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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by canwetalk on April 3, 2003, at 20:29:37
My daughter's new psdoc wants to increase her dilantin to 300mgs. due to aggression, irritability and agitation. Which she displays for short periods of time. Is on Abilify 15mg and this is causing it.
Says he wants to up dilantin to 300mgs and than after it works ok for her increase Abilify slowly till he gets up to 30mgs.
Am concerned because dilantin is a very strange med. Also I am afraid it may be toxic to her because it happened once before when she was on 300mg.
I am not a psdoc but why can't Abilify be increased and than the dilantin. By the way she has epipelpsy and Abilify is only med that has not induced seizures for her.
Her neurologist is elated at last visit no seizure and kept her dose at 150mg. Now this psdoc wants to increase it I am concerned. Never heard of it being used for mood stabilizer before. He did suggest depakote but she can't take it because strange as it sounds she was on it and it induced seizures.
I am very upset, please someone help me.
Posted by utopizen on April 3, 2003, at 22:00:56
In reply to Dilantin??????????????????????????????????, posted by canwetalk on April 3, 2003, at 20:29:37
Dilantin is widely prescribed for over 70 off-label indications, in thousands of prescriptions.
It is a rather well-tolerated medication, although we have been spoiled by things like Neurontin that don't appear to contraindicate anything. If your p-doc is suggesting it, I'd go with it. He's not doing anything extraordinary here, as it's been used in aggressive and unstable states for decades now as a mood stabalizer.
Good luck with your daughter's response. Working with your p-doc may produce some anxiety, but with some patience you should find a pleasant result. If you're worried about toxicity, a simple blood test will resolve your doubts. That's widely done for Dilantin.
As for being "upset," I don't know why you are. We're not psychopharmacologists here, so we should be more confident about our doctors than we sometimes are.
Posted by Ritch on April 3, 2003, at 23:39:56
In reply to Dilantin??????????????????????????????????, posted by canwetalk on April 3, 2003, at 20:29:37
> My daughter's new psdoc wants to increase her dilantin to 300mgs. due to aggression, irritability and agitation. Which she displays for short periods of time. Is on Abilify 15mg and this is causing it.
> Says he wants to up dilantin to 300mgs and than after it works ok for her increase Abilify slowly till he gets up to 30mgs.
> Am concerned because dilantin is a very strange med. Also I am afraid it may be toxic to her because it happened once before when she was on 300mg.
> I am not a psdoc but why can't Abilify be increased and than the dilantin. By the way she has epipelpsy and Abilify is only med that has not induced seizures for her.
> Her neurologist is elated at last visit no seizure and kept her dose at 150mg. Now this psdoc wants to increase it I am concerned. Never heard of it being used for mood stabilizer before. He did suggest depakote but she can't take it because strange as it sounds she was on it and it induced seizures.
> I am very upset, please someone help me.This is very strange. Abilify is *causing* the irritability, correct? Question: Why does your daughter *need* to take Abilify?
Posted by canwetalk on April 4, 2003, at 7:58:15
In reply to Re: Dilantin?????????????????????????????????? » canwetalk, posted by Ritch on April 3, 2003, at 23:39:56
My daughter is taking Abilify for schizophenia. It is the only antipsychotic that has not induced seizures. She also has epilepsy.
She onced had a grand mal and neurologists increased dilantin to 300mgs and it caused toxicity and they lowered it to 200, still was too much for her system and lowered it to 150mgs and has been on this level for a year and a half and it doing fine.
My concern is if it is increased to 300mg she is going to have the same problem. This is why I had originally posted this message.
My question is why increase dilantin, Abilify should be increased since it has not caused seizures for her.
Posted by Ritch on April 4, 2003, at 9:43:51
In reply to Re: Dilantin??????????????????????????????????, posted by canwetalk on April 4, 2003, at 7:58:15
> My daughter is taking Abilify for schizophenia. It is the only antipsychotic that has not induced seizures. She also has epilepsy.
> She onced had a grand mal and neurologists increased dilantin to 300mgs and it caused toxicity and they lowered it to 200, still was too much for her system and lowered it to 150mgs and has been on this level for a year and a half and it doing fine.
> My concern is if it is increased to 300mg she is going to have the same problem. This is why I had originally posted this message.
> My question is why increase dilantin, Abilify should be increased since it has not caused seizures for her.
I think I understand now. Yes, I would be more inclined to stick with the neurologist on the Dilantin level to avoid the toxicity. The pdoc probably is afraid that Abilify would trigger seizures if the dose was raised enough, and may think the Dilantin dose increase would settle the aggression. Is there some way you could get with her neurologist and discuss the aggression issue and what could be done (AED-wise) that could address it, IOW get the opinion of her neuro about how to approach it?
Posted by canwetalk on April 4, 2003, at 20:13:39
In reply to Re: Dilantin-oh I see » canwetalk, posted by Ritch on April 4, 2003, at 9:43:51
Thanks Ritch for your reply. Yes that is what I am going to do it discuss this matter with her neurologist. She has done just fine on 150mg of dilantin. He would know of another med to add along with the dilantin and Abilify I am sure. As I said before her system is so sensative to medications especially antipsychotic ones. Abilify so far hasn't cause any seizures or tremors like the other anti-psychotics. Thanks again for your response. We both are on the same page on what should be done. Now I have to be sure the neurologist and her psdoc are on the same page. Thanks again.
This is the end of the thread.
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