Eslicarbazine

ESLICARBAZINE

Eslicarbazepine acetate (ESL) is a prodrug that has been approved in Europe as adjunctive therapy in adults with partial-onset seizures, with or without secondary generalization. ESL is more rapidly converted to S(+)-licarbazine (eslicarbazine) than is oxcar-bazepine; clearly both prodrugs have the same metabolite as active product. The mechanism of action of carbamazepine, oxcarba-zepine, and ESL appears to be the same, ie, blocking of voltage-gated Na⁺ channels. The R(–) enantiomer has some activity, but much less than its counterpart.Clinically, the drug is similar to carbamazepine and oxcarba-zepine in its spectrum of action, but it is less well studied in other possible indications. The possible advantage of ESL is its once-daily dosing regimen. The measured half-life of the S(+) enantiomer is 9–11 hours. The drug is administered at a dosage of 400– 1200 mg/d; titration is typically required for the higher doses.Minimal drug level effects are observed with coadministration of carbamazepine, levetiracetam, lamotrigine, topiramate, and valproate. Oral contraceptives may be less effective with concomi-tant ESL administration.