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Q:  Trileptal & Red Blood Count

I've recently discovered that my red blood count is low 11 when the normal is 60-180. Could this be due to my medication "trileptal"?


Dear Ms. B' -- 
Trileptal (oxcarbazepine) is thought not to cause blood cell production problems, generally, even to the point where the manufacturer specifically states that no monitoring of blood counts is required while taking this medication. 

But, since you asked, I looked to see if I could find any evidence that rarely oxcarbazepine might cause decreased blood cell counts.  In most references, the standard statements about "no monitoring required" were found.  However, here is one from what seems to be a reasonably trustworthy source (Cleveland Clinic Pharmacotherapy Update, 2001)  indicating that indeed rarely Trileptal might cause this problem: 

However, severe allergic skin reactions (e.g., epidermal necrolysis and Stevens-Johnson syndrome) and hematologic toxicity (e.g., leukopenia and thrombocytopenia) are less common with oxcarbazepine overall.

"Less common", meaning can occur, as I read that anyway. 

In the "Package Insert", the official document from the company (the one the pharmacist sometimes hands you with a new medication, that looks like a ticker-tape strip, as long as your arm in most cases), there is no mention of "anemia", under the possible blood cell effects (white cells yes, red cells no; see page 20 of their PI pdf).  

Putting all that together, I'd say the answer to your question is something like: "probably not, but can't quite give you a definite no".  As a doc' friend of mine says, "medications are guilty until proven innocent".  But then you have to look at what risks you might be taking to get that proof (if you had to stop the medication to find out -- which of course you wouldn't even consider doing without working out a plan with your doctor first).  Sorry I can't be a bit firmer than that. 

Dr. Phelps

Published January, 2005


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