Drug reference

Licarbazepine

Antiseizure agent (active monohydroxy metabolite / dibenzazepine) · Epilepsy

START

Eslicarbazepine 400 mg PO once daily, titrate

TYPICAL MAX

1600 mg/day

STOP IF

Severe rash, symptomatic hyponatraemia, or hypersensitivity

WATCH

Serum sodium, skin, ECG (PR); HLA-B*1502 in at-risk ancestry

CDSCO approvedSchedule HATC N03AF

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1h · absorption
PEAK: 2.5h · Tmax
t½: 16h · t½
DURATION: 1d · once-daily

EXCRETION

Renal — glucuronide and unchanged

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

Use only if clearly needed; antiseizure-drug fetal risk — specialist management.

FDA category + note

Mechanism

The active monohydroxy derivative (licarbazepine; eslicarbazepine is its S-enantiomer) blocks voltage-gated sodium channels, stabilising hyperexcited neuronal membranes and limiting repetitive firing — the principal active species of oxcarbazepine.

Indications

Focal (partial-onset) seizures (as active metabolite of oxcarbazepine / eslicarbazepine acetate)

Dosing

Adult: As eslicarbazepine acetate: 400 mg PO once daily, titrate to 800–1600 mg once daily. (As oxcarbazepine metabolite — dosing governed by parent drug.)
Pediatric: Eslicarbazepine ≥4 y: weight-based titration (specialist).
Renal adjustment: CrCl <30: reduce dose / extend titration (renally cleared metabolite).
Hepatic adjustment: Severe hepatic impairment: not recommended (limited data).
Geriatric: Lower doses; hyponatraemia risk.
Max dose: 1600 mg/day (as eslicarbazepine acetate)

Pharmacokinetics

Onset

Seizure control over days of titration

Peak effect

~2–3 h (eslicarbazepine acetate Tmax to active species)

Duration

~24 h (once-daily)

Half-life

~13–20 h

Bioavailability

>90% (as eslicarbazepine acetate)

Protein binding

~30%

Metabolism

Minimal further metabolism; glucuronidation

Excretion

Renal (mainly as glucuronide and unchanged)

Contraindications

Hypersensitivity to oxcarbazepine/eslicarbazepine/carbamazepine
Second/third-degree AV block (eslicarbazepine)
Caution: hyponatraemia, HLA-B*1502 (SCAR risk)

Side effects

Common

DizzinessSomnolenceHeadacheDiplopiaNauseaHyponatraemia

Serious

Severe hyponatraemia
Serious skin reactions (SJS/TEN, DRESS)
Hypersensitivity multi-organ reaction
PR-interval prolongation

Pregnancy & lactation

Pregnancy

Use only if clearly needed; antiseizure-drug fetal risk — specialist management.

Lactation

Excreted in milk; monitor infant for sedation/poor feeding.

Drug interactions

Carbamazepine

Moderate

Database

Mutual metabolic effects

Monitor levels and tolerability