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Aptiom vs Trileptal
Introduction
For patients with epilepsy or other types of seizure disorders, certain drugs that help to control electrical activity in the brain can be essential in managing symptoms. Aptiom and Trileptal are two such medications often prescribed for these conditions. Both work by stabilizing neuronal membranes and reducing repetitive neuronal firing, but they do so through different mechanisms of action.
Aptiom is known as an antiepileptic drug (AED) containing eslicarbazepine acetate which works primarily by blocking voltage-gated sodium channels, thus inhibiting repetitive neuronal firing and decreasing propagation of seizures within the brain.
Trileptal, on the other hand contains oxcarbazepine, which also serves to inhibit voltage-sensitive sodium channels leading to stabilization of hyper-excited neural membranes. It also impacts potassium conductance and high-voltage activated calcium channels; however it has been observed that some people switching from Trileptal to Aptiom have experienced improvements in side effect profiles.
Aptiom vs Trileptal Side By Side
| Attribute | Aptiom | Trileptal |
|---|---|---|
| Brand Name | Aptiom | Trileptal |
| Contraindications | Should not be taken with MAO inhibitors (MAOIs), hormonal contraceptives, and certain other seizure medications due to potential harmful interactions. | Should not be taken with certain other medicines due to potential harmful interactions, particularly affecting hormonal contraceptives' effectiveness. |
| Cost | For brand-name, around $1,600 for 60 tablets of 200 mg. Generic versions cost significantly less, from $0.90 to about $3 per day. | For brand-name, approximately $900 for 60 tablets of 300 mg. Generic versions are much cheaper, starting from just under a dollar per day. |
| Generic Name | Eslicarbazepine acetate | Oxcarbazepine |
| Most Serious Side Effect | Severe skin reactions, low sodium levels, severe nervous system reaction, heart-related issues, changes in vision, thoughts about suicide or self-harm. | Signs of an allergic reaction, thoughts about suicide or self-harm, worsening of seizures, confusion and unusual changes in mood or behavior, rapid heart rate or irregular heartbeat, low sodium level symptoms. |
| Severe Drug Interactions | MAO inhibitors, hormonal contraceptives. | Hormonal contraceptives, possibly others not specified. |
| Typical Dose | Adults start from 400 mg/day up to a maximum of 1200 mg/day. Pediatric patients aged 4-17 years start at 200 mg/day, increasing weekly by about 10-20mg/kg up to a max of 1000mg or based on weight. | Adults start with 300 mg/day, increasing to 600 mg/day, up to a maximum of 2400 mg/day. For children aged 4-16 years, starts at about 10mg/kg daily, split into two doses. |
What is Aptiom?
Eslicarbazepine (the generic name for Aptiom) is a widely used antiepileptic drug from the class of dibenzazepines which marked significant advancements over the first generation of antiepileptics like carbamazepine. Eslicarbazepine was first approved by the FDA in 2013 and it works by stabilizing electrical activity in the brain, thereby preventing seizures. It is prescribed mainly for individuals with partial-onset seizures. On the other hand, Oxcarbazepine (Trileptal) belongs to a similar family of drugs but it has been available since its FDA approval in 2000. Both these medications work similarly but Aptiom's more refined structure leads to better tolerability and fewer side effects such as hyponatremia and dizziness than Trileptal, making it an improved choice for some patients.
What conditions is Aptiom approved to treat?
Aptiom is approved for the treatment of certain types of seizures:
- Partial-onset seizures in adults (alone or as an adjunct)
- Partial-onset, myoclonic, and primary generalized tonic-clonic seizures associated with Lennox-Gastaut Syndrome in patients aged 4 years and older
Trileptal on the other hand is intended to treat:
- Monotherapy or adjunctive therapy for partial onset seizures in adults
- Adjunctive therapy for partial onset seizures in pediatric patients aged 2–16 years
- Monotherapy for partial onset, mixed seizure patterns that include partial onset type seizure or generalized tonic-clonic seizures.
How does Aptiom help with these illnesses?
Aptiom, also known as eslicarbazepine, aids in controlling seizures by stabilizing electrical activity in the brain. It does this by inhibiting voltage-gated sodium channels on neurons, which interrupts the abnormal firing patterns that lead to seizures. Sodium channels play a crucial role in creating action potentials which are used for communication between neurons and other cells. By blocking these channels, Aptiom reduces the number of signals that can be sent at any given time; thus decreasing hyperactivity and preventing or reducing the frequency of seizures. This mechanism is thought to help individuals with epilepsy manage their condition more effectively while minimizing potential side effects compared to some other antiepileptic drugs.
What is Trileptal?
Trileptal is a brand name for oxcarbazepine, which is an anticonvulsant medication used primarily in the treatment of epilepsy. It works by decreasing nerve impulses that cause seizures and pain. Oxcarbazepine was first approved by the FDA in 2000.
As Trileptal is not a benzodiazepine, it does not work by increasing the effects of GABA in your brain, like some other anti-convulsants do. This means that its side-effect profile differs from those drugs, particularly as it tends to be less sedating and has lower risks of dependence or withdrawal symptoms (common issues with benzodiazepines).
The action mechanism of Trileptal can be favorable for managing certain types of seizures, especially among patients who do not respond well to "typical" seizure medications such as Aptiom.
What conditions is Trileptal approved to treat?
Trileptal is an anticonvulsant that has been approved by the FDA for use in treating:
- Partial seizures, which are characterized by brief periods of physical distortions such as twitching or shaking.
- Tonic-clonic seizures (also known as grand mal seizures), which can cause sudden loss of consciousness and extreme muscle contractions.
How does Trileptal help with these illnesses?
Trileptal, or oxcarbazepine, is a medication commonly used to treat seizures and epilepsy. It works by stabilizing electrical activity in the brain and preventing the rapid and excessive firing of neurons. This action on neuronal excitability helps to reduce the frequency and severity of seizures. Trileptal's influence on sodium channels in the brain cells may also play a role in its effectiveness as an anticonvulsant medication. While it serves a similar purpose as Aptiom (eslicarbazepine), Trileptal has been around longer with more extensive research behind its use. It can be prescribed when patients do not respond well to other antiepileptic drugs, such as Aptiom, or it may be combined with these medications for enhanced effect.
How effective are both Aptiom and Trileptal?
Both eslicarbazepine acetate (Aptiom) and oxcarbazepine (Trileptal) are anticonvulsants, with proven efficacy in the treatment of epilepsy. They were approved by the FDA several years apart, with Trileptal being available earlier than Aptiom. Since they act on different ion channels in neurons, they may be prescribed under differing circumstances. The effectiveness of Aptiom and Trileptal in controlling seizures was directly studied in multiple double-blind clinical trials; both drugs exhibited similar efficacy in managing symptoms of epilepsy as well as promising safety profiles.
A 2013 review indicated that Aptiom is effective at reducing seizure frequency starting from the first week of treatment and has a side effect profile comparable to many other antiepileptic drugs. Moreover, it is generally well-tolerated even among elderly populations due to its straightforward metabolic pathway which reduces potential drug interactions.
On the other hand, a 2008 review revealed that Trileptal seems to be more effective than placebo at controlling partial-onset seizures and appears to have similar efficacy compared to other common antiepileptic medications like carbamazepine or valproic acid. However, hyponatremia can occur with Trileptal use especially amongst those who take diuretics or have cardiac conditions thus careful monitoring should be done for these patients.
The choice between Aptiom and Trileptal often depends on individual factors such as patient's medical history, co-existing health conditions and response to previous treatments. Nonetheless, due to their unique pharmacological properties either could offer an optimal solution for patients not responding well to initial treatments or those requiring add-on therapy due potential drug-drug interactions.
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At what dose is Aptiom typically prescribed?
Oral dosages of Aptiom for adults typically start from 400 mg/day and can be increased to a maximum of 1200 mg/day based on individual response and tolerability. For pediatric patients aged between 4-17 years, the starting dosage should be around 200 mg/day. The dosage can then be increased every week by about 10-20mg/kg or until there is an observed response but not exceeding the maximum daily dose, which is capped at either 1000mg or based upon weight (whichever is lower). In contrast, Trileptal oral dosages for adults generally begin at approximately 600 mg per day divided into two doses (300mg x2), with increases up to a maximum of approximately 2400 mg daily depending upon patient’s needs and responses. For children aged between 2-16 years old, the initial recommended total daily dose of Trileptal ranges from about14–30mg/kg in two divided doses.
At what dose is Trileptal typically prescribed?
Trileptal therapy typically begins with a dosage of 300 mg/day for adults, which is then increased to 600 mg/day, divided into two doses spaced 12 hours apart. If necessary, the dosage can be further increased to a maximum of 2400 mg/day divided into two doses. This highest dose may be considered if there's no response to treatment at the lower dosages after several weeks. For children aged between 4 and 16 years old suffering from epilepsy, Trileptal administration starts at a lower dose of about ten milligrams per kilogram body weight daily (10mg/kg), which is also split in half and administered twice daily approximately every twelve hours.
What are the most common side effects for Aptiom?
Common side effects of Aptiom (Eslicarbazepine) may include:
- Dizziness
- Sleepiness/drowsiness
- Nausea and vomiting
- Double vision
- Headache, feeling unsteady or shaky (lack of coordination)
- Dry mouth
- Diarrhea
- Fatigue (general weakness and tiredness)
On the other hand, Trileptal (Oxcarbazepine) can cause:
- Fatigue and drowsiness
- Dizziness
- Nausea, vomiting, stomach pain
- Tremor or shaking
- Abnormal vision/blurred or double vision
- Rash; in rare cases a severe rash that requires medical attention immediately.
It's important to note that not everyone who takes these medications will experience all of these side effects. If you're concerned about potential side effects, talk with your doctor or pharmacist.
Are there any potential serious side effects for Aptiom?
While taking Aptiom, you should be aware of some potentially serious side effects and seek medical attention if you experience:
- Thoughts about suicide or self-harm
- Signs of an allergic reaction which may include hives, difficulty breathing, swelling in your face or throat
- Severe skin reactions such as fever, sore throat, burning eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
- Changes in vision including blurred vision and seeing halos around lights
- Heart-related issues such as fast or pounding heartbeats, fluttering in your chest accompanied by shortness of breath
- Low sodium levels - symptoms can include headache, confusion, slurred speech severe weakness vomiting loss of coordination feeling unsteady. Severe nervous system reaction with symptoms like very stiff muscles high fever sweating confusion fast uneven heartbeats tremors feeling like you might pass out.
If any unusual changes occur while taking this medication please consult with your doctor immediately.
What are the most common side effects for Trileptal?
Trileptal, a common choice for seizure treatment, comes with its own set of potential side effects. These may include:
- Nausea, vomiting, abdominal pain
- Dizziness or lightheadedness
- Headache
- Blurry vision or double vision
- Troubles with coordination and balance
- Sleep disturbances such as insomnia
- Rash or other skin reactions
- Fatigue and weakness
Please note that while these are possible side effects, not all patients will experience them. It's always important to weigh the benefits of seizure control against these potential risks when considering Trileptal.
Are there any potential serious side effects for Trileptal?
While many patients successfully use Trileptal to manage seizures without experiencing severe side effects, there are important signs of potential complications to be aware of. These can include:
- Signs of an allergic reaction such as hives, itching or skin rash; difficulty breathing; swelling in your face, lips, tongue or throat
- Thoughts about suicide or self-harm
- A worsening frequency and severity of seizures (convulsions)
- Confusion and unusual changes in mood or behavior
- Blurred vision, rapid eye movement that you cannot control
- Rapid heart rate or irregular heartbeat
- Low sodium level symptoms - headache, confusion, slurred speech which may lead to a coma.
If any of these symptoms occur while taking Trileptal it is crucial to seek immediate medical attention.
Contraindications for Aptiom and Trileptal?
Both Aptiom and Trileptal, like many other antiepileptic drugs, may increase symptoms of depression or suicidal thoughts in some people. If you notice your depression worsening, or an increase in suicidal ideation, thoughts, or behavior while taking these medications, please seek immediate medical help.
Neither Aptiom nor Trileptal should be taken if you are consuming certain other medicines such as MAO inhibitors (MAOIs), hormonal contraceptives and certain other seizure medications due to potential harmful interactions. Always inform your healthcare provider about all the medications you are taking; MAOIs will require a period of about 2 weeks to clear from the system before starting Aptiom. Similarly for women on hormonal contraception considering Trileptal therapy , alternative non-hormonal birth control methods might be necessary to prevent unwanted pregnancies as Trileptal can decrease effectiveness of hormonal contraceptives.
How much do Aptiom and Trileptal cost?
For the brand-name versions of these drugs:
- The price of 60 tablets of Aptiom (200 mg) averages around $1,600, which works out to about $26–$52/day, depending on your dose.
- The price for 60 tablets of Trileptal (300 mg) is approximately $900, working out to roughly $15/day.
Thus, if you are in the higher dosage range for Aptiom (i.e., 800 mg/day or higher), then brand-name Trileptal is less expensive on a per-day treatment basis. Please remember that cost should not be the primary consideration when determining which drug best meets your needs.
As for their generic counterparts:
- Eslicarbazepine acetate (generic version of Aptiom), costs are significantly lower: it's available in packs of 30 tablets and above with approximate costs from $0.90 to about $3 per day for dosages ranging from 200mg/day up to typical doses between 400mg and maxing at around 1200mg/day.
- Oxcarbazepine is available in packs starting from as low as just under a dollar per day ($0.05/tablet with average doses being between two and four tablets per day). Prices may vary depending upon where you purchase your medication but generally will not exceed more than a few dollars per day even at maximum daily dosages.
Popularity of Aptiom and Trileptal
Eslicarbazepine acetate, also known by the brand name Aptiom, was prescribed to roughly 300,000 people in the United States in 2020. This drug is used as a once-daily treatment for partial-onset seizures and can be administered without regard to meals. Since its approval by the FDA in 2013, prescriptions for eslicarbazepine have been slowly but steadily increasing as it gains acceptance among medical professionals.
Oxcarbazepine, sold under brands like Trileptal among others, has been around much longer than eslicarbazepine and was prescribed to approximately 2 million Americans in 2020. Oxcarbazepine accounts for nearly one-third of all atypical (not classified as first-line) antiepileptic drugs prescribed within the US. The use of oxcarbazepine has remained relatively steady over the last decade.
Conclusion
Both Aptiom (eslicarbazepine) and Trileptal (oxcarbazepine) have proven efficacy in managing seizures in patients with epilepsy. They are both antiepileptic drugs that work by stabilizing electrical activity in the brain to prevent seizure attacks. At times, these medications may be used together, but this would be under careful doctor supervision as they can interact with each other.
Their mechanisms of action show some differences; while both impact sodium channels which influence neuronal excitability, eslicarbazepine appears to bind more selectively and stably to these channels than oxcarbazepine does. This could lead doctors to choose one over the other based on individual patient needs or responses.
Aptiom is usually considered a second-line treatment option for focal or partial seizures when initial treatments are not effective enough, whereas Trileptal can be used as first-line therapy for partial seizures and also for certain types of generalized seizures.
Both drugs come in generic forms offering significant cost savings especially for those paying out-of-pocket. Patients starting either medication should anticipate an adjustment period where beneficial effects might not yet be evident.
The side effect profiles between Aptiom and Trileptal are similar; common side effects include dizziness, fatigue and nausea among others. With both drugs, it's crucial that patients monitor their symptoms closely when initiating treatment or adjusting dosages - any worsening of mood or increased frequency/severity of seizures should prompt immediate medical attention.
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Refrences
- Shirley, M., & Dhillon, S. (2016, April). Eslicarbazepine Acetate Monotherapy: A Review in Partial-Onset Seizures. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-016-0570-7
- Rocamora, R. (2015, June 8). A review of the efficacy and safety of eslicarbazepine acetate in the management of partial-onset seizures. Therapeutic Advances in Neurological Disorders. SAGE Publications.http://doi.org/10.1177/1756285615589711
- Flesch, G. (2004). Overview of the Clinical Pharmacokinetics of Oxcarbazepine. Clinical Drug Investigation. Springer Science and Business Media LLC.http://doi.org/10.2165/00044011-200424040-00001
- Bang, L. M., & Goa, K. L. (2004). Spotlight on Oxcarbazepine in Epilepsy1. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00023210-200418010-00006