A proposal for a model to replace carbamazepine or oxcarbazepine by eslicarbazepine acetate in clinical practice
*Correspondencia: Dr. Juan José Poza Aldea. Servicio de Neurología. Hospital Universitario Donostia. P.º Doctor Begiristain, s/n. E-20014 San Sebastián (Guipúzcoa).
E-mail: juanjose.pozaaldea@osakidetza.net
Introduction. For many years carbamazepine (CBZ) has been the reference drug for the treatment of partial epileptic seizures. However, the problems related with its pharmacokinetics and safety have led to the development of other derivatives, such as oxcarbazepine (OXC) and, more recently, eslicarbazepine acetate (ESL), which do not display these drawbacks.
Development. In clinical practice, the possibility of replacing CBZ or OCX by ESL is a relatively frequent occurrence, the aim being to maintain the efficacy of its predecessors and benefit from the advantages in terms of the pharmacokinetics and safety of this latter derivative. To achieve this, it is essential to have an approximate dose equivalence and exchange protocol. This review offers a practical reasoned model for carrying out the change.
Conclusions. The shift from OXC to ESL can be completed from one day to the next with a dose equivalence of 1-1.5 to 1. Replacement of CBZ by ESL must be more progressive, and the dose equivalence is established as 1-1.3 to 1.
Desarrollo En la práctica clínica, se presenta con relativa frecuencia la posibilidad de sustituir la CBZ o la OXC por ESL, buscando mantener la eficacia de los predecesores y ganar las ventajas en el ámbito de farmacocinética y tolerabilidad que ofrece este último derivado. Para ello es indispensable disponer de una equivalencia aproximada de dosis y un protocolo de intercambio. La presente revisión ofrece un modelo práctico y razonado para realizar el cambio.
Conclusiones El paso de OXC a ESL se puede realizar de un día para otro con una equivalencia de dosis de 1-1,5 a 1. La sustitución de CBZ por ESL debe ser más progresiva, y la equivalencia de dosis se establece en 1-1,3 a 1.
