Trileptal vs Neurontin

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Introduction

For patients with epilepsy or other neurological conditions, certain drugs that stabilize the electrical activity in the brain can help control seizures and manage symptoms. Trileptal and Neurontin are two such drugs often prescribed for these conditions. They each impact different aspects of neural transmission, but both have seizure-controlling effects in patients with epilepsy. Trileptal, also known as Oxcarbazepine, works by decreasing nerve impulses that cause seizures and pain. It is a voltage-sensitive sodium channel antagonist which stabilizes hyperexcited neurons while still allowing normal neuron firing. On the contrary, Neurontin (Gabapentin), impacts GABA synthesis and glutamate concentration in the brain to reduce abnormal excitability among neurons thereby reducing frequency of seizures.

What is Trileptal?

Oxcarbazepine (the generic name for Trileptal) is a member of the class anticonvulsants, also known as antiepileptic drugs. It was first approved by the FDA in 2000. Trileptal works by decreasing nerve impulses that cause seizures and pain, making it an effective choice for controlling certain types of seizures in epilepsy patients and relieving specific types of nerve pain (such as trigeminal neuralgia).

On the other hand, Gabapentin (the generic name for Neurontin) is also an anticonvulsant drug but has shown to be more effective for neuropathic pain conditions associated with herpes zoster or diabetic neuropathy. While both medications can potentially cause drowsiness and dizziness, Gabapentin may have fewer side effects than Oxcarbazepine due to its less complicated pharmacokinetics and metabolism.

It's crucial to remember that these two medicines have different mechanisms of action on neurotransmitters; hence they are used for different purposes based on their efficacy profile against various neurological conditions.

What conditions is Trileptal approved to treat?

Trileptal is approved for the treatment of the following conditions:

  • Partial seizures in adults and children over two years old
  • Generalized tonic-clonic seizures in adults and children over two years old
  • Mixed seizure types such as those seen in Lennox-Gastaut syndrome, a severe form of epilepsy

Neurontin, on the other hand, has been approved by FDA to treat:

  • Postherpetic neuralgia (PHN), which is nerve pain caused by shingles
  • Seizures as an adjunctive therapy in patients older than 3 years with partial onset seizures.

How does Trileptal help with these illnesses?

Trileptal helps to manage seizures by decreasing the electrical activity in the brain. It does this by blocking voltage-sensitive sodium channels, thus stabilizing overactive nerve cells and preventing them from firing excessively. Sodium channels play a key role in generating and transmitting signals in the nervous system, including those that lead to seizures when they are overly active. Therefore, by limiting these excessive signals, Trileptal can help control epileptic seizures and other conditions characterized by overactivity of neurons.

On the other hand, Neurontin works similarly but with a different mechanism. It binds to specific proteins called calcium channels on neurons' surfaces which also participate heavily in signal transmission within the nervous system. By altering their action, Neurontin reduces pain signals sent out from damaged or excited nerves thus bringing relief for patients managing neuropathic pain conditions as well as helping control certain types of seizure disorders.

What is Neurontin?

Neurontin, the brand name for gabapentin, is an anticonvulsant and nerve pain medication. It was first approved by the FDA in 1993. Gabapentin works by altering electrical activity in the brain and influencing the activity of chemicals that send signals between nerve cells. Neurontin does not work in exactly the same way as Trileptal; it doesn't inhibit voltage-gated sodium channels like Trileptal does. This difference means that its side-effect profile is also different to that of other types of seizure medications, with less risk of causing low sodium levels or severe skin reactions (common side effects associated with Trileptal). Furthermore, unlike many other antiepileptic drugs such as Trileptal, Neurontin can be beneficial for treating neuropathic pain conditions including postherpetic neuralgia and diabetic neuropathy.

What conditions is Neurontin approved to treat?

Neurontin, also known as gabapentin, is primarily approved for the following conditions:

  • Epilepsy: It's used to manage partial seizures in adults and children aged 3 years and older.
  • Postherpetic neuralgia: This refers to nerve pain that occurs after shingles, a painful rash that comes from reactivation of the chickenpox virus. Neurontin can help reduce this type of nerve pain.

How does Neurontin help with these illnesses?

Neurontin, also known as gabapentin, works by interacting with voltage-gated calcium channels in the nervous system. This action reduces the release of excitatory neurotransmitters, helping to reduce nerve pain and seizures. Neurontin's primary use is for neuropathic pain and epilepsy, similar to Trileptal. However, it has a different mechanism of action compared to Trileptal since it does not inhibit sodium channels like Trileptal does. It can be used alone or combined with other antiepileptic drugs depending on the patient’s condition and response to therapy. Just like Wellbutrin was an alternative option when patients did not respond well to typical SSRI antidepressants such as Prozac; Neurontin may be prescribed when a patient doesn't respond well or cannot tolerate traditional seizure medications.

How effective are both Trileptal and Neurontin?

Both oxcarbazepine (Trileptal) and gabapentin (Neurontin) are widely used in the treatment of seizures and neuropathic pain. They were approved by the FDA within a decade of each other, with Trileptal gaining approval in 2000 and Neurontin in 1993. These drugs have different mechanisms of action: while Trileptal stabilizes hyperexcited nerve fibers by blocking voltage-sensitive sodium channels, Neurontin works by binding to specific sites on voltage-gated calcium channels.

The efficacy of both these medications was evaluated in several clinical trials for various conditions. For instance, a 2012 meta-analysis indicated that Trileptal is effective as monotherapy for partial epilepsy, with favorable safety profiles similar to those seen with carbamazepine therapy but with fewer side effects.[1] Meanwhile, numerous studies attest to Neurontin's effectiveness against postherpetic neuralgia and diabetic peripheral neuropathy,[2] although its success at managing epilepsy is more variable.

A comprehensive review published in 2017 highlighted the beneficial role of Trileptal not only as an antiepileptic drug but also potentially useful for bipolar disorder patients who do not respond well or cannot tolerate lithium.[3] The optimal dose varies depending on age and weight but generally lies between 600-2400 mg daily divided into two doses.

On the other hand, Neurontin has been found to be less effective than expected when used as an adjunctive agent for controlling resistant focal seizures[4]. It may be considered when first-line treatments fail or cannot be tolerated due to adverse effects. However, it remains valuable due to its unique pharmacology which makes it suitable for certain patient groups such as those intolerant or allergic to other anti-seizure medication classes.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543706/ [2] https://www.ncbi.nlm.nih.gov/pubmed/10576486 [3] https://onlinelibrary.wiley.com/doi/full/10.1002/ddr.21414 [4] http://n.neurology.org/content/57/5/840.short

abstract image of a researcher studying a bottle of drug.

At what dose is Trileptal typically prescribed?

Oral dosages of Trileptal generally start at 600 mg/day, divided into a twice-daily regimen for adults and adolescents over the age of 12 years. This is considered effective in managing partial seizures. For children aged between 2-4 years, the dosage usually starts at around 8-30 mg/kg/day, while children between ages of 4-12 may begin with doses from about 30-46 mg/kg/day. The dosage can be increased gradually every week if there is no response or control of seizures. However, it's important to note that daily dose should not exceed a maximum of 2400 mg per day for adults and adolescents, and ranges from maxima of 900mg to1800mg per day depending upon weight for younger children.

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At what dose is Neurontin typically prescribed?

Neurontin therapy typically begins with a dosage of 300 mg per day, usually in the evening. Depending on the individual's response to treatment and tolerance, the dose can be increased up to 600 mg/day divided into two doses that are spaced about 12 hours apart. If necessary, for optimal control of symptoms, the maximum daily dose may be escalated to 2400-3600 mg/day divided into three doses spread out roughly every 8 hours. This increase is considered only if there is no substantial improvement after several weeks at an intermediate dose level. As always, any changes in medication or dosing should be made under medical supervision.

What are the most common side effects for Trileptal?

Common side effects of Trileptal (Oxcarbazepine) include:

  • Dizziness
  • Sleepiness/drowsiness or fatigue
  • Nausea and vomiting, potentially leading to loss of appetite
  • Unsteadiness (abnormal gait)
  • Double vision or other vision changes
  • Abdominal pain and diarrhea
  • Tremor (unintentional trembling or shaking)
  • Headache

On the other hand, Neurontin (Gabapentin) may cause these common side effects:

  • Fatigue and drowsiness
  • Ataxia or coordination problems
  • Viral infections in children
  • Fever
  • Nystagmus or involuntary eye movement
  • Peripheral edema or swelling in extremities
  • Hostility
  • Nausea, vomiting, and/or heartburn

As always if you experience any severe reactions to either medication it's paramount that you seek immediate medical assistance.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Trileptal?

In rare cases, Trileptal can cause serious side effects including:

  • Thoughts about suicide or self-harm
  • Signs of allergic reaction: hives, difficulty breathing, swelling in your face or throat
  • Vision changes such as blurred vision, double vision, or sudden visual loss
  • Abnormal heart rhythms: fast pounding heartbeats, shortness of breath and feeling like you might pass out
  • Low sodium levels in the body - symptoms may include nausea, headache, confusion and a lack of energy
  • Severe skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis which are characterized by fever followed by red or purple skin rash that spreads causing blistering and peeling -Severe nervous system reaction - very stiff (rigid) muscles high fever sweating confusion fast uneven heartbeat tremors feeling like you might pass out

If you experience any of these potential side effects after taking Trileptal it is important to contact your healthcare provider immediately.

What are the most common side effects for Neurontin?

Neurontin, also known as Gabapentin, has a list of potential side effects that are important to consider. These can include:

  • Drowsiness or dizziness
  • Dry mouth and throat
  • Vision changes such as blurred vision
  • Unusual eye movements
  • Swelling in the hands or feet
  • Symptoms of viral infection including fever, cough or flu-like symptoms
  • Nausea, vomiting, and loss of appetite
  • Constipation -Sleep disturbances like insomnia
    -Tremors and feelings of nervousness or anxiety
    -Rapid heartbeat (tachycardia)
    -Mental confusion or agitation
    -Potential for rash development
    -Unexplained weight loss is possible but rare -Increased frequency in urination
    -Generalized muscle pain and joint discomfort.

However, everyone reacts differently to medications so not all patients will experience these symptoms when taking Neurontin. Always consult your healthcare professional before changing any medication regimen.

Are there any potential serious side effects for Neurontin?

While Neurontin is generally well-tolerated, it does carry potential risks that users should be aware of. Signs of a serious reaction to the medication can include:

  • An allergic response, which may manifest as hives, difficulty breathing or swallowing and swelling in your face or throat
  • A severe skin reaction characterized by fever, sore throat, burning eyes and skin pain followed by a red or purple skin rash that spreads (particularly on the face or upper body) and causes blistering and peeling
  • New or worsened seizures
  • Unusual changes in mood or behavior including confusion
  • Eye problems: blurred vision, tunnel vision, eye pain or swelling and seeing halos around lights
  • Rapid heartbeats; other cardiac irregularities
    If you experience any signs suggestive of an adverse reaction while taking Neurontin such as racing thoughts unusual bursts of energy reckless behavior extreme happiness irritability talking more than usual insomnia stop using it immediately contact your healthcare provider right away.

Contraindications for Trileptal and Neurontin?

Both Trileptal and Neurontin, as with many other anticonvulsant medications, may exacerbate symptoms of depression in some individuals. If you notice your mood worsening or an increase in suicidal thoughts or behavior while taking these medications, it's imperative to seek immediate medical attention.

Neither Trileptal nor Neurontin should be taken if you are using or have recently used MAO inhibitors (MAOIs). These require about five weeks to clear from the system before you can safely start taking anticonvulsants like Trileptal and Neurontin. Always inform your healthcare provider about all the medicines you are currently on to avoid potentially dangerous drug interactions.

How much do Trileptal and Neurontin cost?

In comparison to the brand name versions of these drugs:

  • The price for 60 tablets of Neurontin (300 mg) averages around $400, which equates to approximately $6.70–$20 per day depending on your dosage.
  • The price for 60 tablets of Trileptal (300 mg) is about $470, working out to roughly $7.80–$23.50 per day.

Thus, if you are in a higher dosage range for Trileptal (i.e., 1800 mg/day or higher), then brand-name Neurontin could be less expensive on a per-day treatment basis. Please remember that cost should not be the only factor in determining which drug is right for you.

For the generic versions of these medications:

  • Gabapentin, the generic version of Neurontin, can be obtained in packs from 30 capsules and above with approximate costs ranging from as low as $0.15/day up to about $1/day.
  • Oxcarbazepine or generic Trileptal can also be procured in packs from 30 tablets upwards with costs starting at around $0.18/day and going up to nearly $1/day based on typical dosages ranging between 600mg -2400mg per day.

Costs may vary based upon location and pharmacy used; however, generally speaking both generics offer significant savings over their brand-name counterparts while maintaining similar effectiveness.

Popularity of Trileptal and Neurontin

Oxcarbazepine, known by the brand name Trileptal, was estimated to have been prescribed to about 1.3 million people in the US in 2020. Oxcarbazepine accounted for just over 2% of anticonvulsant prescriptions in the US. However, it appears to be more commonly used as a mood stabilizer and less frequently used for epilepsy than some other anticonvulsants.

Gabapentin, including brand versions such as Neurontin, was prescribed to approximately 64 million people in the USA in 2020 making it one of the most widely prescribed drugs overall. In terms of prescriptions for nerve pain related medications or anticonvulsants specifically, Gabapentin accounts for nearly half. Its usage has been generally increasing since its approval date due to its effectiveness and broad therapeutic index.

Conclusion

Both Trileptal (oxcarbazepine) and Neurontin (gabapentin) are medications primarily used in the treatment of seizures and nerve pain. They have been proven effective through numerous clinical studies, showing they are more beneficial than placebo treatments. There may be instances where these drugs could be combined for certain therapeutic benefits but this must only be done under the supervision of a physician due to potential drug interactions.

Trileptal works by blocking voltage-sensitive sodium channels which stabilizes hyper-excited neural membranes, inhibits repetitive neuronal firing, and diminishes propagation of synaptic impulses. On the other hand, Neurontin modulates calcium channels to decrease release of excitatory neurotransmitters.

While both drugs are available as generics, saving costs for patients who need to pay out-of-pocket expenses, each has its unique features that can influence a doctor's prescription decision: Trileptal is commonly preferred for focal or partial seizures while Neurontin is often selected for neuropathic pain management along with its anticonvulsant properties.

The side effect profile between these two medicines is broadly similar; common side effects include dizziness and drowsiness. However, there might be slight variations such as hyponatremia being more associated with Trileptal use whereas peripheral edema tends to occur with Neurontin use. Patients should closely monitor their response upon starting either medication and promptly seek medical help if they notice any increase in seizure frequency or intensity or emergence of new types of seizures.