Oxcarbazepine in the Treatment of Bipolar Disorder: A Review

By Pratoomsri, Wetid; Yatham, Lakshmi N. et al. | Canadian Journal of Psychiatry, July 2006 | Go to article overview

Oxcarbazepine in the Treatment of Bipolar Disorder: A Review


Pratoomsri, Wetid, Yatham, Lakshmi N., Bond, David J., Lam, Raymond W., Sohn, Chang-ho, Canadian Journal of Psychiatry


Objective: To review the data on the efficacy of oxcarbazepine (OXC) in bipolar disorder (BD) and to provide recommendations for clinicians on the use of this medication in treating BD.

Method: Using the terms oxcarbazepine and bipolar disorder, oxcarbazepine and mania, or oxcarbazepine and bipolar depression, we conducted a computer-aided search of MEDLINE for the years 1950 to 2005.

Results: Case reports, retrospective chart reviews, open prospective studies, and double-blind studies reported the efficacy and effectiveness of OXC in treating BD. The data indicate that OXC has efficacy in treating acute mania and may be a useful add-on in treating acute bipolar depression and in BD prophylaxis. OXC is generally well-tolerated.

Conclusion: We recommend using OXC as monotherapy or as add-on therapy in refractory mania, but we recommend it be used predominantly as an add-on treatment for other phases of BD in patients who have not improved with well-established treatments or in patients who have difficulty tolerating adequate dosages.

(Can J Psychiatry 2006;51:540-545)

Information on funding and support and author affiliations appears at the end of the article.

Clinical Implications

* OXC is effective in treating acute mania.

* OXC can be used as an adjunctive treatment for refractory BD.

* Compared with carbamazepine, OXC has fewer drug interactions and is better tolerated.

Limitations

* The efficacy of OXC in bipolar depression has not been widely studied.

* It is unknown whether OXC has efficacy in the maintenance treatment of BD.

* Although it is recommended for use in refractory BD. the data suggesting this strategy are not supported by Level I evidence.

Key Words: oxcarbazepine, bipolar disorder, mania, depression, drug interactions

Abbreviations used in this article

BD bipolar disorder

BRMRS Bech and Rafelson Mania Rating Scale

CARS-M Clinician Administered Rating Scale for Mania

CBZ carbamazepine

CYP cytochrome P450

DHD dihydroxy metabolite

IMPS Inpatient Multidimensional Psychiatric Scale

MHD monohydroxy metabolite

OXC oxcarbazepine

SD standard deviation

VPA valproate

YMRS Young Mania Rating Scale

Although lithium is considered the gold standard of treatment for BD, research and clinical experience over the past 4 decades have indicated that only a small proportion of patients with BD remain episode- or symptom-free using lithium monotherapy in long-term maintenance treatment (1,2). Thus, to improve outcomes for a substantial number of patients with BD, anticonvulsants and atypical antipsychotics are often used as alternatives or augmentation strategies to lithium. Among anticonvulsants, VPA and CBZ have proven efficacy in treating acute mania (3), and they are likely effective in maintenance treatment, although well-designed double-blind, placebo-controlled trials supporting their prophylactic efficacy are lacking. Although VPA is generally well tolerated, CBZ has significant side effects. Further, it induces CYP enzymes leading to numerous drug interactions with concomitant medications.

OXC is an anticonvulsant developed through structural variation of CBZ with the intention of avoiding metabolites that cause side effects. OXC is metabolized primarily through its reduction to an MHD form that undergoes glucorinidation. OXC is better tolerated than CBZ because it has fewer side effects. Owing to its better tolerability profile, OXC is used increasingly to treat BD.

This paper systematically reviews the pharmacology of OXC and the data on its efficacy in treating BD and provides recommendations for clinicians on the use of this medication in treating BD.

Method

Using the terms oxcarbazepine and bipolar disorder, oxcarbazepine and mania, or oxcarbazepine and bipolar depression, we conducted a computer-aided MEDLlNE search for the years 1950 to 2005 . …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Oxcarbazepine in the Treatment of Bipolar Disorder: A Review
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.