Oxcarbazepine as an Adjunct of Antipsychotic Therapy in Acute Schizophrenia
Status:
Completed
Trial end date:
2008-07-01
Target enrollment:
Participant gender:
Summary
Over recent years an approach with the adjunctive administration of various anticonvulsant
drugs has been discussed and a limited number of open and controlled studies were performed
for carbamazepine, valproic acid, and lamotrigine. While the latter shows promising effects
in the long run it has some handling difficulties in the acute treatment of acute psychotic
exacerbations. Valproic acid has shown inconsistent effects in schizophrenia with no
significant effects in a recent controlled study. Although still controversially discussed,
carbamazepine was found to offer beneficial effects in the treatment of schizophrenia.
Nonetheless, data on these effects are limited by small sample sizes or poor design of most
of the respective studies. Furthermore, the complex pharmacological interactions of new
atypical neuroleptics with carbamazepine underline the necessity of alternative strategies in
adjuvant treatment of schizophrenia as well as in combined treatment of bipolar disorders
with mood stabilizers and neuroleptics.
Oxcarbazepine (OXC) is a new anticonvulsant drug that acts as a pro-drug for the
10-monohydroxy metabolite (MHD), an active metabolite also of carbamazepine that is suggested
to be responsible for most of its therapeutic actions. Therefore, the pharmacological action
of OXC is very well comparable to carbamazepine whilst there are fewer unwanted side effects
of OXC regarding eg. skin rush, and effects on blood compounds or cardiotropic effects.
The effects of OXC on cytochrome CYP3A4 and CYP3A5 are moderate and UDPGT is only slightly
affected by OXC, which leads to less interaction with other compounds on a pharmacokinetical
level.
In psychiatry, the few studies published until now report positive effects of OXC in bipolar
disorders. With regards to our own clinical observations, OXC has shown potential beneficial
effects as an adjunct in the treatment of schizophrenia as well that require further
evaluation in a controlled study design.