Acute antimanic efficacy and safety of oxcarbazepine in an open trial with an on-off-on design.
OBJECTIVE
Carbamazepine has shown reasonable antimanic properties, but its use has been limited because of enzyme-inducing effects. The keto-derivative oxcarbazepine (OXC) is very similar to carbamazepine, however, the metabolic pathway is different. OXC is not metabolized to the 10, 11-epoxide, which seems to be responsible for several undesirable side-effects of carbamazepine and furthermore OXC has less enzyme-inducing properties.


METHODS
In this non-random open label study, patients were treated with OXC for 14 days, crossed over to no OXC for 7 days, and then crossed back over to OXC for the remaining 14 days. OXC was titrated to a final dose in a range of 900-2100 mg due to individual response. Treatment success was defined as a reduction of the original Young Mania Rating Scale (YMRS) score of more than 50% at the end of study period.


RESULTS
Four of the 12 included patients (33%) met defined response criteria at the end of study period. Fifty percentage of the patients had to be prematurely excluded from the trial. The mean YMRS scores of the on-periods were obviously different from the off-period. Forty-two percentage of the patients experienced side-effects leading to premature discontinuation in two of 12 patients.


CONCLUSIONS
Antimanic activity of OXC was demonstrated in this pilot study only for patients with mild or moderate manic symptoms. Further studies are encouraged to clarify OXC's role as mood-stabilizer and assess whether it has a profile similar to that of carbamazepine.
Hummel
Barbara
B
Stanley Foundation Bipolar Network Centers, Department of Psychiatry, LMU Munich, Germany. robert.stampfer@psy.med.uni-muenchen.de
Walden
Joerg
J
Stampfer
Robert
R
Dittmann
Sandra
S
Amann
Benedikt
B
Sterr
Andrea
A
Schaefer
Martin
M
Frye
Mark A
MA
Grunze
Heinz
H
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000078330:Oxcarbazepine; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
D000927:Anticonvulsants; D002220:Carbamazepine; D000078330:Oxcarbazepine