 1 ampola mensal há 6 meses(este foi o melhor remédio que tomei para a menopausa, na falta deste sentia muitas dores de cabeça,alem de onda de calor.Posso continuar o medicamento?esta dose é mais adequada ? quanto tempo preciso aguardar para sentir melhoras? è péssimo ter depressão, com pesadelos pior ainda. Tem algum remedio que melhore pesadelos ,sem levar à dependencia?

After 20 years of cycling depression, I was finally diagnosed with Bipolar II last year. I have taken a series of anti-depressants for the last 7 years, most recently Wellbutrin - they seem to work for awhile and then don’t seem to help much. While trying to learn more about Bipolar II, I kept reading that anti-depressants actually aggrivate symptoms in some people. So I have recently gotten off the Wellbutrin and don’t seem to be missing it at this point.

I tried lamictal and it was amazing, worked wonders for me. But sadly I developed the allergic rash, so had to quit taking it. I also tried Abilify and Geodon - which both had such horrific side effects I was rendered completely non-functional. I just can’t seem to tolerate the mood stablizers. This week my doctor prescribed Trileptal and I’m about to start that. I so hope it will help. It is sad to finally know what I have and not be able to tolerate any of the meds to treat it.

I have used Trileptal for over 7 years and I have to say it is the best I ever had. it helped me better than any thing I have ever taken. It really helped mania. I feel better with than any other med. I think clear with it.

I’m bipolar1 and was on 50 mgs lamictle and 400 seroqual for 6 months. Saw doc yesterday and she took me off lamictle (noticed side effects) and has added 300 mgs trileptal and seroquel down to 300 (I was drooling!) OH, also .25 xanax. My question is “when will an anti depressant be added in treatment? Does that come in after the moods are stabalized? I was on Prozac for 19 years until I went manic in October 08 after death of my brother (I was caretaker) Eventhough I feel calmer I still feel that down low depression. So if I feel calm but still depressed, shouldm’t I be on an anti depressant? Thanks for any info you can give me. I asked the doc yesterday and she said what I’m taking are for depression - very comfusing. Loretta PS I was told by doc that 19 years ago all they has was prozac?

I am bipolar and am prone to rapid cycling and,as the disorder progresses,I experience more depressions and mixed episodes than manic episodes. I tried many medication combinations including lithium, depakote, lamictal, prozac and some others that I can no longer recall. I gained wieght, became lethargic and unmotivated on certain meds, or remained depressed or manic on others. I finally told my psychiatrist that the only way I had any hope of staying on a medication was if it did not have wieght gain as a side effect. If you are taking several different meds that all have a 10 lb average wieght gain side effect, you could end up very obese…which is not healthy. On lithium my hands shook so badly it was embarassing, on depakote I felt ill and swelled up quite groteskly. We picked Trileptal out of a medical book and gave it a try. I have taken Trileptal and zoloft for at least 4 years now and am happier and healthier than I once believed possible. As long as I take my meds exactly as I should, I am very “normal”. No one would ever guess that I am bipolar. I even took my meds through out my pregnancy…I simply could not go without or I would have had full blown episodes. My 2 year old is very healthy. My only complaint is that trileptal is expensive. It is my miracle drug….honestly, for 2 years, once diagnosed, I took many different meds and nothing worked. My life, and the lives of those around me were pure hell. Ocasionally I forget a few pills, or simply don’t care to keep up with my meds the way that I should and I immediately start experiencing hypo-manic episode or mixed episodes or begin getting depressed.
I still can’t believe that Trileptal and zoloft work for me….it seemed for years that I was doomed to be “sick” for the rest of my life.
If I experience any side effects from the Trileptal, I’d say lack of concentration and focus. I find it very difficult to follow conversations or stay on track with my thoughts, they jump around. I also forget a lot. I lose my train of thought, forget names, lose memories etc. My son is ADHD so it has crossed my mind that I am also ADHD…who knows.

I take 600mg of Trileptal 2x a day and 100 mg of zoloft 1x a day. Trileptal has to be taken 2x a day due to short half life. I was also told anything under 600 mg is not a theraputic dose. I get a dizzy high feeling when I take my dose in the morning on an empty stomach with coffe, but am ok with that. Lamictal keeps may anger and anxiety in check; keeps mixed episodes and rapid cycling at bay. Those of you who have yet to find the right meds, don’t lose hope, just keep working with your doctor, but also educate yourself. I had one psychiatrist prescribe a medicine to be taken 1x a day, only to find out that if I did not take it 2x a day, it would not do any good. Doctors make mistakes too. You have to study up and research; you know you and your illness better than anyone.

I have depression (which I have had for many years) about 5 years ago I was also diagnosed with Bipolar 2 disease. I take Lithium and Trileptal. No more alcohol, gain some weight (beer belly now) some memory loss and a few other minor issues. I still have some problems: mini-mania and some minor depression. Other than that I seem to be better. I need to work out though. I have done quite a bit of investigation on depression and bipolar.

Hi all! I have been on at least 10 different medications in 10 years, and the best and by far most tolerable (though not ideal) has been Trileptal. This has kept me together! For two years now I have been very close to having only minor mood swings with this medication, and I take the maximum allowable dosage. No problems besides dizziness, focus and concentration issues, which in balance, are not too hard to deal with, considering the alternatives!

Surprised no one has mentioned tremors. I’m manic depressive. Began taking this in 2003 as alternative to Depakote, which made me dopey and 15 pounds heavier. While 900 mg/day worked well, in 2005 went to Lamictal (400 mg), and Lamictal has been incredible: softened highs and lows, esp effective preventing depression. However, added back Trileptal in 2006 (300 mg) during esp. stressful time. The combination of lam’tal and tri’tal worked, but w/in a year Trileptal (seasonal from 600-900 mg) has caused tremors that are embarassing, and I’m now hoping to get off the drug and go with just Lamictal.

I was just diagnosed with Bipolar and ADHD. I am on Trileptal and feel great other than if I even dare to lay down I am OUT!!!!! No problem sleeping now that for sure. My question is though any one experiance weight gain on this medicine????

I would encourage y’all to start looking for alternatives to the drugs. I was depressed for 14 yrs and briefly tried drugs, then went a nutritional route, followed by Vipassana meditation (www.dhamma.org). Cured now 25 yrs. There are a lot of “orthomolecular” approaches now. Just read about Omega-3 oil; a good source being fish oil.

Particularly once you have stabilized on the drugs its a good time to look for alternatives before the deleterious effects on your health build up.
all the best.

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Candida Fink, M.D. and Joe Kraynak are authors of Bipolar Disorder for Dummies. Pick up the book today!
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