TRILEPTAL 60MG ML SUSP 250ML

Oxcarbazepine is an antiepileptic medicine that blocks voltage-gated sodium channels in neuronal membranes, stabilising them in an inactive state and preventing repetitive firing that leads to seizures. It is the 10-keto analogue of carbamazepine with a broadly similar mechanism but improved tolerability and fewer drug interactions.

Trileptal suspension is used to treat:

•       Focal (partial) seizures — with or without secondary generalisation — as monotherapy or adjunctive therapy in adults and children aged 2 years and older.

The liquid suspension is particularly useful for children, patients who have difficulty swallowing tablets, and for precise dose titration.

Always use the graduated oral syringe provided to measure each dose accurately — do not use kitchen spoons. Shake the bottle well for at least 10 seconds before each use. The suspension may be mixed with a small glass of water or taken directly.

Typical adult dose (monotherapy): start 300 mg twice daily; increase by 300 mg/day at weekly intervals to 600–1200 mg/day in two divided doses. Maximum: 2400 mg/day. Children (2–17 years): 8–10 mg/kg/day in two divided doses (adjust per weight). Your neurologist will prescribe the exact dose and titration schedule.

Oxcarbazepine should not be used in: known hypersensitivity to oxcarbazepine or carbamazepine (cross-reactivity exists in approximately 25–30% of patients with carbamazepine hypersensitivity); and atrioventricular block (use with caution).

Use with caution in: renal impairment (CrCl < 30 mL/min — halve the starting dose); hepatic impairment; heart failure; the elderly; and pregnancy (category C — discuss benefit vs risk).

•       CYP3A4/5 substrates (hormonal contraceptives, ciclosporin, calcium channel blockers, some statins): oxcarbazepine induces CYP3A4/5 and reduces levels — use alternative contraception (barrier method or IUD).

•       Strong CYP inducers (rifampicin, phenobarbital, phenytoin, carbamazepine): reduce oxcarbazepine active metabolite levels.

•       Other sodium channel-blocking antiepileptics (lamotrigine, carbamazepine): additive CNS depression and sodium channel blockade.

•       Diuretics / desmopressin / NSAIDs: additive hyponatraemia risk.

•       Alcohol: additive CNS depression — avoid.

Store at room temperature (below 30°C). Do not refrigerate or freeze. Keep bottle tightly closed between doses. After opening, use within the period stated on the label (typically 7–10 weeks for the suspension). Keep out of reach of children.

Trileptal suspension needs to be shaken well before every dose — the particles settle at the bottom and an unshaken bottle will give an inaccurate dose. Use the oral syringe carefully, checking the graduation marks at eye level.

Hyponatraemia (low sodium) is a particular risk with oxcarbazepine. Symptoms can be subtle — if you notice unusual confusion, headache, or generally feeling unwell between your regular blood test appointments, contact your doctor or epilepsy nurse.

If you are using hormonal contraception (pill, patch, ring), oxcarbazepine reduces its effectiveness significantly. Use additional non-hormonal contraception (barrier method) to prevent unintended pregnancy.

Oxcarbazepine is a prodrug rapidly converted to its active metabolite, the monohydroxy derivative (MHD / licarbazepine). Pharmacokinetics are more predictable than carbamazepine (autoinduction not seen with oxcarbazepine). Sodium monitoring: baseline, 2–4 weeks, then 3–6 monthly — more frequently in at-risk patients. The active metabolite is primarily renally excreted — halve starting dose in CrCl <30 mL/min. The 60 mg/mL suspension with the graduated oral syringe is the ideal formulation for paediatric dosing; confirm the volume in mL at dispensing (e.g. for a 20 mg/kg/day child weighing 20 kg = 400 mg/day = 6.67 mL/day in 2 divided doses of 3.33 mL each). Cross-hypersensitivity with carbamazepine: approximately 25–30% — use a different drug class if carbamazepine caused a severe rash.

Is this medicine safe in children?

Yes — Trileptal is licensed from age 2 years. The suspension is particularly suitable for children as doses can be measured precisely by weight. It is well-tolerated in children at appropriate doses.

My carbamazepine gave me a rash — can I take oxcarbazepine?

There is approximately a 25–30% chance of cross-reactivity in people who had a rash from carbamazepine. Discuss carefully with your neurologist — if carbamazepine caused a serious skin reaction (e.g. SJS), oxcarbazepine should usually be avoided.

Does this medicine affect my contraceptive pill?

Yes — oxcarbazepine significantly reduces the blood levels of hormonal contraceptives (pill, patch, implant), potentially making them ineffective. Use a reliable barrier method of contraception in addition to any hormonal contraception.

Can I drive while taking Trileptal?

Initial treatment may cause dizziness, drowsiness, and double vision — do not drive until stabilised on a dose that does not cause these effects. Additionally, driving regulations for people with epilepsy vary by country — check local DVLA/licensing authority rules.

What happens if I accidentally give a double dose to my child?

Contact your doctor or pharmacist immediately. Symptoms of overdose include drowsiness, dizziness, nausea, and, rarely, cardiac effects. Keep the poison control centre number accessible.