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    Old 05-04-2006, 04:13 PM   #1
    bettyst
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    Keppra question

    Since Keppra has a half-life of only 6-8 hours...why take it just twice daily...why not 3 times daily. Tripp only takes(right now...feel sure it will increase) 750 mg am and 500 pm... 12 HOURS apart....and he will have a SP around 4 o'clock everyday. Seems they (docs) would have you take it every 6 or 8 hours....NOT 12 hours apart. Maybe he just needs to get more in his system...HUH????

    Travis, Tripp's Tegretol was 10...SO it was OKAY...no problems. NO side effects. THANKS for your help with that one!! We will be testing again when he has been on Keppra for a bit longer.

    Betty

     
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    Old 05-05-2006, 02:39 AM   #2
    Travis from MN
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    Re: Keppra question

    Keppra uses the age of up to 12 for children for their texts. (then they say 4 to under 16, so don't ask). All their documentations, that I'm sure you went over; I just scanned only show BID test dossages, not TID.

    I don't know WHY. I can GUESS that it's hard for people like me to take the middle day dose. It was back when I was younger and still in middle school and they tried to add one tab of Teg at lunch that only lasted 6 months.

    *****
    IF Keppra would be administered 3x a day, Remember, the drops HALF down after 6-8 hours have passed (HALF of the keppra dose is still in a persons system).

    Then it's bumped up by the NOON dose (so add on another half life of 6-8) now (now 1 1/2 of the keppra is in a persons system; full noon, and half of the AM dose).

    Now we have been awake for 12 to 16 hours and it would be time for a PM dose to be administered, (with 1/2 of 1/2 of our morning, and 1/2 of the Noon STILL in our system!) and SLEEP needed for the night.
    So the Keppra would remain at a higher level overall then if taken BID where it would degrade midday in a persons system.


    Then we go through this cycle all over again, but with the half lives, it would level out. This just illistrates the first day drug cycle and how it carries over with time. Very similar to how Other medications do the same.

    *****
    Consider the degradation of medication somewhat as science class. It's there, but every X hours it's amount drops in half, and is effected if the substance is RE-added at the half life time. So it takes a while to get out of your system if you are on a high dose.

    It may be spacing is as problamatic as my TID Teg was when my Dr tried me on 2200mg of TegXR. I had to space that Teg VERY carefully or encounter toxic symptoms. Of course that was a very high dose of teg. Unless the patient can take it spaced properly to avoid this problem, and even when I did this, I felt a slight "peak" of the Teg the following 90 minutes or so, then it faded. I ended up dropping the noon dose due to the toxic symptoms not going away.

    If you found by looking at his past blood levels that his Teg levels are where they have been, then don't worry. Just keep your logs of the past levels so you know what they were at on what dose.

    I go from a Morning dose (around 10-11 AM) to my PM dose (10, sometimes 11). so I space mine 11 hours. But I KNOW I can safely. I don't want other people trying to stretch their doses farther out when reading this.

    When to administer the doses is person to person. It sounds he is tollerating a higher level of Teg then most people. 10's are the high end; but if it is working (as my doc said to me) don't mess with it.

    --Travis

     
    Old 05-05-2006, 05:51 AM   #3
    bettyst
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    Re: Keppra question

    I am still confussed. LOL...He is 26 years old but mentally delayed. He takes the 400mg of Tegretol 3 times a day. Has done this for over a year, though. Before that he was on 400mg am,200mg noon, and 400mg pm...taken as 8,2 and 8. The last blood test was taken about 2 or 3 hours before his last dose for the day.

    Found this on E site: Seizure control without adverse effects, not the blood drug level, is the criterion for judging the efficacy of treatment. For example, if a patient's seizures are well controlled but the level of drug in the blood is below the expected therapeutic range, the doctor will usually be satisfied and will not increase the dosage to raise the blood drug level.
    NOTICE: IT does not say IF IT IS HIGH??? HUH!!!

    AND:Checking the blood level of a drug at consistent times of day and consistent times after the last dose of medication is taken allows the doctor to compare levels at different dosages. Routine blood levels are best measured when the amount of the drug in the bloodstream is at its lowest point, which is called the trough level. This generally corresponds to the time just before the medication is taken. Trough levels fluctuate up to 15 to 20 percent in many patients who take the drug on a consistent schedule.



    DO YOU think I just need to wait for the Keppra to "kick in" BUT he has been at this level 750mg Am and 500mg PM for a week today. How long does it take for this med to get control. IF it does??? Do you think once we go up to 750 at night he will gain better contol once he REACHES A STEADY LEVEL in his blood???

    Betty

     
    Old 05-05-2006, 06:46 AM   #4
    Travis from MN
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    Re: Keppra question

    If it were me, I'd say talk to the Dr here...

    I can't say what was on my mind;
    Take a look at the time span between PM and AM. Do you feel safe with that? If it were me I'd push PM later depending on when he nods off. This is where calling the Doc comes into play big time! See what they say for spacing. It may just be me that thinks the overnight span is a little long.
    Remember, I am just a patient taking meds myself, no training to give professional advice.


    Read the article at in a stop and go manner: Patient X has a low drug level. Seizures are controlled. Blood results are BELOW the "acceptable" range. Dr does nothing (due to lack of seizures, and no problems mentioned by the patient).

    It said levels were LOW, and seizures were well controlled. If we use Dilantin as the random drug (range 10-20) and the level came out as 9, but the patient was not having seizures, why increase the dose? Patient may have held at 14 normally. If the dose was upped 50 or 100mg, that may cause toxic symptoms.

    To expand on that, there's low, and below. "Low" MIGHT mean the patient is under what they should be for the regular reading, but within acceptable for the drug. Sometimes a medication or lab test does a hiccup and the test comes back low for some odd reason (as my Keppra did, mentioned in my other post). My Dr did nothing. It was within the range, and I was not having an increase in seizures.

    Are you asking what (in theory) should be done if it is high (toxic) levels.
    I can only relay what happened to me on Keppra when I was on 4000/day, Neuro's orders. I called the clinic when I "felt" problems. He brushed it off told me it would go away. 6 weeks later I checked into another hospital ER and they did bloodwork. They didn't believe the results and had to ask me twice for my dose. The ER instructed me to drop my dose by 1000mg. That fixed the problem.
    In THIS case I was Toxic, Feeling symptoms of the medication, and had a Dr that ignored my call to report it. I made sure I stayed around people that could keep an eye on me "just in case" for safety.

    As for when to draw blood samples. That article sounded like it pointed to before AM dose. Some Dr's don't care when. Mine lets me decide the time to go in and if it should be a regular level, peak, or trough. My previous clinic wanted me to come in AM and have blood drawn then before meds (and so I didn't miss much school trough worked out well).

    Keppra takes about ONE DAY to normalize in a persons system. It does not take long compared to Teg (Teg is up to 3 weeks!).

    Keppra at 750mg BID does *not* sound high. Usually they like to increase it in 500's (boy do I know that)!

    I say watch and see what the increase does. A lot of the times medication is like baby steps (don't I know that!). They move slow to make sure it is working properly. Not sure what to tell you on what to keep your eyes out for on Keppra related problems. Wish it was easy to spot.

    --Travis

     
    Old 05-06-2006, 05:50 AM   #5
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    Re: Keppra question

    Travis,
    YOU are so knowledgeable of all this!! I,for one,am so glad you are on this board!
    My GUT tells me it is the Tegretol causing the afternoon/early evening seizures. It really started a year ago when Tripp was going off Lamitcal. The crazy neruo told us to decrease the Lamictal by (I think) 25 mg weekly until complete off. He did not even start another drug just said to "call when off Lamitcal and he'd start Zonegran" SO our GP said..."We need to increase the Tegretol by 200mg in the afternoon if Dr Pante is not starting something eles" WELL....all this time it has stayed at 4oo mg in the afternoon.SOOOOO SEE why I think it is the Tegretol! The afternoon dose needs to go back to 200 in the afternoon.

    I DO remember one time when the Tegretol level was at 14. BUT showed 10 at about 2 or 3 hours from his last dose of the day. I would think it would have been lower!!

     
    Old 05-07-2006, 07:51 AM   #6
    Travis from MN
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    Re: Keppra question

    At times I wonder if I had the twin of his Dr up in Minneapolis.

    He put me on Depakote, Teg and Dilantin at the same time. The combination that the FDA texts WARN not to use!!!

    Thankfully it was that Dr's medication moves that taught me to read about my meds and not trust them as much as I did before (I do trust my current Dr!)

    IF you can find a specalist or epileptologist they tend to be good, if you have coverage. I know my previous GP kept tabs on my case, but didn't play any part in it's treatment. Nice to know your family Dr is interested in more than your general health.

    After too many medical miskakes from my Dr, I started reading about my meds online when they were changing me, or right AFTER they handed me a new script. That way I could be warned by more than the one page generic pharmacy page often times it doesn't have items on it. The 8 page printouts are a lot, but if you can ingest it, they help.

    I was NOT warned about TegXR passing through your system. You can imagine how that freaked me out the first day (thanks Doc!). Least my friend had been on it and let me know it was perfectly normal.

    I just wish it were easier to judge in his condition if the meds have an adverse effect based on dose. :/

    From what others posted, not everybody could go into the 1000's for TegXR for dossage. That just came back to memory. Some people just can't tollerate it. (that may be a new thread to ask away at)

    --Travis

     
    Old 05-08-2006, 04:20 PM   #7
    bettyst
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    Re: Keppra question

    I took Tripp to get blood levels checked today. Neuro wanted them test BEFORE his afternoon dose.
    I really believe it is the Tegretol.....he gets SO SLEEPY after he takes that afternoon dose!!!
    Will have to wait a couple of days for the blood work to come back.
    Thanks for everything,Travis....I believe like you...we got to be our own doctors!!! I know I am more knowledgeable about his seizures and meds than I was even a year ago.

    Betty

     
    Old 06-21-2006, 11:16 PM   #8
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    Unhappy Re: Keppra question

    i am a mother of a 19 month old on keppra. she started having seizures about 1 month ago an they put her on this before her nuero exam. should this be cause for worry. not only that my sweet baby has turned evil in like 1 week of being on this i am scared that it is screwing her up more than helping. if anyone can help me it would be great. thank you

     
    Old 06-23-2006, 01:43 PM   #9
    Travis from MN
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    Re: Keppra question

    I was unaware they were starting them that young on Keppra! yikes.

    The symptoms could be an indication of "KeppRAGE" Usually emotional outursts that are uncontrollable, anger to sometimes tears.

    Let the Doc know about the symptoms you explained on here. They may have to try another med or go slower on the increases or decreases.

    From the reading on Keppra, published reports and on here, I've never heard of it being used on that young of a patient. Published reports use starting age at age 4.

    Children they tend to (in the past anyway) try Dilantin, Tegretol, Phenobarbital.

    Some medications some in a syrup, that may be the ones they are going for for the young patients (in general, not knowing anything).

    Best of luck getting something to work, and keep in touch with the Dr on if it works or not. ASKING QUESTIONS never hurts with the Doc!!

    --Travis

     
    Old 06-23-2006, 03:32 PM   #10
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    Re: Keppra question

    My husband was on Keppra and he to got the kepprage. I wish he were never put on that medication. His neurologists took him off of it because of his rage. He would be so hard to control. Keppra did so much damage with him that now he may be diagnosed with bipolar. Things havent been the same for us since Keppra. We have tried so many meds to reverse the effects but have had no success. Right now he has started taking lamictal for both bipolar and his epilepsy. If you get the chance to talk to your doc and tell them about the rage. I would ask if there is an alternative med. My husband has had epilepsy since the age of 6. They started him on tegretol. He has been through tegretol, depakote, and dilantin. Currently he is on zonegran, carbatrol and lamictal. His seizures are very well controlled. He can go a couple of months without having a seizure. Now we have bigger things to worry about.

    Keep us posted.

    Annette

     
    Old 06-23-2006, 07:56 PM   #11
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    Re: Keppra question

    Hi, My husband is on keppra too. He has these times when he gets angry and your not sure why, but he also got that way with depakote and pheno. I think some of it was from having seizures for so many years. Topamax causes problems also. Right now he is on Lamictal and Keppra. He had temperal lobe surgery two years ago and has not had any seizures since. Thank God!. They have weened him off of all his topamax and we are hoping he can be left just on the Lamictal. Which I understand is also used for bipolar. I always tell him I have been living with Dr. Jekyl and Mr. Hyde for the last 39 years. I never new about the Keppra till I read these posts. I sure hope we can get rid of it. He's on about 3000 mgs aday. Best wishes to all. Karen

     
    Old 06-23-2006, 11:00 PM   #12
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    Thumbs up Re: Keppra question

    thank you for the reply!! it is makeing this whole this alittle easier knowing that i am not the only one dealing with this. so what i am understanding is that kepprage is a known factor? Why would the put anyone through this let alone alittle baby. but thank you again she goes to the neuro for the first time on monday i will let you all know how that goes.:

     
    Old 06-26-2006, 10:15 PM   #13
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    Unhappy Re: Keppra question

    just to let everyone know we took the baby to her neuro today. Well her EEG was normal so now we are moving onto the next step of MRI. i also asked the dr about Keppra an her mood swings. He said that it is normal but if it doesnt go away in another 2 weeks then we are going to change. But he upped the dose? why we dont know but i guess he paid alot of money to go to school he knows what he is talking about right? He also said that keppra is the best for babies because it is in a liquid. Also because it is water based so it goes right through her system so it doesnt sit in her liver like other ones. so i guess she doesnt have to have the blood work all the time. i dont know nothing seems to look up for me anymore. but i would like to thank you guys for helping me through this i just need someone with knowledge on this to help. Thank you lots!!!

    you are my angels!!
    Tara

     
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