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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by katrina on June 18, 2001, at 16:43:47
Did anyone else feel funny getting on this stuff? I just started 100 mg of tegretol with only 350 mgs. of depakote, but when I added the tegretol I got this weird feeling like I was totally disconected or just really off... Can anyone relate? Does this wear off or just pass etc.? Any help would be great...I am upping the dose in another week so I am not looking forward to it again or more intensely.
Posted by Sunnely on June 18, 2001, at 21:55:27
In reply to Tegretol/depakote start-up issues??? Feel strange, posted by katrina on June 18, 2001, at 16:43:47
Hi Katrina,
The combined use of carbamazepine (Tegretol) and divalproex sodium (Depakote) increases the risk of more pronounced central nervous system (CNS) side effects (neurotoxicity) than if either drug used alone. CNS side effects may include drowsiness, dizziness, vertigo, and unsteadiness. Feelings of derealization or depersonalization (what you probably experienced) may also occur.
Aside from "pharmacodynamic" drug interaction (site of action), "pharmacokinetic" drug interaction (usually involves metabolism) can also occur between Tegretol and Depakote. The addition of Depakote to Tegretol may lead to an increased ratio of 10,11-carbamazepine epoxide (CBZE) via inhibition of the enzyme called epoxide hydroxylase. This could lead to neurotoxicity in some patients. Also, Depakote may cause displacement of Tegretol from protein-binding proteins, producing a transient increase in Tegretol effects. Conversely, Tegretol reduces Depakote levels but increases levels of Depakote's metabolite (daughter compound) called 2-propyl-4-pentanoic acid, which is hepatotoxic (can cause damage to the liver) and teratogenic (can cause birth defects).
Although the Tegretol-Depakote combination is usually well tolerated, avoid this combination if possible. However, if the combination is used, the following measures should be followed to avoid potential toxicity:
1. Monitor blood levels of both Tegretol and Depakote closely.
2. Obtain blood level of CBZE (10,11 carbamazepine epoxide) if possible. (Note: Checking for the blood level of this Tegretol daughter compound is rarely obtained in clinical practice.)
3. Closely monitor the patient for signs of neurotoxicity and adjust the dose accordingly.
4. Liver function tests (LFTs) should be checked more frequently than with either drug alone.
5. This combination seems more useful in patients with bipolar disorder who are partially or treatment-resistant to either drug alone. Patients with schizoaffective disorder and brain-injury seem more prone to occurrence of neurotoxicity with this combinatioin.
6. Keep in mind that in some patients maintained on this combination, discontinuing Tegretol may lead to subsequent increased in Depakote blood level.
7. Last but not least, for women of child-bearing age, supplemental dosage of folic acid (400 mcg) is advisable when taking either or both drugs.
*********************************
> Did anyone else feel funny getting on this stuff? I just started 100 mg of tegretol with only 350 mgs. of depakote, but when I added the tegretol I got this weird feeling like I was totally disconected or just really off... Can anyone relate? Does this wear off or just pass etc.? Any help would be great...I am upping the dose in another week so I am not looking forward to it again or more intensely.
Posted by chloe on June 22, 2001, at 9:50:48
In reply to Re: Tegretol/depakote start-up issues??? Feel strange » katrina, posted by Sunnely on June 18, 2001, at 21:55:27
> Hi Katrina,
>
I can only share my experience. I was on a small dose of Depakote, like you are, when I added Tegretol. The Tegretol knocked me out! I was unsteady, tired and had terrible heartburn. I slowly over time, was able to adjust to the both of the meds. But I think that the Tegretol, for me, was very difficult to take. Though I felt pretty "normal" after a month or so, I always had heartburn and anorexia, and tended to feel unsteady on my feet.After 2 years on Tegretol, I lost too much weight to continue on it. The GI symptoms for me were unbearable. So I switched to Trileptal, a "cleaner" form of Tegretol. It is much gentler on my stomach, but I do have a little more trouble with my rapid cycling. But I will take Trileptal anyday over Tegretol. Tegretol is a great drug, but in my case, the side effects made it too tough for me to function.
I hope you are beginning to adjust. Keep us posted!
Chloe
Posted by katrina on June 22, 2001, at 10:38:51
In reply to Re: Tegretol/depakote start-up issues??? » Sunnely, posted by chloe on June 22, 2001, at 9:50:48
> > Hi Katrina,
> >
> I can only share my experience. I was on a small dose of Depakote, like you are, when I added Tegretol. The Tegretol knocked me out! I was unsteady, tired and had terrible heartburn. I slowly over time, was able to adjust to the both of the meds. But I think that the Tegretol, for me, was very difficult to take. Though I felt pretty "normal" after a month or so, I always had heartburn and anorexia, and tended to feel unsteady on my feet.
>
> After 2 years on Tegretol, I lost too much weight to continue on it. The GI symptoms for me were unbearable. So I switched to Trileptal, a "cleaner" form of Tegretol. It is much gentler on my stomach, but I do have a little more trouble with my rapid cycling. But I will take Trileptal anyday over Tegretol. Tegretol is a great drug, but in my case, the side effects made it too tough for me to function.
>
> I hope you are beginning to adjust. Keep us posted!
> Chloethanks...I do not have the GI probs., but I am just going up to 200mgs. Did the tegretol help with depression, too. It has helped the rapid cycling and squash some of the hypomania, but I have had some horrible depression...my doc says to hang on and give the teg/dep. a try before we do more...
Posted by Cam W. on June 22, 2001, at 11:47:56
In reply to Tegretol/depakote start-up issues??? Feel strange, posted by katrina on June 18, 2001, at 16:43:47
Katrina - What you are experiencing sounds a lot like antimuscarinic side effects (dizziness, dry mouth), probably from the Tegretol. Also, Tegretol can cause agitation and restlessness, especially when first starting it. They titrate the dose slowly, to try to avoid some of these side effects. Then doses are adjusted according to blood levels. Your body does adjust to the Tegretol (and the Depakote) over time and these side effects will fade.
The Depakote's GI irritation and dizziness can add to these problems.
Tegretol does have antidepressant activity, but lately, research says that the antidepressant activity is not that strong. Tegretol™ (carbamezepine) is a tricyclic molecule (like Elavil) and does have strong antimuscarinic activity, like the TCAs. I do believe that Tegretol does stabilizes one's mood, so that the lows are not so low, and the highs not so high.
Hope that this is of some help. - Cam
Posted by chloe on June 22, 2001, at 16:42:34
In reply to chloe, posted by katrina on June 22, 2001, at 10:38:51
> > > Hi Katrina,
> > >
I don't think I got much AD effect from Teg. I am aware of the TCA component, but I never felt any elation or positive feelings on Teg, like I might on an SSRI, for example. But Teg. did such a great job of evening me out, that the cycling was under control, which was such a relief! And, since my mood was so stable, I was able to add a LITTLE antidepressant to chase away the gloom and doom.If you can tolerate the side effects (which do get better in time, at least a month...), this is a great drug and can give you alot of benefit, in my opinion. AND some people do experience some AD effect. So hang in there, and see how you do!
All the best,
Chloe
Posted by 2sense on April 20, 2002, at 17:23:15
In reply to Re: Teg/dep issues » katrina, posted by chloe on June 22, 2001, at 16:42:34
What were your side effects? I am just starting for a seizures due to cold turkey from Klonopin Hotel -- long story -- thanks for any info.
Sue
Posted by Chloe on April 20, 2002, at 17:32:40
In reply to Re: Teg/dep issues » chloe, posted by 2sense on April 20, 2002, at 17:23:15
> What were your side effects? I am just starting for a seizures due to cold turkey from Klonopin Hotel -- long story -- thanks for any info.
>
> SueHi Sue,
Very sorry to hear about your withdrawal seizures.
Which one are you starting, Tegretol or Depakote? They both have very different side effect profiles. Could you tell me which one you are starting?Chloe
Posted by 2sense on April 20, 2002, at 17:38:50
In reply to Re: Teg/dep issues » 2sense, posted by Chloe on April 20, 2002, at 17:32:40
NO DEPAKOTe just Tegretol starting at 100 mg now headed for 600 mg.
Posted by Chloe on April 20, 2002, at 17:52:39
In reply to Re: Teg/dep issues » Chloe, posted by 2sense on April 20, 2002, at 17:38:50
Hi Sue
Tegretol, FOR ME, was one of the more difficult meds to adjust to in terms of side effects. I had to increase my dose VERY SLOWLY, and it took 2 or 3 months until I felt "like myself" on it.My chief complaints were:
dry mouth/throat
stomach cramps
constipation
loss of appetite
weight loss
unsteadiness on my feet.But I always slept well, had less rapid cycling, and I don't remember any sexual disfunction. The hardest part about this med is letting your body adjust to it. It really takes many weeks. Though I am not sure if I ever got my "land legs" back. I always felt a bit unsteady at 350 mgs. Though I am very med sensitive, I NEVER can take therapuetic dose of anything.
I can see you are very anxious about taking Tegretol. It's a good drug, and has been around a long time. And over time, I think it's antianxiety effects will kick in too. Give yourself some time to get adjusted. I would not increase the dose until you feel ok at 100 mgs.
BTW, I went off it due to stomach complaints and weight loss. So not everyone gains weight on Teg.
Hope this helps.
Chloe
Posted by 2sense on April 20, 2002, at 18:09:08
In reply to Re:Tegretol » 2sense, posted by Chloe on April 20, 2002, at 17:52:39
Thank you very much, I really appreciate it.
Sue
Posted by Chloe on April 20, 2002, at 18:59:27
In reply to Re:Tegretol » Chloe, posted by 2sense on April 20, 2002, at 18:09:08
> Thank you very much, I really appreciate it.
>
> SueGlad I could help. Keep us posted on how you are doing.
Hang in there ;-)
C
Posted by zero on April 21, 2002, at 0:19:14
In reply to Re: Teg/dep issues » chloe, posted by 2sense on April 20, 2002, at 17:23:15
Sue,
Wanted to add a 2nd positive experience w. Tegretol (I am with Chloe on this).I took 600mg./day for over 4 yrs.
It helped me alot.
No weight gain.
No sexual impairment at 600mg./day.
Helped alot with anxiety.
Felt very "solid".
No longer had to worry about feeling "out of control".
Always slept well.Only dislike was that I got headaches starting out at 200mg. (they stopped in a few days), and they recurred each time my doc upped the dose by another 200mg. (in retrospect, I should've gone up slower).
Hope it works for you too.
Best wishes,
zero
Posted by 2sense on April 21, 2002, at 7:27:25
In reply to Re: Teg/dep issues » 2sense, posted by zero on April 21, 2002, at 0:19:14
Thank you ever so much, between yourself and Chole, my anxiety (without the help of meds :-)) has dropped to null.
Is there a particular reason you were on it? Is there a particular reason your doc choose Teg. vs. another anti-convulsant?
I sort of feel, given my psych-doc was jumping up and down almost literally, thankfully my husband was with me and also saw him do this little Ruplestillskein (?spelling -- no idea sorry ?) dance along with commentary (positive not angry as the latter Grimm's character), we felt given his "demonstration" was in the waiting room and there were other patients he might/should have contained his "happiness" that he "won" out. I am taking it after due to a set of circumstances having nothing to do with his treatment plan or diagnosis, I was being placed on this anti-convulsant that doubles as one of the mood disorders)because of cold turkey Klonopin disorder (which he refused to take me off of). I need a new psych-doc but the eating disorder therapist is EXCELLENT, as I have mentioned in other posts, so the insurance problems come into play along with liability issues -- I talked to the insurance company Friday though, and they agree there has been quite a bit of "irresponsibility" on the part of several doctors and I shouldn't have to stay with this psych and give up the only person who is making progress with my relearning coping mechanisms to stress, etc.. which there is no shortage of the latter in my life.
Thanks again -- and I have no idea (and of course it is none of my concern/business) why you choose the username - zero - but you are no zero to me or to anyone else -- you are 6 zeros with a 1 in front AT LEAST!!!
Sue
Posted by zero on April 21, 2002, at 10:37:06
In reply to Re: Teg/dep issues » zero, posted by 2sense on April 21, 2002, at 7:27:25
Sue,
I was given Tegretol as a mood stabilizer to help w. Bipolar II plus comorbid panic disorder/social phobia (this, more or less, has been my diagnosis).When I first started Tegretol, there weren't that many mood stabilizers to choose from (really only Lithium, Depakote and Tegretol). I took my doc's advice on it, and wasn't sorry.
Good luck w. your "situation", and hoping the Tegretol helps you.
zero
Posted by 2sense on April 21, 2002, at 12:06:38
In reply to Re: Teg/dep issues » 2sense, posted by zero on April 21, 2002, at 10:37:06
Thanks again. I've only had four (4) doses
Friday PM , Saturday AM, and Saturday PM, and
then this morning. The dose is 1/2 of a 200 mg.
tablet. I do not know what I expect to happen,
but I feel like I don't know -- that is why
yours and Chole's input has been so HELPFUL!!Take Care ... Sue
This is the end of the thread.
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