Posted by medlib on December 5, 2000, at 22:20:07
In reply to This is madness, I tell you, posted by S. Howard on December 4, 2000, at 20:11:44
> Friends-
> Presently I'm taking 500 mg depakote, 100 mg seroquel and cutting back on 30 mg paxil to 0,Gracie---
I believe that your instinct not to begin Dilantin may be a good one--at least, not without consulting a *competent* psychopharmacologist, or at least, a neurologist.
All 3 of the meds you mentioned have the potential to interact with one another. Dilantin can increase the clearance of Seroquel. (Because S. would leave the body faster, a larger dose would be needed to maintain the same therapeutic blood level.) Dilantin and Depakote can interact to increase the effects of Dilantin and decrease the effects of Depakote. Dilantin has a relatively small "therapeutic window"; a 10% dosage increase may produce toxic blood levels. Both Depakote and Dilantin are anticonvulsants; typically, one does not take 2 different anticonvulsants together. (Dilantin is an older drug, thus cheap; many newer ACs have fewer side effects, but cost more.)
Dosage of anticonvulsants for seizure control usually is greater than for psych purposes. A serum blood level of the drug is compared to the therapeutic index measured in mg.s/kg of body weight. For seizure control purposes, taking less than a therapeutic level of an anticonvulsant is pointless; *almost* just doesn't cut it.
Re evidence of seizure: If you "woke up" with a severe headache and bitten tongue, you had what once was called a grand mal, now a tonic-clonic, seizure. By the time that many hospitals get around to administering an EEG, brain wave patterns may have returned to normal, hence the test is "clear." Believe me, seizures are nothing to mess around with. In many states, doctors are required to report seizures they suspect may be evidence of a recurring pattern to the DMV, which often suspends licenses for 2 or more seizure-free years. (On the other hand, you can be just as dead from falling asleep at the wheel as from seizing.)
Depakote is most frequently prescribed for "absence" or partial seizures. Even a therapeutic level of it may fail to prevent, or sometimes *cause*, other types of seizures. It (like all other anticonvulsants) should never be abruptly discontinued; it must be tapered down, lest it cause what it's meant to prevent.
Please forgive me if this sounds preachy (or morbid), but the meds you have been prescribed are "heavy hitters." It's worth using 7 day pill cases and avoiding casual or recreational drug interactions--death is not necessarily the worst potential outcome of many types of accidents.
Well wishes from a former rehab hospital patient-----medlib
poster:medlib
thread:49925
URL: http://www.dr-bob.org/babble/20001130/msgs/50011.html