Changing meds... Dilantin to ???

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daviscy60

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Hey - I'm new to this. I have taken Dilantin for at least 30 years, 300 mg/day. Wasn't good at taking it at first but have finally over come those issue. Now about 4 to 6 months ago I have started having breakthrough seizures. I have been told by my PCP to take 400 mg/day. I do not like the way it makes me feel. Dizzy, hard to concentrate, and I have been depressed and having bad anxiety. Not sure if the being depressed and anxiety is from taking 400mg/day or if it good be other issues. Suppose to have an EEG in two weeks and neuro says we may talk about changing to another med. After reading some of the stories on here i'm really not sure this is what I want to do. Has anyone had to go thru this? Do you think I will eventually get use to taking the 400 mg/day. I'm not that big of a person. I'm a 52 yr female, 5'2" and weight around 135. Isn't 400 mg /day a little much? I would really just like to forget all this. Some times feel like maybe just stop taking it all together and see what happens......
 
Hello, & Welcome, Davis! First, I would let your primary care M.D./PCP & your neurologist definitely know how you feel on the increased dose of Dilantin, and how you feel overall about the possible change in your medication, how you feel about your breakthrough seizures, & how you feel about your scheduled testing. On Monday, please schedule an appointment so you can discuss this with them. However, whatever you decide, please DO NOT stop taking your Dilantin as prescribed.
 
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Hi daviscy60, welcome to CWE!

You might ask to have your blood Dilantin levels tested -- they may be on the high side as you suspect, and causing the dizziness and other problems. If the side effects are problematic or intolerable, then you shouldn't put up with them -- definitely ask your neuro about backing off the dose a bit and/or switching to another med entirely.

Do you keep a seizure/symptom/med diary? That can help you track how you're affected by any changes in meds ordosages, and can also help you look for patterns or triggers that may have contributed to the recent breakthroughs. Sometimes fluctuating hormones can be a trigger for instance -- I don't know if that's relevant to you, but some folks do see an increase in seizures around perimenopause.
 
Thanks for advise... both. I have had the levels checked multiple of times. Dec breakthrough in ER and it was low even though I know I took it the night before. Taking 3 a day. My PCP checked it in March (renew meds pres.) At 4/ day it seems to stay around 19 or 20 which is what causes me the problems but she thinks that is where it needs to be. Neuro says last visit little over a week ago that because of my size she can see why is all I got out of her so far.... she wants me back next Monday to do EEG and she is I guess looking over info... Today I think I have made my decision..... I would really like to just drop all of this including the meds and what ever is Gods decision from there... I will let it be his. All I know is I have almost a whole week to go before I go back and I can't take how I feel today or how I felt yesterday for another week.... My insurance has some sort of nurse hot line... I called them last Friday they gave me to some behavioral place... All I am looking for is someone that may understand what I am feeling and realize that it is the meds that are making me feel this way and I'm not just a crazy person.... or maybe I am. It is starting to make me feel this way. They changed my work schedule at work to where I don't get off till midnight, so I take it at around 10:00. Last night decided I'm only going with 3. but the other one in my pocket to throw in trash when I went to restroom. Later felt guilty about it so I pulled it out of my pocket and took it. Today I'm just saying I can't go anymore..... I really just want to put it all behind me. Maybe menopause is just making me a crazy person..... who knows??? I really don't think anyone does. Just WISH I COULD FIND SOMEONE THAT WOULD UNDERSTAND....
 
hi and welcome!
just FYI I'm male/43 about 170 lbs. and I take 500mg of phenytoin a day.
100mg per 30-50 lbs. seems to be around the range for me too - but I don't know precisely what the recommended dosage is

but that phenytoin is a drug where they suggest taking another one if you start to feel weird - so there seems to be some wiggle room also - and it is one of the oldest and most tolerated in general
I hope you are able to come to some peace about these things
we're here to provide each other support
you found a good place
I've been here about 4 years - I developed tonic-clonics at age 38 and started off with phenytoin
 
Hey Daviscy60,

Sounds like you are really having issues with dilantin, at least the upping of the medication. If it doesn't go away then definitely go back to the 3/day. I was on lamotrigine for 6 months before it started messing with me. For 6 months it seemed to work like all the other meds i had been on, but the side effects were not as bad. But it made my seizures after 6 months very violent. I told my doc this and what did he do, but up my dosage to the max, which i was already close to. Well that increase caused me to have shortness of breath, doing things i do regularly. So i knew that it was the meds causing it and i emailed the doc, he did nothing, so i had to demand him to take me off of it. Which he did and i moved on to another medicine, Gabapentin.

We can't tell if it's the meds that is causing you to feel the way you are, only you know yourself the best and if physically or psychologically you feel something is wrong then go with your feelings.

I was on dilantin a few months, but the doc had to change it because i could never reach the therapeutic range which is between 10-20. Your being at 19 seems right on the border. Definitely talk to your doctor and let her know what you have told us.

Cheers,
Zolt
 
... At 4/ day it seems to stay around 19 or 20 which is what causes me the problems but she thinks that is where it needs to be...

I've taken Dilantin for 40+ years and I know that 19 to 20 is definitely on the high side. Since 20 is the upper bounds of the therapeutic limit, you could actually be slipping over the line at times. I do tend to have problems with over dosing (one time I was at a level 43 - very dizzy and seeing double, yikes!). I did find a wonderful doctor who discusses my dosages & levels with me. I've been keeping track of my levels for 15 years along with the dosage. This helps me and my doctors to understand "where I've been".

Currently I take 400mg one day and 300 mg the next. I've taken all sorts of variations on this to keep my blood levels at 16/17 which is where I find I feel the best. Every one is different of course but I know I did find that lowering just a little can make a big difference in how I feel.

I do hope everything works out for you whatever you decide to do.
 
Thanks Dolores for the advice of 400 one day/ 300 the next.... I have had the level up around 25 before and know what it feels like. I also know the difference in the way I feel when it is around 10 taking 300/day and what I feel like when it gets up around 20 taking 400/day. It does seem like if I can't handle the 10 anymore that at least 16 or 17 would be better than keeping it close to 20.
 
I have to say or add... One of my issues I'm dealing with right now, is I have been comfortable with 300/day and keeping the level around 10. My problem has never been so bad that even if I missed a dose for some reason I did not usually have any problems. Over the last 6 months all of a sudden things have changed. I have had two spells at work. In the past I lost one job because of a spell at work due to trying to work two jobs at same time. So for now... I'm scared not to take the 4, I'm scared to take 4 because of how I feel, yet after reading info on other meds I'm scared to change.... Just want to go back to the way thing were and I could just forget about it and put it out of my mind. I keep telling myself this week that after I get appointment for EEG and Nero next Monday.... maybe I can put this all behind me and forget about it.
 
Daviscy60 - I immediately thought of you when I got my blood test results today! Every so often my Dilantin levels spike and I feel dizzy and depressed and all the fun side-effects. Happened last year at this time so we decreased my Dilantin dose - and my levels plummeted from 21 to 12. We've be keeping a close eye on my levels since and changing dosage as needed. I had been at a level 16 at the last check.

Today I got the news that I was at a level 20.4 - yikes! So my doctor changed my dosage to a 3 day rotation of 300-300-400. Will get another blood test in 6 weeks.

The problem with Dilantin is that it builds (and falls) at an exponential rather than a linear rate. So, even though your on the same dosage, one week you can be at a good level and the next it can have climbed into the danger zone. That's when I get start feeling dizzy and depressed and lose coordination. Luckily I haven't been feeling that way this time but give it another week and I'm sure I would have.

For me, this is the only real problem with Dilantin. And once I discovered what was happening (thanks to a great doctor) I've been able to deal with it. It keeps my epilepsy under control which is the important part. I'm not willing to try different medicines because they all have their side-effects and at least I know Dilantin and what to do.

Anyway, just thought I'd let you know.
Hope your doing well :)
 
Dolores, thanks for the info.... I'm new to this form thing, not even sure if I am doing this right, but I must say it is so good to finally be able to communicate with someone that has somewhat the same issues. Also you information has been really helpful. I started my journey with these issues when I was around 19. At first I was a newly married and stayed at home while my husband, whom is now my ex. was working. I would do usual house work and such what some soaps and then take a shower get ready to cook dinner and get ready for him to come home. I had moved miles away from any family and in a new place did not really know anyone. One of my biggest issues is I find it uncomfortable to talk about to other people. I feel like they just think you are weird and have mental issues.... Could be one of the reasons for the depression along with meds. Anyway, it has been good to talk to someone with same issues. After reading some of peoples stories on here it also helps me to realize that my problems with seizures are not really as bad as others. I am not good at talking to Dr.'s I have gone back to a neruo that I saw years ago that I do like and maybe she can help with the issues I have had over the last 6 months. One of the scariest things is that I felt I had it all under control and was accustomed to taking the 300/day. Now I feel like I'm going back to some of the problems I had when this all first started. It was a very scary and depressing issue to go thru. I at that time (19 years old) thought I was so grown up but there was so much I didn't know. Since I do not like to talk about the issue when Dr.'s or other people ask me about it I had decided to write it down so they can read it and this tells how it started I have more on the paper. You may want to read it but then again you can just ignore it... Which ever you chose I want to say thanks for the support and info you have shared with me. I have appointment with neruo Monday for another EEG and I guess to talk to Dr. about where we go from here. All I think is if I can just get Monday behind me then maybe I can go back to living the way I was and try to forget it.

Beginning of my story:
Married in February 1979 and moved to New Orleans or rather to a small community outside Picayune Mississippi not far from New Orleans. My husband worked in New Orleans and I was staying at home, planning on going back to school in the fall. I would spend my day not doing much… maybe go to the grocery store to get items needed for dinner that evening, had 3 soap opera shows I was into watching. After they were over I would go take a shower or rather would have to take a bath and stick my head under the facet. The place we lived I could not get the shower to work so this was the alternative. One day after having my shower/bath, I had got out. Started having this weird feeling that the best way I can describe it was a déjà vu experience. It was like a dream or something you could see but could not make out. I sat down on the toilet. The next thing I know I was picking myself up off the floor. After I did this the feeling of picking myself up off the floor was like did I really do this or am I just imagining that I did this. Felt so strange and so odd. I did not bite my tongue nor did I have any bruises or such. I felt that it was so odd and strange that I did not mention this to anyone. About a month or so later it happened again and also just as I had finish with my bath/shower. Not sure exactly how many times this happened, but again because it was so strange and I did not know how to explain it to anyone I did not mention it to anyone. I was always alone too therefore no one else saw what was happening. Not sure how much time had passed since the first episode but I do know that the next instance was in the fall. It was on a Sunday and my husband (now my ex), where at home watching the Dallas Cowboys and other games I guess as well. I remember lying on the couch, and I kept getting the déjà vu feelings…. I would get this and then I would just go off to a deep sleep. I spent most of the day it seems like sleeping. I guess there were no physical signs of it so my husband probably thought that I was just tired and sleeping. We went to bed that night, I don’t even know if I remember going to bed. I do remember coming to and my father-in-law was standing in the bed room door with his wife there behind him. My husband standing next to the bed and said, “come on we are taking you to the ER, you just had a seizure”. I had a grand mal seizure after going to bed in my sleep. We went to the ER in Slidell, LA. They did not really do anything but told him that I needed to go see a neurologist. We made an appointment with a Dr. Patricia Cook in New Orleans, LA. She sent me to have a CT scan of which she later informed us that it did not show any brain tumor, so wanted me to have an EEG. After the EEG all she informed me of was that the EEG did show some irregular brain activity, gave me a prescription for Dilantin and told me to take 100/mg 3 times a day. I had never known anyone with an issue like this and she did not really explain a whole lot. Computer as we have them today were not as advanced. If you wanted to find out anything you either went to a book store or a library. I went to a book store and read in a book where Dilantin could affect your liver. This of course at my age was horrifying.
 
I do understand being shy and finding it difficult to talk about my epilepsy. I had my first seizure when I was in the 7th grade talking in front of the parent-teacher org. I started to speak and my eyes started to swivel and the next thing I knew I was in the hospital and they told me I had epilepsy. The doctors talked to my mom (who was just as frightened as I was) and never brought up all the details. My mom gave me a booklet on epilepsy and all I did was look at the list of famous people with E, saw Alexander the Great and thought "well he rode Bucephalus so I'm in good company".
My main problem is a lack of short term memory. For decades I thought I was fooling everyone into thinking I was smart because I knew I couldn't remember a thing. It was ages before I had access to the internet and then took me time to think to search for epilepsy and memory problems. Back then only got a few hits but enough to convince me that I was right, I wasn't stupid, the dilantin or epilepsy or both just made it impossible to remember things.

That's still a big problem for me but knowing why seems to help, I don't berate myself as being stupid, I just figure out ways to compensate.

The people here at CWE have been really great and provided me with lots of information. Plus there are a lot of understanding shoulders to lean on when it all gets to be just a bit too much.

Let us know what happens with the EEG and keep writing your story.
Take care!
 
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Right now all I can think of is if I can just get tomorrow over and behind me just maybe I can go back to forgetting about all of this I HOPE... Today spent time on tread mill walking and running. Listened to 3 songs by Zac Brown Band. 1) Knee Deep 2) Toes & 3) Where the Boat Leaves From. Now if I could just find this boat and island I would have it made. Thanks, Zac Brown Band for making my day so much better!!!
 
Had EEG today. Dr wants me to ad Keppra at this time then will later try to work off the Dilantin. I have read so much bad on here about Keppra that I'm a little worried about trying it. Going to try to stay positive and give it a try. I really feel like hormones play a big roll in my seizures and maybe in a couple of years I can get off everything and for now try to be positive about it.
 
I love your descriptions. I have had the exact same de'ja vu feelings and even now, it is hard for me to share that experience with anyone. This forum has helped a great deal. I have been sharing and processing stuff on here.
 
First dose of Keppra today. Still on Dilantin. Please tell me this dizzy feeling will go away...... :-/
 
Thanks Nakamova. Info was very helpful. In on 500 mg twice a day along with dilantin 400 mg/day. Next week suppose to increase keppra up to 1500/day. Dr appt next Thursday maybe. She wants to push it back and give me time to adjust. After a month or so if okay on keppra will start to work off Dilantin. Don't think I have ever taken so much meds in my life. I'm sure there are those out here that have. My plan is to hopefully be off everything in 2 year. Of course my GP does not think so.....
 
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