Posted by Ritch on April 6, 2003, at 12:50:22
In reply to Please help-trileptal!!!-manic?, posted by e503 on April 6, 2003, at 10:37:11
> I need help for my son. He is 16, bipolar (?), autistic. He was on tegretol for many years but had to come off because of a low wbc. We switched to trileptal about feb. 1. We started low,and kept on increasing. (He had been on 1400 mg. tegretol). The same time that we switched he seemed anxious, in fact he started pulling his hair out of his head. He also takes and has taken for many years with his tegretol, 75 mg. zoloft, 1 mg. risperdol, and 15 mg. buspar. Once we got up to maybe about 900 mg./day about 1 month later, he seemed quite obsessive/agitated. We assumed it wasn't enough, so we have increased it to 2400 mg./day over the next 5-6 weeks. He is doing horribly. He was pacing last night and VERY VERY obsessive. I should let you know that also when we have tried seroquel, zyprexa, and increased his risperdol he got manic/agitated, so don't even THINK about that!
>
> Anyways, we decided that we need to cut back on the trileptal to at least 1500 mg./day until I can get to my pdoc. PRoblem is, everytime he suggests something, (typically zyprexa or one of those) he gets more agitated.
> I don't understand the chemistry of these meds, but maybe someone can tell me what the heck is going on and what I can suggest to my pdoc for Ben. Please help---I am losing my son to much agitation. Does anyone have any ideas as to what mood stabilizer might help? Only other one we tried was depakote many years ago and it didn't do anything. Do you think I should take him off trileptal? I have read elsewhere that when people have increases in dosages there seems to be some agitation, but then it stops. I remmeber with tegretol i noticed a positive response within a week or so.
> Sorry so long, but I am devastated and need some help. ThanksSwitching from Tegretol to Trileptal *may* have increased the level of Risperdal in his body, since carbamazepine stimulates liver enzymes which tend to clear a lot of other medications more quickly than usual. Perhaps you could suggest a dose *reduction* of the Risperdal as a trial? As far as a different med to try or add, has his doctor considered Neurontin for the agitation? Also, has his thyroid, liver enzymes and electroytes been checked very recently? There might be some alternative explanations. Trileptal can cause low serum sodium, i.e. (more likely to do so than Tegretol). If it isn't the Trileptal itself causing the trouble I wouldn't be surprised that the levels of the other meds (and their active metabolites) have been altered significantly by the Teg-Trileptal switch and that may be the root of the trouble. You might go over this idea with his doctor. Hope this helps.
poster:Ritch
thread:216660
URL: http://www.dr-bob.org/babble/20030402/msgs/216678.html