Practical guidance and considerations for transitioning patients from oxcarbazepine or carbamazepine to eslicarbazepine acetate - Expert opinion

Jukka Peltola, Martin Holtkamp, Rodrigo Rocamora, Philippe Ryvlin, Kasia Sieradzan, Vicente Villanueva

    Research output: Contribution to journalArticleResearchpeer-review

    21 Citations (Scopus)

    Abstract

    © 2015 Elsevier Inc. There is currently a lack of guidance on methodology and special considerations for transitioning patients from oxcarbazepine (OXC) or carbamazepine (CBZ) to eslicarbazepine acetate (ESL), if deemed clinically necessary. An advisory panel of epilepsy experts was convened to share their experience on the use of adjunctive ESL in clinical practice and to provide practical recommendations to help address this gap. When changing over from OXC to ESL, an OXC:ESL dose ratio of 1:1 should be employed to calculate the ESL target dose, and the changeover can take place overnight. No changes to comedication are required. Since CBZ has a different mechanism of action to ESL and is a stronger inducer of cytochrome P450 (CYP) enzymes, the transitioning of patients from CBZ to ESL requires careful consideration on a patient-by-patient basis. In general, a CBZ:ESL dose ratio of 1:1.3 should be employed to calculate the ESL target dose, and patients should be transitioned over a minimum period of 1-2. weeks. Special considerations include adjustment of titration schedule and target dose in elderly patients and those with hepatic or renal impairment and potential adjustment of comedications metabolized by CYP enzymes. In summary, due to structural distinctions between ESL, OXC, and CBZ, which affect mechanism of action and tolerability, there are clinical situations in which it may be appropriate to consider transitioning patients from OXC or CBZ to ESL. Changing patients over from OXC to ESL is generally more straightforward than transitioning patients from CBZ to ESL, which requires careful consideration.
    Original languageEnglish
    Pages (from-to)46-49
    JournalEpilepsy and Behavior
    Volume50
    DOIs
    Publication statusPublished - 1 Sep 2015

    Keywords

    • Carbamazepine
    • Eslicarbazepine acetate
    • Mechanism of action
    • Oxcarbazepine
    • Tolerability
    • Treatment transition

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