Names and pronunciation
(es′lye-kar-bay′ze-peen) Aptiom
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Drug reference
(es′lye-kar-bay′ze-peen) Aptiom
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Func. class.: Anticonvulsant
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Chem. class.: Carboxamide derivative
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ACTION: Exact mechanism unknown; a voltage-gated sodium-channel blocker inhibits repetitive neuronal firing
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USES: Partial seizures, adjunctive treatment
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CONTRAINDICATIONS: Hyper- sensitivity to this product or OXcarbazepine Precautions: Breastfeeding, abrupt discontinuation, depression, driving/ operating machinery, ethanol intoxica- tion, hepatic disease, renal disease, hyponatremia, suicidal ideation, pregnancy
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SIDE EFFECTS CNS: Drowsiness, dizziness, amnesia, depression, insomnia, lethargy, memory impairment, confusion, fatigue, headache, speech disturbance, suicidal thoughts/ behaviors, tremors CV: Hypertension, peripheral edema EENT: Blurred vision, nystagmus, diplopia GI: Nausea, constipation, diarrhea, hypercholesterolemia/hypertriglyceride- mia, vomiting, hepatotoxicity GU: Cystitis INTEG: Rash, Stevens-Johnson syn- drome, toxic epidermal necrolysis, ana- phylaxis, angioedema META: Hyponatremia RESP: Cough
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INTERACTIONS Decrease: effects of bedaquiline, boceprevir, bosutinib, cabozantinib, cobicistat, elvitegra- vir, emtricitabine, crizotinib, cycloSPORINE, dronedarone, erlotinib, fosamprenavir, galantamine, gefitinib, HYDROcodone, maraviroc, oxyCODONE, paliperidone, per- ampanel, pimozide, praziquantel, QUEtia pine, ranolazine, rilpivirine Decrease: eslicarbazepine effect— CYP1A2, CYP2C19 substrates Decrease: effect of CYP3A inducers NURSING CONSIDERATIONS
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Black Box Warning: Mental status: mood, sensorium, affect, behavioral changes, suicidal thoughts/behaviors; if mental status changes, notify prescriber • Eye problems: need for ophthalmic examinations prior to, during, after treat- ment (slit lamp, fundoscopy, tonometry) • Allergic reaction: purpura, red, raised rash; if these occur, product should be discontinued • Beers: avoid in older adults unless safer alternative is unavailable; may cause ataxia, impaired psychomotor function • Pregnancy/breastfeeding: use in pregnancy only if benefits outweigh risks to fetus. Patient should enroll in North American Antiepileptic Drug (NAAED) Pregnancy Registry (888-233-2334; www.aedpregnancyregistry.org). Product is present in breast milk; consider bene- fits of breastfeeding, risk of potential infant drug exposure, and risk of an un- E treated or inadequately treated condition
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DOSAGE AND ROUTES • Adult: PO 400 mg daily; after 1 wk, in- crease to 800 mg daily, max 1600 mg daily Renal dose • Adult: PO CCr <50 mL/min 200 mg daily; after 2 wk, increase to 400 mg daily, max 800 mg daily
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Available forms: Tablets 200, 400, 600, 800 mg
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Administer: • May be taken without regard to food • May be crushed or whole • Store at room temperature
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Assess: • Hyponatremia: nausea, vomiting, in- creased seizures, headache, weakness, confusion, irritability • Seizures: character, location, duration, intensity, frequency, presence of aura • Hepatic studies: ALT, AST, bilirubin; sodium
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Evaluate: • Therapeutic response: decreased sei- zure activity; document on patient’s chart
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Patient and caregiver information: • To carry emergency ID stating pa- tient’s name, products taken, condition, prescriber’s name, and phone number • To avoid driving, other activities that require alertness, usually for the first 3 days of treatment • Not to discontinue medication quickly after long-term use • Pregnancy: to notify prescriber if preg- nancy is planned or suspected; to use ad- ditional contraceptives if using hormonal contraceptives; to avoid breastfeeding • Not to abruptly discontinue drug • To report signs of decreased renal function, dizziness, increased cholesterol, ocular toxicity, suicide risk, skin rashes • To take with or without food; that tablet can be crushed • To report increased seizures, head- ache, nausea, vomiting, weakness, confu- sion, irritability (hyponatremia) HIGH ALERT
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PHARMACOKINETICS Peak 1-4 hr; metabolized by liver; mod- erate CYP2C19 inhibitor; weak/moderate CYP3A4 inducer; steady-state 4-5 days; excreted in urine, feces; half-life 13-20 hr; protein binding <40%
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• Adult: PO 400 mg daily; after 1 wk, in- crease to 800 mg daily, max 1600 mg daily Renal dose
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• Adult: PO CCr <50 mL/min 200 mg daily; after 2 wk, increase to 400 mg daily, max 800 mg daily
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