Trileptal: Epilepsy Drug Shows Some Promise in Bipolar Disorder

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Trileptal (generic name: oxcarbazepine) is an anticonvulsant medication used to treat epilepsy, but Trileptal is also prescribed off-label to treat bipolar disorder.

Trileptal holds U.S. Food and Drug Administration approval to treat partial seizures in adults and children. It is closely related to carbamazepine, which has a variety of brand names, including Tegretol. Carbamazepine is used as a mood stabilizer in bipolar disorder.

Although some psychiatrists prescribe Trileptal to treat bipolar disorder, research hasn't shown definitively that it's effective.

A review of the medical literature conducted in 2011 concluded that the drug didn't work well to treat bipolar disorder in children and adolescents, and worked about as well as other bipolar disorder medications in adults. The authors said better studies are needed to determine whether Trileptal is truly effective in bipolar disorder.

Trileptal Warnings and Side Effects

Trileptal can reduce the effectiveness of hormonal birth control medication. In addition, be careful with alcohol and sedating medications, since Trileptal may have a sedative effect. Don't drive or operate heavy machinery until you have gauged your response to this drug.

The most common side effects include:

  • dizziness
  • drowsiness
  • double vision (diplopia)
  • fatigue
  • nausea and vomiting
  • unsteadiness on your feet (ataxia)
  • abnormal vision
  • abdominal pain
  • tremor
  • acid reflux (dyspepsia)
  • abnormal gait

A fairly rare side effect was hyponatremia (low blood sodium). Symptoms of this condition include not passing much urine, headache, confusion, tiredness and, if very severe, seizures and coma, so contact your doctor if you suspect this may be beginning.

About 25% to 30% of patients with a known sensitivity to carbamazepine may experience hypersensitivity to Trileptal. These patients should immediately discontinue using Trileptal. Trileptal may interact with certain drugs such as felodipine (Plendil) and verapamil (Covera, Calan, Isoptil, Verelan). To guard against these types of interactions, always make sure your doctor knows all medications you are taking.

Weight gain with Trileptal isn't common — it's only experienced by about 1% to 2% of patients.

Trileptal and Suicide Risk

Oxcarbazepine treatment carries a risk of suicidal ideation, which is increased thoughts of suicide, and increased attempts at suicide.

About one in every 500 people — both children and adults — who was treated with Trileptal for various conditions, including epilepsy and mental disorders, during various clinical studies of the drug became suicidal during treatment. Some people developed suicidal thoughts and behaviors extremely quickly during treatment — within one week of beginning the medication.

It's important that both you and your family members recognize this risk of treatment with Trileptal before beginning treatment, and watch for any signs of it during your treatment. Contact your doctor immediately (and ask your family to call your doctor immediately) if you experience any of these symptoms:

  • panic attacks
  • agitation or restlessness
  • new or worsening irritability, anxiety, or depression
  • acting out dangerous impulses
  • insomnia
  • aggressive, angry or violent behavior
  • mania
  • thinking about or talking about harming yourself or killing yourself
  • withdrawing from friends and family
  • preoccupation with death and dying
  • giving away prized possessions
  • any other unusual changes in behavior or mood


Ghaemi, S.N., et al. Oxcarbazepine treatment of bipolar disorder. Journal of Clinical Psychiatry 64(8)August 2003 934-5.

Wagner, K.D., et al. A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. American Journal of Psychiatry 163(7)July 2006 1179-86.

U.S. National Library of Medicine. Oxcarbazepine fact sheet. Accessed March 5, 2016.

RxList. Trileptal Side Effects and Drug Interactions. 2006. Accessed Dec. 4, 2006.

Vasudev A et al. Oxcarbazepine for acute affective episodes in bipolar disorder. The Cochrane Database of Systematic Reviews. 2011 Dec 7;(12):CD004857.

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