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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Cynthia on March 24, 2000, at 16:37:50
I have been having an increasing problem with double vision on Topamax and Tegretol 400mg and 2400mg day respectively. Especially when other meds are added ( Klonopin, Seroquel, Zyprexa,Celexa, Remeron) Since the dosages have been reduced there has been no problem, but I am on the edge of mania constantly. I am now at 350mg of the Topomax and still on 2400 of tegretol and have dropped the other meds ( with an occasional klonopin) and have not had any double vision. I am concerned about where my mood stability is , I like where I am , If I could be assured It would stay here. Any ideas would be greatly appreciated.
Posted by Cam W. on March 24, 2000, at 21:33:46
In reply to Diplopia on Topamax and Tegretol, posted by Cynthia on March 24, 2000, at 16:37:50
Cynthia - With the mood stabilizers one can never be sure that your body's reaction to Tegretol and Topamax will remain static. Tegretol is a finicky drug. It can even induce its own metabolism after a while, reducing blood levels. Also, if any other drugs are added to your regimen, Tegretol can affect and be affected by these drugs, changing blood levels. Topamax is not extensively metabolized, so adding other drugs does not affect it much.Caveat - What I have said above will not necessarily happen, but what could potentially happen. You may very well remain stable for a long time (hopefully). As with most medications, it is a wait and see game. Also, your disease state may also change over time, requiring an adjusting of meds. Monitor and make notes on any changes in mood and side effects (eg keep a diary about the way you feel). This can help you notice any trends towards changes in your body and you can show this info to you doctor. It will help him immensely in deciding if any changes need to be made. Hope this helps -
Cam W.
Posted by Scott L. Schofield on March 25, 2000, at 9:15:29
In reply to Re: Diplopia on Topamax and Tegretol, posted by Cam W. on March 24, 2000, at 21:33:46
> > I have been having an increasing problem with double vision on Topamax and Tegretol 400mg and 2400mg day respectively. Especially when other meds are added ( Klonopin, Seroquel, Zyprexa,Celexa, Remeron) Since the dosages have been reduced there has been no problem, but I am on the edge of mania constantly. I am now at 350mg of the Topomax and still on 2400 of tegretol and have dropped the other meds ( with an occasional klonopin) and have not had any double vision. I am concerned about where my mood stability is , I like where I am , If I could be assured It would stay here. Any ideas would be greatly appreciated.
> Cynthia - With the mood stabilizers one can never be sure that your body's reaction to Tegretol and Topamax will remain static. Tegretol is a finicky drug. It can even induce its own metabolism after a while, reducing blood levels. Also, if any other drugs are added to your regimen, Tegretol can affect and be affected by these drugs, changing blood levels. Topamax is not extensively metabolized, so adding other drugs does not affect it much.
It might be a good time to have some blood work done. As Cam said, the blood levels of Tegretol (carbamazepine) can fluctuate for a variety of reasons. Perhaps the emergence of manic symptoms reflects a decrease in levels. Regular blood tests should really be part of any treatment that includes Tegretol. Aside from monitoring blood levels, they serve to screen for a condition called agranulocytosis. Agranulocytosis is a decrease in the formation of white blood cells, an essential component of the immune system. Since this can occur at any time during treatment with Tegretol, such regular blood tests are necessary.
Have you always been on the edge of mania, or is this the result of having reduced the dosage of Topomax?
Is the mania you experience actually a mixed-state? That is to say, are there feelings of depression or irritability that occur along with the mania that, overall, make mania an uncomfortable experience?
What benefits have you seen with the introduction of Topomax?
Have you tried Depakote (valproate, valproic acid)? This is another anticonvulsant that works well for subtypes of bipolar disorder that do not fit the classic bipolar I diagnosis. These would include mixed-states and bipolar II, in which mania does not reach beyond the state of the more mild hypomania. Depakote is now accepted as being the first choice for treating these conditions.
Wishing you good health,
Scott
Posted by Cynthia on March 27, 2000, at 10:00:41
In reply to Re: Diplopia on Topamax and Tegretol, posted by Scott L. Schofield on March 25, 2000, at 9:15:29
Cam and Scott - thanks for replying- I have been very manic recently and very quickly. blood work shows I have been "chewing up " the tegretol. It has not been at a good thereputic level. My doc has left my levels lowered for no other reason than fear I suppose of side effects . I am rapidly cycling on and off here between mania and depression. I did a horrible 6 day stint of mania (no sleep) during which my son was hospitalized for diabetic ketoacidosis. ( I had to be "good' in the hospital, didn't want anyone to write "5150' on a piece of paper) anyway strangely went from mania into another course of hypomania and now a semi depression and I don't know where from here. It is all very exhausting. Tried to get assistance from doc and nurse and the nurse thought it strange that i only have crisis while I am around my husband ( Not accepting my response that I only feel safe enough to let down my guard around my husband) She believes that this is more behavioral than chemical and I am angry with them for dumping me because I am difficult and they are not able to find the " quick fix". Scott- Yes - tried Depacote- 3000 mg a day , bood levels did not even show at theraputic level. I don't know where I stand now. I guess my choices are to live with the rapid cycling of the disorder or to live with the side effect of double vision. both rotten choices.
This is the end of the thread.
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