8 Oxcarbazepine Side Effects to Know About: Dizziness, Tiredness, and More

Oxcarbazepine (Trileptal, Oxtellar XR) is an anti-seizure medication. It’s used to treat focal onset seizures, also known as partial seizures. Oxcarbazepine can be used alone or with other anti-seizure medications.

Like all medications, oxcarbazepine may cause side effects. If you’ve been prescribed the anti-seizure medication, it’s helpful to know about these side effects in advance. Below, we’ll cover eight notable oxcarbazepine side effects and how to manage them if they occur.

Oxcarbazepine side effects at a glance

Oxcarbazepine side effects are often mild and can typically be managed at home. But in some cases, oxcarbazepine can cause serious side effects that require medical care. Below, we’ll cover both mild and severe oxcarbazepine side effects. But keep in mind that this isn’t an exhaustive list of the possible risks.

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Some of the more common oxcarbazepine side effects include:

• Tiredness and fatigue

• Dizziness and vertigo

• Poor coordination

• Double vision and rapid eye movements

• Tremors

• Headaches 

• Mood changes, such as irritability

• Nausea and vomiting

• Mild hyponatremia (low sodium levels)

Rare but more serious side effects, some of which may require emergency care, include:

• Severe hyponatremia

• Serious skin rash

• New or worsening seizures

• Injuries and falls due to poor coordination

• Increased risk of suicidal thoughts or behavior

• Blood cell problems, such as low white blood cells

1. Dizziness and poor coordination

Dizziness and poor coordination are among the most common oxcarbazepine side effects reported in studies. These side effects can make it hard to perform daily tasks. For example, slower reactions and coordination problems can make driving difficult. It may also lead to falls, which can result in broken bones or other injuries. This is especially risky for older adults.

To be safe, it’s best to avoid driving, operating machinery, and doing other activities that require coordination when you first start taking oxcarbazepine. Wait until you know how oxcarbazepine affects you before engaging in these activities. And when you’re moving around or changing positions, take extra precautions. Have something sturdy to hold onto, and make sure your home is free of tripping hazards.

If you experience dizziness or poor coordination that impacts your daily life, reach out to your prescriber. They may decrease your oxcarbazepine dosage, or suggest trying a different anti-seizure medication altogether.

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2. Tiredness and fatigue

Tiredness and fatigue are common oxcarbazepine side effects. Like dizziness and poor coordination, these side effects can make it hard to drive, use tools or machinery, and perform other activities. 

When you first start taking oxcarbazepine, avoid driving and other activities that require alertness until you know how the medication affects you. This lowers your risk of accidents and injuries. Also, keep in mind that drowsiness related to oxcarbazepine can be worse if you take other medications that can make you tired.

If you experience tiredness or fatigue that affects your ability to perform daily activities, especially if it doesn’t improve after a few days, let your prescriber know. They may prescribe you a lower oxcarbazepine dosage to see if it helps with your symptoms. If your symptoms continue, they may recommend switching to a different anti-seizure medication.

3. Nausea and vomiting

Nausea and vomiting are common oxcarbazepine side effects. It can be hard to know if these effects are related to oxcarbazepine or another cause, though. There are many medications and medical conditions that can cause nausea and vomiting.

If you suspect oxcarbazepine is causing your symptoms, there are plenty of things you can try . Avoiding triggers that can make nausea worse, such as spicy or fried foods, is a good place to start. Taking your oxcarbazepine doses with food can also help.

If these strategies don’t work, an over-the-counter (OTC) or prescription nausea medication may be helpful. But talk to your prescriber first about what they recommend.

Good to know: If you throw up after taking oxcarbazepine, contact your prescriber or pharmacist. They can give you guidance based on how soon you threw up after taking the medication. Taking too much oxcarbazepine can increase your risk of side effects, so don’t take another dose before talking to them. 

4. Headaches

Headaches are a commonly reported oxcarbazepine side effect. But it can be hard to know if headaches are related to oxcarbazepine or caused by something else. There are several possible causes for headaches, including dehydration and even exercise. And numerous medications besides oxcarbazepine may cause headaches.

If you’re experiencing mild headaches, consider trying an OTC pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Just be sure to check with a healthcare professional first if you’re not sure if it’s safe for you to take one. OTC pain relievers aren’t recommended for everyone.

If your headaches continue, reach out to your prescriber. If the headaches feel severe, or you experience vision changes or neck pain with them, seek emergency care.

5. Vision and eye problems

Vision and eye problems are possible oxcarbazepine side effects. Up to 40% of people taking a higher dosage of oxcarbazepine (2,400 mg per day) may experience diplopia (double vision). While less common, nystagmus (uncontrollable and repetitive rapid eye movements), and other symptoms of abnormal vision, may also occur.

Let your prescriber know right away if you have vision or eye problems while taking oxcarbazepine. They may recommend that you stop taking the medication or reduce your dosage. But don’t make any changes without consulting them. Suddenly stopping oxcarbazepine treatment may worsen seizures.

6. Rash

Both mild and serious rashes are possible with oxcarbazepine. While mild rashes are more common, there’s no way to tell whether a mild rash will turn into a severe reaction. If you develop an unexplainable rash, stop taking oxcarbazepine and reach out to your prescriber immediately. If the rash feels severe, or you have other symptoms like fever, chills, or enlarged lymph nodes, seek emergency care.

A serious skin rash from oxcarbazepine may be associated with a condition like Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. These conditions can also cause fever and swelling in the lymph nodes. And DRESS can negatively impact the liver, kidneys, heart, and other organs.

SJS and TEN are most likely to occur within the first few weeks of oxcarbazepine treatment. Certain genetic factors can increase your risk for these reactions. Specifically, having a gene variant called HLA-B*1502 increases your risk. People of certain ancestry are more likely to carry HLA-B*1502. If you’re more likely to carry the gene, your prescriber may recommend genetic testing before you start taking oxcarbazepine.

DRESS may occur up to 8 weeks after starting oxcarbazepine treatment. Early signs of DRESS, such as fever or enlarged lymph nodes, may be present without a rash. These symptoms still warrant immediate evaluation by a healthcare professional.

7. Low sodium levels

Oxcarbazepine may cause hyponatremia, or low sodium levels. Studies have had conflicting results about how common this side effect is. But one study involving over 1,000 people found that about 30% developed hyponatremia with oxcarbazepine treatment. Most people didn’t have symptoms. But about 7% of people had severe hyponatremia, which is defined as a sodium level of less than 128 mmol/L. 

Hyponatremia may occur at any time while taking oxcarbazepine. However, it's most likely to happen in the first 3 months after starting treatment. Certain factors — such as older age, taking diuretics, or taking more than one anti-seizure medication — can increase your risk of hyponatremia.

Often, hyponatremia from oxcarbazepine is mild and doesn't cause symptoms. But if your sodium levels are very low, symptoms are more likely and can be more concerning. Examples of possible symptoms include confusion, worsening seizure severity, and hallucinations.

Your prescriber may check your sodium levels routinely during treatment. If your sodium is mildly low, they may ask you to restrict your fluid intake and see if your levels increase. Or they may recommend decreasing your oxcarbazepine dosage. If your sodium levels are very low or you’re experiencing symptoms, they may switch you to another medication.

8. Risk of suicidal thoughts

All anti-seizure medications, including oxcarbazepine, carry a warning for increased suicidal thoughts and behaviors. 

This warning was assigned by the FDA in 2008 after the results of a large study found that anti-seizure medication may increase the risk for suicidal thoughts and behaviors. However, it’s important to note that this study grouped together data from 11 medications. So the specific level of risk with oxcarbazepine isn’t known. 

Additionally, several other studies show mixed results on whether anti-seizure medications increase suicidality. One factor that makes it hard to determine if this is true is that having seizure disorder (epilepsy) itself increases suicide risk.

Pay close attention to your moods and any changes in your thought patterns while taking oxcarbazepine. And if you’re comfortable, let a close friend or family member know you’re taking the medication. They can help watch for any changes in your behavior.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the 988 Suicide & Crisis Lifeline at 988, or text “HOME” to 741-741 to reach the Crisis Text Line.

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Written by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Soojin Jun, PharmD

Soojin has 10 years of experience in various pharmacy settings, from inpatient to outpatient settings, and population health in value-based healthcare models. She completed training in various areas of healthcare to ensure patient safety, from activism, geriatric pharmacy, medication safety, healthcare quality, patient safety, death and dying, and trauma-informed care.

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