Eslicarbazepine acetate

How it works

It is a voltage-gated sodium channel blocker that stabilises the inactivated state of the channel, reducing repetitive neuronal firing.

Prescribing in practice

• Serious hyponatraemia and rare but life-threatening skin reactions (including DRESS and Stevens-Johnson syndrome) can occur, so check sodium and advise patients to report rash promptly.
• It should not be stopped abruptly because of the risk of rebound seizures; withdraw gradually.
• Use with caution alongside other sodium-channel-blocking antiepileptics and in patients with conduction abnormalities, and counsel on the small increased risk of suicidal thoughts seen with antiepileptics.

Monitoring

Monitor serum sodium, particularly in those at risk of hyponatraemia or on other drugs that lower sodium, and review seizure control and tolerability.

Counselling the patient

• Do not stop this medicine suddenly, as this can provoke seizures.
• Seek urgent advice if you develop a rash, mouth ulcers, fever or feel generally unwell.
• Report any new or worsening low mood or thoughts of self-harm.

Evidence & guidelines

Eslicarbazepine acetate is licensed for focal seizures on the basis of randomised controlled trials demonstrating efficacy as monotherapy and adjunctive therapy.