eslicarbazepine acetate add-on therapy for drug-resistant focal epilepsy

Last edited 01/2022 and last reviewed 01/2022

ESL is a novel, once-daily AED for the adjunctive treatment of drug resistant epilepsy. It shares a similar structure with carbamazepine and oxcarbazepine but does not inhibit most cytochrome P450 enzymes (CYP450) and has a low potential for drug interaction (1)

  • Eslicarbazepine is the main active component of ESL and its pharmacokinetics are not aIected by age, gender, food or moderate hepatic impairment, but clearance of ESL is dependent on renal function
  • review of 7 trials of short-term duration (n=2185, age 2-77 years) notes eslicarbazepine reduced seizure frequency when used as an add-on treatment in this population (overall risk ratio for >=50% reduction in seizure frequency was 1.57; 95% 1.34 to 1.83) (2)
    • moderate-certainty evidence provided by this review demonstrates that both eslicarbazepine acetate (ESL) 800 mg and 1200 mg taken once-daily can significantly reduce seizure frequency in adults with treatment-resistant focal epilepsy, in the short term
    • dizziness, nausea, somnolence, vomiting and diplopia were significant adverse effects in adults
    • most significant contribution of this update is the finding that ESL may reduce seizure frequency in children from six to 18 years of age; however, the results are inconclusive


  1. Almeida L, Soares-da-Silva P. Eslicarbazepine acetate (BIA 2-093). Neurotherapeutics 2007;4(1):88-96.
  2. Chang X-C, Yuan H, Wang Y, Xu H-Q, Hong W-K, Zheng R-Y. Eslicarbazepine acetate add-on therapy for drug-resistant focal epilepsy. Cochrane Database of Systematic Reviews 2021, Issue 6. Art. No.: CD008907. DOI: 10.1002/14651858.CD008907.pub4. Accessed 12 January 2022.