Mechanism of action The active component,<unk> , has the same mechanism of action as oxcarbazepine (which is a prodrug for licarbazepine, the racemate of<unk>  and most likely the closely related carbamazepine. It stabilises the inactive state of voltage-gated sodium channels, allowing for less sodium to enter neural cells, which leaves them less excitable. According to some sources, it has not been shown conclusively that this is the actual mechanism. Pharmacokinetics<unk>  is absorbed to at least 90% from the gut, independently of food intake. It is quickly metabolised to<unk> , so that the original substance cannot be detected in the bloodstream. Peak plasma levels of<unk>  are reached after 2–3 (1–4) hours, and plasma protein binding is somewhat less than 40%. Biological half-life is 10 to 20 hours, and steady-state concentrations are reached after four to five days after start of the treatment. Oxcarbazepine, for comparison, is also nearly completely absorbed from the gut, and peak plasma concentrations of licarbazepine are reached after 4.5 hours on average after oxcarbazepine intake. Plasma protein binding and half-life are of course the same. Other metabolites of ESL are the less active (R)-(−)-licarbazepine (5%; the stereoisomer of<unk> , the pharmacologically active oxcarbazepine (1%), and inactive glucuronides of all of these substances. The drug is excreted mainly via the urine, of which two thirds are in the form of<unk>  and one third in the form of<unk>  glucuronide. The other metabolites only account for a few percent of the excreted drug. Pharmacogenomics Persons with certain genetic variations in human leukocyte antigens (HLAs) are under increased risk of developing skin reactions such as acute generalized exanthematous pustulosis (AGEP), but also severe ones such as Stevens–Johnson and DRESS syndrome, under treatment with carbamazepine and drugs with related chemical structures. This is true for the HLA-A*3101 allele, which occurs in 2 to 5% of Europeans and 10% of Japanese people, and the HLA-B*1502 allele, which is mainly found in people of Asian descent. Theoretically, this may also apply to ESL.
Eslicarbazepine acetate
Propazepine
Carbamazepine
Oxcarbazepine
Nitroxazepine
Capsazepine
Zonisamide
Lamotrigine