Treatments

Oxcarbazepine

In this section:

Key points | Benefits and Harms | Comment

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Key points

  • For GRADE evaluation of interventions for Trigeminal neuralgia, see table.
  • There is consensus that oxcarbazepine is an effective treatment in people with trigeminal neuralgia and may have fewer side effects than carbamazepine, although there is a lack of RCT-based data to confirm this.
  • Oxcarbazepine rarely provides complete or long-term pain relief, although studies evaluating durability of response with this drug are lacking.
  • It is the first-line medical treatment for trigeminal neuralgia in Scandinavian countries and it is regularly used as a second-line medical treatment after carbamazepine in the UK and North America.
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Benefits and harms

Oxcarbazepine versus carbamazepine:

We found one small RCT comparing oxcarbazepine with carbamazepine in people with classical trigeminal neuralgia.[33]

Pain relief

Oxcarbazepine compared with carbamazepine We don't know how oxcarbazepine and carbamazepine compare at relieving pain after 4 to 6 weeks of treatment in people with classical trigeminal neuralgia (very low-quality evidence).

Ref (type)PopulationOutcome, InterventionsResults and statistical analysisEffect size (for ORs and RRs)Favours
Pain

[33]

RCT

48 people with classical trigeminal neuralgia

Number of pain attacks per week, 4–6 weeks

with oxcarbazepine

with carbamazepine

Other comment

Oxcarbazepine and carbamazepine both reduced the number of pain attacks per week by at least 50% from baseline after 4–6 weeks' treatment

Results were not directly compared between groups

Significance not reported

Psychological distress

No data from the following reference on this outcome.[33]

Ability to perform normal activities

No data from the following reference on this outcome.[33]

Adverse effects
Ref (type)PopulationOutcome, InterventionsResults and statistical analysisEffect size (for ORs and RRs)Favours
Adverse effects

[33]

RCT

48 people with classical trigeminal neuralgia

Adverse effects

with oxcarbazepine

with carbamazepine

Absolute results not reported

Other comment

The most common adverse effects with both oxcarbazepine and carbamazepine were fatigue and dizziness

No direct comparison of adverse effects between oxcarbazepine and carbamazepine was performed

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Comment

As Clinical Evidence was unable to perform a second appraisal of results retrieved by the contributor's search, we may have missed studies that could affect our overall assessment of this intervention.

Clinical guide:

On the basis of observational studies, including a 15-year prospective cohort study,[20] most clinicians regard oxcarbazepine as effective. Furthermore, there is consensus among clinicians that oxcarbazepine is associated with fewer adverse effects than carbamazepine. Although studies assessing the durability of response with oxcarbazepine are lacking, this drug rarely provides complete or long-term pain relief. It is the first-line medical treatment for trigeminal neuralgia in Scandinavian countries and second-line medical treatment after carbamazepine in the UK and North America. One non-systematic review (3 RCTs, 130 people)[34] found that oxcarbazepine and carbamazepine were associated with similar reductions in attacks (pain, global symptoms) of trigeminal neuralgia. Although oxcarbazepine has not demonstrated superiority over carbamazepine for pain control, and is more expensive in countries where it is still under patent, many clinicians favour it for its lower toxicity profile.