Alcohol, Birth Control Pills, and More: 8 Oxcarbazepine Interactions to Watch Out For

Oxcarbazepine (Trileptal, Oxtellar XR) treats certain types of seizures in adults and children. It may be used alone or with other anti-seizure medications.

Like most medications, oxcarbazepine has potential drug interactions to be aware of. For example, some medications can increase the severity of oxcarbazepine side effects. Other medications lower oxcarbazepine levels in the body, making the anti-seizure treatment less effective. What’s more, oxcarbazepine can affect the levels of other medications, too.

In this article, we discuss oxcarbazepine interactions and what risks they pose. We’ll also talk about which potential interactions should be avoided completely.

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Oxcarbazepine interactions at a glance

While this isn’t a comprehensive list, the following medications, supplements, and substances can interact with oxcarbazepine:

• Alcohol

• Opioids, such as oxycodone (Roxicodone, Oxycontin) 

• Benzodiazepines, such as alprazolam (Xanax)

• Some antidepressants, such as mirtazapine (Remeron)

• Some over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl, Zzzquil)

• Sleep medications, such as zolpidem (Ambien)

• Diuretics, such as hydrochlorothiazide (Microzide)

• Other seizure medications, such as phenytoin (Dilantin, Phenytek) and carbamazepine (Tegretol) 

• Oral birth control pills

• Rifampin (Rifadin)

• St. John’s wort

Below, we review eight notable oxcarbazepine interactions in more detail.

1. Alcohol

It's best to avoid or limit alcohol while taking oxcarbazepine. This is because both oxcarbazepine and alcohol can cause drowsiness as a side effect. Combining the two substances increases your risk of experiencing sleepiness, dizziness, and trouble with coordination, which can lead to falls and injuries.

It's not possible to predict how the combination of oxcarbazepine and alcohol will affect you. So even having one drink while taking the medication isn’t recommended. But it’s especially important not to binge drink, because this increases your risk of having alcohol withdrawal and having a seizure.

Be honest with your prescriber about whether you drink alcohol before you start taking oxcarbazepine. Since avoiding alcohol is recommended with most seizure medications, your prescriber can talk to you about ways to cut back on drinking if needed. 

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2. Medications that increase drowsiness, such as opioids and benzodiazepines

Drowsiness is among the most common side effects of oxcarbazepine — and several other medications.

Taking other medications that cause drowsiness with oxcarbazepine can worsen this side effect. If the combination causes severe drowsiness, it can affect your ability to drive or do other activities that require focus.

Medications that can worsen drowsiness when combined with oxcarbazepine include:

• Opioids, such as tramadol (Conzip) and oxycodone

• Benzodiazepines, such as diazepam (Valium) and alprazolam

• Muscle relaxers, such as carisoprodol (Soma) and cyclobenzaprine (Amrix)

• Sleep medications, such as zolpidem and eszopiclone (Lunesta)

• Some antidepressants, such as amitriptyline

• Some OTC antihistamines, such as diphenhydramine and doxylamine (Unisom SleepTabs)

• Gabapentinoids, such as gabapentin (Neurontin) and pregabalin (Lyrica)

Since there are many medications that can cause drowsiness, this interaction can be hard to avoid. But your pharmacist can review your current medications and let you know if interactions are possible. If so, your prescriber may suggest a change to your medication regimen. Or they may recommend watching for excessive drowsiness.

3. Medications that decrease sodium

Hyponatremia (low sodium levels) is a rare but potentially serious side effect of oxcarbazepine. While many people don’t notice symptoms with low sodium levels, it’s possible to experience fatigue, nausea, and forgetfulness. More frequent seizures and trouble breathing can also occur in severe cases.

Taking oxcarbazepine with other medications that decrease sodium levels raises your risk of hyponatremia. Examples of medications that can decrease sodium levels include:

• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft)

• Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Zestril)

• Diuretics, such as hydrochlorothiazide

• Amiodarone (Pacerone)

Low sodium levels are most likely to develop in the first 3 months of taking oxcarbazepine. So your prescriber may order blood tests, such as an electrolyte panel, to check your sodium levels during your first few months of treatment. This is especially true if you take other medications that decrease sodium or you’re an older adult, which increases your risk.

Let your neurologist or prescriber know right away if you develop symptoms of low sodium levels. They may need to adjust your medication regimen. If you have symptoms that feel severe, seek emergency care.

4. Phenytoin

Phenytoin (Dilantin, Phenytek) treats different types of seizures. Phenytoin and oxcarbazepine can interact in two ways: oxcarbazepine can increase phenytoin levels and phenytoin can decrease oxcarbazepine levels.

Oxcarbazepine dosages above 1,200 mg per day may increase phenytoin blood levels. This can raise your risk of phenytoin side effects such as nystagmus (unpredictable eye movements) and worsened coordination. In severe cases, phenytoin toxicity can occur, which may lead to seizures or coma.

On the other hand, if phenytoin lowers levels of oxcarbazepine in your body, it can make the medication less effective at managing your seizures.

If your prescriber recommends both medications, they may prescribe you a lower phenytoin dosage. They may also ask you to have blood tests to check the levels of phenytoin or oxcarbazepine in your body.

5. Carbamazepine

Oxcarbazepine and carbamazepine are chemically related seizure medications. Because they’re so similar, they’re not typically used together. However, it’s worth noting that carbamazepine can lower blood levels of oxcarbazepine, making it less effective at reducing seizure frequency.

Beyond carbamazepine and phenytoin, there are other seizure medications, like the IV medication phenobarbital (Sezaby), that can interact with oxcarbazepine. So if you’re prescribed more than one seizure medication, ask your healthcare team to check for potential interactions. Some potential interactions may require dosage adjustments, while others may warrant watching for certain side effects or the return of seizures.

6. Birth control pills

Birth control pills are an effective form of contraception. But when taken with oxcarbazepine, they can be less effective. This can cause unintended pregnancies or, if you’re taking birth control pills for a condition like endometriosis, worsening symptoms.

Birth control pills either contain an estrogen with a progestin or a progestin alone. Oxcarbazepine can affect blood levels of both estrogens and progestins. Since all oral birth control pills contain at least one of these hormones, this may not be the best form of contraception for you if you take oxcarbazepine.

Your prescriber may suggest you use another form of contraception, such as condoms or spermicide, alongside birth control pills. Or they may recommend trying a different birth control option, such as Paragard (copper IUD). Hormonal IUDs, such as Mirena or Skyla, are also an option. Though hormonal IUDs contain a progestin, they don’t interact with oxcarbazepine because they deliver the progestin directly to the uterine area and only a small amount enters the bloodstream.

7. Rifampin

Rifampin (Rifadin) is an antibiotic that treats latent or active tuberculosis. It can also be used to help prevent meningitis.

Rifampin can decrease oxcarbazepine levels in the body. So taking rifampin and oxcarbazepine together can make oxcarbazepine less effective.

Rifampin isn’t a commonly prescribed antibiotic. But if your healthcare professional thinks you need it, they may ask you to have more frequent blood tests to monitor your oxcarbazepine levels. They may also adjust your oxcarbazepine dosage.

8. St. John’s wort

St. John’s wort is an OTC herbal supplement that some people use to manage symptoms of depression. But St. John’s wort can decrease oxcarbazepine levels in the body, making the medication less effective.

Let your prescriber know before taking St. John’s wort with oxcarbazepine. They may recommend against using St. John’s wort and suggest other treatment options for depression.

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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:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

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