Hyponatremia following esclicarbazepine therapy

• A high frequency of hyponatremia following ESL therapy was found (4/32).
• ESL related hyponatremia occurs in elderly stroke patients with comorbidities.
• ESL related hyponatremia is not dose related.
• Sodium levels need to be monitored in elderly on ESL therapy.
• In ESL related hyponatremia, it should be withdrawn or dose reduced.

PurposeTo evaluate the safety of eslicarbazepine acetate (ESL) in new onset elderly poststroke seizure patients, especially with respect to hyponatremia.MethodIn a two year, single center open labeled observational study of ESL in patients with imaging proven stroke with new onset post stroke seizure were included. ESL was titrated between 400 mg and 1200 mg once daily during 1 month observation period. The titrated dose of ESL was continued during 96-week maintenance period. The patients were followed up for seizure control and side effects, including serum sodium on first examination, at the end of 1 month and then at three monthly intervals for 24 months (total eight visits).ResultHyponatremia developed in four out of 32 (12.5%) patients; it was symptomatic in three and asymptomatic in one patient. No statistically significant difference between mean sodium levels at different time period, compared to baseline was found.ConclusionHigh incidence of hyponatremia in ESL treated post stroke patients, was found, hyponatremia symptoms since can be subtle and delayed, so monitoring of serum sodium in the patients on ESL treatment is recommended especially in elderly.