What is the Difference Between Carbamazepine and Oxcarbazepine?

Carbamazepine and oxcarbazepine are both anticonvulsant drugs used to treat epilepsy and other seizure disorders. They have some similarities and differences in their structure, mechanisms of action, and side effects:

Similarities:

Both are anticonvulsant drugs used to treat epilepsy and other seizure disorders.
Both drugs work by blocking voltage-gated sodium channels.

Differences:

Carbamazepine is an older drug, while oxcarbazepine is a newer drug developed as a structural analog of carbamazepine.
Oxcarbazepine follows a different metabolic pathway than carbamazepine, resulting in several clinical advantages.
Unlike carbamazepine, which is converted to an epoxide metabolite, oxcarbazepine is rapidly converted to its monohydroxy derivative (MHD), which is the main active metabolite.
Studies have shown that oxcarbazepine is 20% less likely to produce side effects when compared to carbamazepine.
Carbamazepine is a potent inducer of CYP3A4, which can render many medications, such as antipsychotics and antidepressants, ineffective. Oxcarbazepine induces CYP3A4 to an extent 50% less than that of carbamazepine.
Oxcarbazepine is not associated with aplastic anemia or agranulocytosis, which are observed at a rate of 1 in 100,000 with carbamazepine.

Despite their differences, both drugs appear to be similarly effective and well-tolerated. However, the possibility of important differences existing between these drugs cannot be ruled out.