Oxcarbazepine Metabolite (MHC), Serum
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Oxcarbazepine (OCBZ) is approved as monotherapy and adjunctive therapy for partial seizures with and without secondary generalized seizures in adults and as adjunctive therapy for partial seizures in children. In humans, OCBZ is a prodrug that is almost immediately and completely metabolized to 10-hydroxy-10,11-dihydrocarbamazepine, known as monohydroxycarbamazepine (MHC), an active metabolite that is responsible for OCBZ's therapeutic effect. The elimination half-life is 1 to 2.5 hours for OCBZ and 8 to 10 hours for MHC. The therapeutic range (3–35 mcg/mL) is based on concentrations of the metabolite, not the parent drug; this assay measures the metabolite only.
In clinical practice, the OCBZ dosage should be individually adjusted for each patient to achieve the desired therapeutic response. Toxicity associated with OCBZ includes hyponatremia, dizziness, somnolence, diplopia, fatigue, nausea, vomiting, ataxia, abnormal vision, abdominal pain, tremor, dyspepsia, and abnormal gait. These toxicities may be observed when blood concentrations are in the therapeutic range.
Monitoring serum concentration during oxcarbazepine therapy
Assessing potential toxicity
Therapeutic ranges are based on specimens drawn at trough (ie, immediately before the next dose). Most individuals display optimal response to oxcarbazepine therapy when serum levels of the metabolite (measured in this assay) are between 3 mcg/mL and 35 mcg/mL. Some individuals may respond well outside of this range, or may display toxicity within the therapeutic range. Thus, interpretation should include clinical evaluation.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Toxic levels have not been well established.
This test cannot be performed on whole blood. Serum must be separated from cells within 2 hours of draw.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Oxcarbazepine metabolite: 3-35 mcg/mL
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Patsalos P, Berry D, Bourgeois B, et al: Antiepileptic drugs-best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008;49(7):1239–1276
2. Johannessen S, Tomson T: Pharmacokinetic variability of newer antiepileptic drugs: when is monitoring needed? Clin Pharmacokinet 2006;45(11):1061-1075