Current role of carbamazepine and oxcarbazepine in the management of epilepsy

• Published in: Seizure (London, England) Vol. 83; pp. 251 - 263
• Main Authors: Beydoun, Ahmad, DuPont, Sophie, Zhou, Dong, Matta, Maha, Nagire, Venkatramana, Lagae, Lieven
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2020
• Subjects: Anticonvulsants - therapeutic use; Carbamazepine; Carbamazepine - therapeutic use; Epilepsy - drug therapy; Epilepsy guidelines; Epilepsy, Generalized - drug therapy; Focal onset seizures; Humans; Oxcarbazepine; Oxcarbazepine - therapeutic use; Real-world effectiveness; Therapeutic strategy; Topiramate - therapeutic use; AED; CBZ-CR; RWE; RCT; Real-world effectiveness; Focal onset seizures; Carbamazepine; QOL; Oxcarbazepine; Epilepsy guidelines; CBZ; CBZ-IR; OXC; IPD; Therapeutic strategy
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2020.10.018

•The role of carbamazepine & oxcarbazepine relative to newer antiepileptic’s is reviewed.•Guidelines list both drugs as 1st/2nd-line options for focal or generalized seizures.•The effectiveness of both drugs has measured up to the newer antiepileptic drugs.•Carbamazepine and oxcarbazepine remain the mainstay of antiepileptic drug treatment.•Therapeutic drug monitoring and genetic testing to be encouraged for optimal outcome.
Epilepsy is one of the most common neurological disorders, affecting approximately 50 million people worldwide. Despite a dramatic increase in treatment options over the past 30 years, it still ranks fourth in the world’s disease burden. There are now close to 30 antiepileptic drugs (AEDs), with more than two thirds introduced to the market after carbamazepine (CBZ) and one third after its derivative, oxcarbazepine (OXC). Following the introduction of these newer AEDs, the role of CBZ and OXC in the therapeutic armamentarium for seizure control and effective epilepsy management needs to be reviewed. The main guidelines list both CBZ and OXC as first-line options or second-line alternatives for the treatment of focal-onset epilepsy and primary generalized tonic-clonic seizures. While evidence suggests that overall AEDs have similar efficacy, some newer AEDs may be better tolerated than CBZ. In line with this, there have been changes in treatment patterns, with many variations across different countries. However, CBZ remains among the two or three most prescribed drugs for focal epilepsy in many countries, and is widely used across Europe, Africa, South America, and Asia, where it represents a good compromise between cost, availability, and effectiveness. OXC is among the first-choice options for the initial treatment of focal-onset seizures in several countries, including the US and China, where the oral suspension is commonly prescribed. This review provides guidance on the optimal use of these two drugs in clinical practice, including in children, the elderly, and in pregnancy.