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Bipolar Medication Spotlight: Trileptal (Oxcarbazepine)

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.

Bipolar Medication Spotlight: Trileptal (Oxcarbazepine)

Candida Fink, MD

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APA Reference
Fink, C. (2008). Bipolar Medication Spotlight: Trileptal (Oxcarbazepine). Psych Central. Retrieved on November 29, 2020, from


Last updated: 12 Sep 2008
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