I found some stuff on google, couldn't get the website to cut and paste. the following info may be useful re the drug's pharmacokinetics. probably little data on its use w/ bf but drug levels could be done on the mom and babies, and monitoring of side effects etc. Oxcarbazepine (Trileptal) Oxcarbazepine is a keto-analogue of carbamazapine. The modification to the molecular structure prevents it from being metabolized by oxidation to CBZ-10,11-epoxide, which is the metabolite that is thought to be responsible for much of the toxicity of CBZ. OCB is metabolized by conjugation rather than by oxidation, and largely excreted by the kidney. See e.g. Lloyd et al. It has been on the market for over 10 years in various countries. The neurologists that I have spoken to seem to regard it as exactly equivalent to CBZ for seizure control ("It's Tegretol without the toxicity"). The clinical efficacy for seizure control of OCB compares favorably with CBZ in clinical trials, and there are case reports of its efficacy for bipolar disorder, and a very small placebo-controlled 1983 study (interestingly, this study was one of the early favorable reports for the use of VPA in mania). More recently, other studies have compared OCB (favorably) to lithium and to haloperidol, and at the 2001 APA meeting Reinstein presented a poster reporting equal effectiveness compared to valproate for acute mania. There have been no instances of marrow suppression in 7000 cases according to one citation. Compared with CBZ, P450 enzyme induction is greatly reduced; there is only a moderate induction of CYP3A4 and other isoenzymes seem not to be affected. It seems to be less prone to causing cognitive impairment than CBZ (see Grant & Faulds 1992). When switching from CBZ to OCB, one should be aware that the previous induction of CYP enzymes will be considerably decreased, and as a result the serum levels of other drugs may rise. The only medical issue of note is its occasional side effect of hyponatremia. Summary: Half-life: the parent compound is rapidly and extensively metabolized to a monohydroxy derivative (MHD), which is responsible for the therapeutic effect; MHD is eliminated with a half-life of about 8-10 h Metabolism: ~ 27% of the dose is recovered in the urine as unchanged MHD and a further 49% as a glucuronide conjugate of MHD. It appears that the kinetics of OCB should not be affected by impaired liver function. Impaired kidney function does not affect the kinetics of MHD, but the glucuronide conjugate will accumulate in these patients. Maintenance therapeutic range: N/A; it is unclear if eventually serum levels will be useful Dosage: 800-1800mg/day. When converting from CBZ to OCB, multiply CBZ dose by 1.5 to get an approximately equivalent OCB dose. Drug interactions: mild induction of CYP3A4 — watch for some decrease (may be subclinical) in 3A4 substrates such as estrogens and progesterone (watch for effects on OCPs!), the dihydropyridine calcium-channel blockers (nimodipine, amlodipine, felodipine, isradipine), pimozide, quinidine, alprazolam, diazepam, haloperidol, lovastatin, trazodone. When switching from CBZ to OCB expect relative de-induction of CYP enzymes, including 3A4, so, e.g., lamotrigine levels may rise, as may those of many other drugs. Side effects: in monotherapy (incidence greater than or equal to 5 percent) were dizziness, nausea, headache, diarrhea, vomiting, upper respiratory tract infection, constipation, dyspepsia, ataxia and nervousness Cautions: hyponatremia (2.5% incidence in controlled clinical trials) — usually asymptomatic and did not usually require dose adjustments, but fluid restriction might be necessary Routine laboratory monitoring: none; serum sodium levels might be checked for elderly patients or those at risk for hyponatremia (see Smith 2001). Laurie Wheeler, IBCLC, MN, RN New Orleans Louisiana, s.e. USA _________________________________________________________________ The new MSN 8: advanced junk mail protection and 2 months FREE* http://join.msn.com/?page=features/junkmail *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html