Oxcarbazepine (OXC) has a chemical structure similar to that of carbamazepine (CBZ), an anticonvulsant and the first-generation mood stabiliser. The efficacy of CBZ in the treatment and prophylaxis of bipolar disorder (BPD) has been validated in the last four decades. OXC’s metabolism is different from that of CBZ. Carbamazepine is oxidised mainly by the enzyme CYP3A4 of cytochrome P-450, resulting in 10, 11-epoxide of CBZ. On the other hand, OXC is metabolised in the liver by the enzyme CYP2C19 of cytochrome P-450 into pharmacologically active 10-mono-hydroxy-carbazepine (MHD). OXC causes less pharmacokinetic interactions and probably has less adverse effects than CBZ. However, the therapeutic efficacy of OXC in BPD has not been such well confirmed as that of CBZ.
In this work, the pharmacokinetic properties of OXC as compared with CBZ are presented. A review of the studies on the efficacy of OXC in BPD was performed, also considering comparative studies with CBZ efficacy. They show that OXC can be used in the treatment of manic episodes and in the prevention of recurrences in BPD. The analysis of adverse effects of OXC, also in comparison with CBZ, was performed based on data of its application in BD, in epilepsy and trigeminal neuralgia. In summary, it is concluded that given pharmacokinetic and clinical profile and the evidence for its efficacy, OXC can make an important alternative to CBZ in the treatment and prophylaxis of BPD in adults. A possibility of its use in BPD in children and teenagers requires further studies.