Benzhydrocodone
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Drug reference
Oxcarbazepine
Antiepileptic / dibenzazepine carboxamide derivative · Antiepileptic
START
300 mg BD; check baseline sodium, LFTs, CBC; counsel on dizziness and hyponatremia risk
TYPICAL MAX
2400 mg/day; 3000 mg/day exceptional
STOP IF
Na+ <125 mmol/L, severe rash (SJS/TEN), anaphylaxis, hepatic failure, suicidality
WATCH
Sodium at baseline, 2 weeks, then monthly x 3 (hyponatremia), seizure frequency, LFTs, mood/suicide ideation, rash
CDSCO approvedSchedule HATC N03AF02
KDIGO 2024 + manufacturer label
- ONSET
- 1.3h · absorption onset
- PEAK
- 5h · MHD peak (active metabolite)
- t½
- 9h · MHD: 8-10 hours
- DURATION
- 12h · 12-hour coverage (BD dosing)
EXCRETION
Renal (95%, as MHD glucuronide)
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Compatible with pregnancy; folic acid supplementation recommended; monotherapy preferred; risk of neural tube defects with AEDs
FDA category + note
Top interactionssee all 12 →
- BenzhydrocodoneSevereDatabaseDDInter
- BictegravirSevereDatabaseDDInter
- BuprenorphineSevereDatabaseDDInter
- ButorphanolSevereDatabaseDDInter
Available in India
256 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Prodrug metabolized to 10-monohydroxy derivative (MHD), the active metabolite. MHD blocks voltage-gated sodium channels in their inactive state, stabilizing neuronal membranes and inhibiting repetitive neuronal firing. Unlike carbamazepine, oxcarbazepine has minimal effect on CYP enzymes and does not auto-induce metabolism.
Indications
Partial (focal) seizures with or without secondary generalization (monotherapy or adjunctive)Generalized tonic-clonic seizures (adjunctive)Trigeminal neuralgia (off-label, when carbamazepine fails or not tolerated)
Dosing
- Adult
- Monotherapy: start 300 mg BD (600 mg/day); increase by 300 mg/day every 3 days to 1200 mg/day. Usual: 600-1200 mg BD (1200-2400 mg/day). Max: 2400 mg/day (3000 mg/day in exceptional cases)
- Pediatric
- 4-16 years: start 8-10 mg/kg/day divided BD; titrate to 900-1800 mg/day. <4 years: limited data
- Renal adjustment
- eGFR <30: start 50% of usual dose and titrate slowly
- Hepatic adjustment
- No adjustment needed; active metabolite is not hepatically metabolized
- Geriatric
- Start 300 mg/day; titrate slowly; monitor sodium and cognitive effects
- Max dose
- 2400 mg/day (adults); 3000 mg/day (exceptional)
Pharmacokinetics
Onset
Days to weeks (antiepileptic effect)
Peak effect
Oxcarbazepine: 1.5 hours; MHD: 4-6 hours (Tmax)
Duration
8-12 hours (BD dosing)
Half-life
Oxcarbazepine: 2 hours; MHD: 8-10 hours
Bioavailability
~100%
Protein binding
Oxcarbazepine: 60%; MHD: 40%
Metabolism
Rapid hepatic reduction to active MHD (10-monohydroxy metabolite); MHD undergoes glucuronidation
Excretion
Renal (95%, primarily as MHD glucuronide); fecal (<1%)
Contraindications
- Hypersensitivity to oxcarbazepine or eslicarbazepine
- Hypersensitivity to carbamazepine (cross-reactivity ~25-30%)
- Atrioventricular block
- Hyponatremia (severe)
Side effects
Common
DizzinessDrowsinessHeadacheNauseaVomitingDiplopiaAtaxiaFatigueHyponatremiaRash
Serious
- Severe hyponatremia (SIADH; 20-40% of patients, usually mild)
- Stevens-Johnson syndrome / TEN
- Hepatotoxicity
- Blood dyscrasias (rare)
- Anaphylaxis / multi-organ hypersensitivity (DRESS)
- Suicidal ideation (class effect of AEDs)
- Thyroid dysfunction (reduced T4, increased TSH)
Pregnancy & lactation
Pregnancy
Compatible with pregnancy; folic acid supplementation recommended; monotherapy preferred; risk of neural tube defects with AEDs
Lactation
Excreted in breast milk (MHD); infant exposure ~5% of maternal dose; generally compatible with breastfeeding; monitor infant for sedation
Drug interactions
Bictegravir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Buprenorphine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Cabotegravir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Citalopram
Severe
Database
Drug interaction classified as: metabolism.
Source: DDInter
Desogestrel
Severe
Database
Clinical effect not specified
Source: DDInter
Dextropropoxyphene
Severe
Database
Clinical effect not specified
Source: DDInter
Dienogest
Severe
Database
Clinical effect not specified
Source: DDInter
Dolutegravir
Severe
Database
Clinical effect not specified
Source: DDInter
Doravirine
Severe
Database
Clinical effect not specified
Source: DDInter
Drospirenone
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Initial monotherapy for newly diagnosed epilepsy
ILAE · Neurology · 2013
Functional (psychogenic non-epileptic) seizures
AAN · Neurology · 2026
Stroke and TIA — secondary prevention
AHA · Neurology · 2021
Initial monotherapy for newly diagnosed epilepsy
IAN · Neurology · 2023
Status epilepticus
AAN · Neurology · 2020
Ask House about Oxcarbazepine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19