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
poster:Scott L. Schofield
thread:28061
URL: http://www.dr-bob.org/babble/20000321/msgs/28119.html