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Old 08-30-2007, 01:17 PM   #1
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unexplained drop in dilantin level

I have been taking dilantin since 1991, 500 mg a day is the effective dose for me. The only problems occurred after a lowering of dose by my docter.
Recently I had a seizure taking the 500 mg a day. My dilantin level 10. This was about 3 to four hours after my morning dose.
My historical levels and therapeutic range has been 16 to 21(trough). I have maintained good control and levels for many years on this dose. This led me to suspect the dilantin batch that I was taking at the time. After switching lots, my levels are fine again within one week and have I had levels tested every week since 15.9, 19,20.,21.9,22.. Is this a coincidence, or is it the dilantin. Three weeks before the seizure, I had a riding accident and hurt my back, causing swelling and much pain, I took advil for it, but do so every month reqularly for menstrual pain. I can see this being the cause of the seizure, but not the lowered level. Anyone else have this problem recently
I sent the pills for testing to Pfizer and called the fda. the pills were dated
4/17/07 and were from Medco. thanks

 
Old 08-30-2007, 04:44 PM   #2
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Re: unexplained drop in dilantin level

Dilantin used to be made by a differnt company...are these generic? That can be a big cause for a lowered level. Ten is still at the lower end of normal limits. I wouldn't worry too much unless it continues to be low. Have you been more active than usual? Metabolism changes? Diet pills? I'd be more concerned about levels over 20, in the toxic range.

Last edited by neurowreck; 08-30-2007 at 04:45 PM. Reason: addition

 
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Old 08-31-2007, 05:28 AM   #3
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Re: unexplained drop in dilantin level

Quote:
Originally Posted by neurowreck View Post
Dilantin used to be made by a differnt company...are these generic? That can be a big cause for a lowered level. Ten is still at the lower end of normal limits. I wouldn't worry too much unless it continues to be low. Have you been more active than usual? Metabolism changes? Diet pills? I'd be more concerned about levels over 20, in the toxic range.
The dilantin was Parke Davis distributed by Medco. I need to stay in the upper therapeutic range of 16 to 20. And have done so for many years. I had a gran mal on the level of 10. After switching lot nos. of the dilantin, my levels have been 15.9, 19, 20, 21. , 22 tested weekly.
My habits, exercise, etc remained the same, However, I did have a riding accident 3 weeks prior and hurt my back causing swelling. I can see this as a reason for the seizure but the doctors said it would lower the level. I did take motrin. But I have taken motrin for many years too.

 
Old 08-31-2007, 04:18 PM   #4
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Re: unexplained drop in dilantin level

The riding accident could cause generalized stress, but the back swelling shouldn't cause med levels to change. You're bound to get different lot numbers since they can only make so many of a certain lot. But, the quality control should still guarantee that there are the same number of mg/pill no matter what the lot. I don't think the Motrin would cause a lower dilantin level. Did you have the test about the same time after taking the meds as previous tests? Granted, the half-life and overall level should stay relatively stable, but there can be some changes, depending on when you took the med and when you got the level done....

 
Old 09-02-2007, 10:30 AM   #5
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Re: unexplained drop in dilantin level

Quote:
Originally Posted by neurowreck View Post
The riding accident could cause generalized stress, but the back swelling shouldn't cause med levels to change. You're bound to get different lot numbers since they can only make so many of a certain lot. But, the quality control should still guarantee that there are the same number of mg/pill no matter what the lot. I don't think the Motrin would cause a lower dilantin level. Did you have the test about the same time after taking the meds as previous tests? Granted, the half-life and overall level should stay relatively stable, but there can be some changes, depending on when you took the med and when you got the level done....
The low level of 10 was taken about 3 hours after my morning dose.
All other levels were trough levels taken before I took the morning dilantin. All at the same relative time. My surprise is that a level taken after my dose could be so low compared to ones prior to my dose. I realize that the lot nos. change and I am skeptical of the qc of this lot. dated 4/17/07 from Medco.

 
Old 09-02-2007, 10:48 AM   #6
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Re: unexplained drop in dilantin level

Have you gotten them through Medco before? I'm used to getting meds (brand) from the company that makes them, not a supplier, so I guess I don't understand that (sorry). A lot of meds are being made out of this country, and packaged for companies based in the US, so you have reason to wonder about quality control. Most test a few pills from each batch, but if they're made who knows where, they may have different qc procedures. Can you get a prescription from a different pharmacy that doesn't get their Dilantin from Medco? 10 is low for a peak.

 
Old 09-02-2007, 11:34 AM   #7
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Re: unexplained drop in dilantin level

Quote:
Originally Posted by neurowreck View Post
Have you gotten them through Medco before? I'm used to getting meds (brand) from the company that makes them, not a supplier, so I guess I don't understand that (sorry). A lot of meds are being made out of this country, and packaged for companies based in the US, so you have reason to wonder about quality control. Most test a few pills from each batch, but if they're made who knows where, they may have different qc procedures. Can you get a prescription from a different pharmacy that doesn't get their Dilantin from Medco? 10 is low for a peak.
Medco Health services is a vipps pharmacy that my husbandss company has used for several years. It is basically a warehouse of pharmaceuticals with FDA
oversight. Because I was skeptical about Medco myself, I did get a prescription filled at CVS, which gave good high levels but so did another batch that I just received from Medco after the suspect one.
The dilantin is parke davis made in Puerto Rico by Warner Chilcott a division of Pfizer. Now that is reassuring isn't it. Pfizer farmed out dilantin to that company several years ago.
I haven't received the results from the testing yet at pfizer or heard back from the FDA. Hopefully this week.

 
Old 09-02-2007, 12:10 PM   #8
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Re: unexplained drop in dilantin level

So many drug companies are using cheaper labor in other countries to make the medications we need to keep us healthy.....it's horrible. If there were US FDA inspectors on sight, I'd feel better, but I"m not holding my breath that that's going to happen. Can you get the CVS meds?

 
Old 09-02-2007, 12:35 PM   #9
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Re: unexplained drop in dilantin level

Quote:
Originally Posted by neurowreck View Post
So many drug companies are using cheaper labor in other countries to make the medications we need to keep us healthy.....it's horrible. If there were US FDA inspectors on sight, I'd feel better, but I"m not holding my breath that that's going to happen. Can you get the CVS meds?
The CVS meds are also parke davis -,warner chilcott.
But yes I am considering switching my prescription to CVS
because the problem may be with the pharmacy and not PD.
I want to see what the results bring back. It would be helpful to
know if anyone else is experiencing these low levels, but I haven't
heard anything about that from anyone.

 
Old 09-02-2007, 07:13 PM   #10
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Re: unexplained drop in dilantin level

Since Parke Davis created Dilantin, and had made the stuff in the US for years, if there's any way to get US made stuff through CVS, I'd go for it. Med levels are hard enough to get regulated, without some offshore warehouse possibly storing them too hot, or humid, or whatever, or the QC not being adequate.....

 
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