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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
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. Thanks
Posted by canwetalk on April 6, 2003, at 12:33:36
In reply to Please help-trileptal!!!-manic?, posted by e503 on April 6, 2003, at 10:37:11
Sounds like you are really going through something. I can halfway understand it too! I was having similiar problems with my daughter.
Have you every heard of the med Abilify? I do believe it would help your son greatly. Your son is young to have had as many drugs given to him. He is still on a lot as well.
I would suggest Abilify to your son's psychiatrist the next time you see him. In taking the Abilify your son should not have to be taking so many medications.
Go on web and you can do some research on Abilify and decide yourself. I strongly feel it is worth a try.
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.
Posted by judy1 on April 6, 2003, at 18:36:24
In reply to Please help-trileptal!!!-manic?, posted by e503 on April 6, 2003, at 10:37:11
I also had a lot of problems with agitation on trileptal (and also risperdal). If he needs an AP, seroquel is fairly sedating and for a mood stabilizer depakote is also calming- has he tried either of those meds? i am so sorry for both of you and i hope you'll be able to find an effective combo soon. i really do think he should be weaned off of the trileptal asap. take care, judy
Posted by e503 on April 6, 2003, at 18:49:02
In reply to Re: Please help-trileptal!!!-manic? » e503, posted by judy1 on April 6, 2003, at 18:36:24
Thanks so much to all who answered my post. Judy- ben has been on seroquel....in fact that is what started this whole "mania" thing, i think. As usual, we kept on increasing it and he got worse and worse. Terribly agitated. Called the pdoc that weekend and that's when he started tegretol. Depakote- we had tried a while ago, before tegretol, and it didn't seem to do anything.
Anyways, wanted to tell you all that we decreased the trileptal yesterday to 1500 mg./day (from 2400 mg.) and sure enough he was MUCH better today. Still obsessive but in a GREAT mood.....like I haven't seen him since he started trileptal. So, what does this all mean? Do I keep on cutting back? I have to tell you, since ben gets so activated/agitated on the meds that it seems are supposed to be calming, I almost am afraid to try anything! the doc did mention abilify to me and said that would be the next thing to try (that was before this weekend). I am now trying to figure out if he would be better off not on this stuff (trileptal)or just a smaller dose.
Thanks all and if anyone knows why he gets so agitated from risperdol, seroquel, zyprexa, and now high dose trileptal, can you let me know? is abilify the same type of drug as risperdol? will it cause the same type of affects for ben?
lisa
Posted by e503 on April 6, 2003, at 18:56:30
In reply to Re: Please help-trileptal!!!-manic?-follow up , posted by e503 on April 6, 2003, at 18:49:02
Hi ritch-
I think you were the person who helped me with ben once before (a year ago). He was only taking zoloft in the p.m. and was wild during the day. You suggested he take it during the day,,,something with the metabolite (?) and sure enough, it helped! So thank you. As far as neurontin is concerned, been there. Ben got too "uninhibited" (is that what I want to say?). What do you think about Abilify? Is it too much like risperdol? as far as a reduction in risperdol, I know I have tried before, and for some reason we kept it. You are saying that possibly there is "more" risperdol makes sense to me. What would you do if you were me? Keep on going down in trileptal? try abilify?
thanks,
elise
Posted by e503 on April 7, 2003, at 12:08:16
In reply to Re: Please help-trileptal!!!-manic? » e503, posted by Ritch on April 6, 2003, at 12:50:22
Just spoke to ben's school. They said he was "awesome" this am. This is the problem: seems that about 4 hours or so after he takes his "cocktail" of trileptal, buspar and zoloft he gets manic. Not agitated so far, but non-stop talking, etc. Last year we figured out that if he takes his zoloft during the day (he only takes 75 mg. total--50 in the a.m. and 25 after school)it seems to "calm" him down. So what to do now? I have noticed also this weekend after we give him his afternoon dose (same meds) the same thing happens about 3-5 hours later...non stop talking. It also is like that first thing in the a.m. until he gets his meds. I don't think it could be the 1 mg. risperdol he takes at night, as it happens all day long. What has a half life that could be causing this? can it be the trileptal???????
thanks,
elise
Posted by Ritch on April 7, 2003, at 12:55:29
In reply to Re: Please help-trileptal!!!-manic?, posted by e503 on April 7, 2003, at 12:08:16
> Just spoke to ben's school. They said he was "awesome" this am. This is the problem: seems that about 4 hours or so after he takes his "cocktail" of trileptal, buspar and zoloft he gets manic. Not agitated so far, but non-stop talking, etc. Last year we figured out that if he takes his zoloft during the day (he only takes 75 mg. total--50 in the a.m. and 25 after school)it seems to "calm" him down. So what to do now? I have noticed also this weekend after we give him his afternoon dose (same meds) the same thing happens about 3-5 hours later...non stop talking. It also is like that first thing in the a.m. until he gets his meds. I don't think it could be the 1 mg. risperdol he takes at night, as it happens all day long. What has a half life that could be causing this? can it be the trileptal???????
>
> thanks,
> elise
You might suggest holding off on the Trileptal dose until noon and have him just take his Zoloft and Buspar dose in the morning and see what happens. If the "non-stop talking" occurs about the time he is getting out of school-you may have found what is causing it (Trileptal). You need to find out which one is doing it first before you start switching (IMO).
Posted by e503 on April 7, 2003, at 13:16:57
In reply to Re: Please help-trileptal!!!-manic? » e503, posted by Ritch on April 7, 2003, at 12:55:29
> > Just spoke to ben's school. They said he was "awesome" this am. This is the problem: seems that about 4 hours or so after he takes his "cocktail" of trileptal, buspar and zoloft he gets manic. Not agitated so far, but non-stop talking, etc. Last year we figured out that if he takes his zoloft during the day (he only takes 75 mg. total--50 in the a.m. and 25 after school)it seems to "calm" him down. So what to do now? I have noticed also this weekend after we give him his afternoon dose (same meds) the same thing happens about 3-5 hours later...non stop talking. It also is like that first thing in the a.m. until he gets his meds. I don't think it could be the 1 mg. risperdol he takes at night, as it happens all day long. What has a half life that could be causing this? can it be the trileptal???????
> >
> > thanks,
> > elise
>
>
> You might suggest holding off on the Trileptal dose until noon and have him just take his Zoloft and Buspar dose in the morning and see what happens. If the "non-stop talking" occurs about the time he is getting out of school-you may have found what is causing it (Trileptal). You need to find out which one is doing it first before you start switching (IMO).That's a great idea! I was trying to figure out how to do that (figure out which one is causing problems). What about if I didn't give him the trileptal until after school? Do you think that would work? Is it ok to wait all day do you think?
Posted by Ritch on April 7, 2003, at 22:04:11
In reply to Ritch!, posted by e503 on April 7, 2003, at 13:16:57
> > > Just spoke to ben's school. They said he was "awesome" this am. This is the problem: seems that about 4 hours or so after he takes his "cocktail" of trileptal, buspar and zoloft he gets manic. Not agitated so far, but non-stop talking, etc. Last year we figured out that if he takes his zoloft during the day (he only takes 75 mg. total--50 in the a.m. and 25 after school)it seems to "calm" him down. So what to do now? I have noticed also this weekend after we give him his afternoon dose (same meds) the same thing happens about 3-5 hours later...non stop talking. It also is like that first thing in the a.m. until he gets his meds. I don't think it could be the 1 mg. risperdol he takes at night, as it happens all day long. What has a half life that could be causing this? can it be the trileptal???????
> > >
> > > thanks,
> > > elise
> >
> >
> > You might suggest holding off on the Trileptal dose until noon and have him just take his Zoloft and Buspar dose in the morning and see what happens. If the "non-stop talking" occurs about the time he is getting out of school-you may have found what is causing it (Trileptal). You need to find out which one is doing it first before you start switching (IMO).
>
> That's a great idea! I was trying to figure out how to do that (figure out which one is causing problems). What about if I didn't give him the trileptal until after school? Do you think that would work? Is it ok to wait all day do you think?Hi, I would ask your doctor if it would be OK to drop the Trileptal from 1500mg to 1200mg (One 600mg tab twice daily-once at bedtime and once at lunchtime at school). See if you can get a school nurse to give him his dose (if you don't trust his compliance) at lunchtime. You don't want to spread the time out too much between doses of Trileptal because of its relatively short half-life. Then find out from his teachers how his behavior is throughout the day. What would be telling is his behavior pre-dosing and his behavior post-dosing from other objective reporters.
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