Fluctuating Medication Level

[Good Cook]

Hi,
I was on 1,125 mg of Depakote several years ago (125 AM and 1000 PM), then switched to Keppra for a couple of years, and am now on Depakote again taking 1,000 mg (500 AM and 500 PM). Its a long story of why the switch back and forth. However, when I was on Depakote awhile ago my level was typically hugging around 90-100 (recommended is 50-100). My dr was never concerned when it was close to 100 because he said I was feeling fine, my seizures were under control, and my liver function looked good. Now that I am on Depakote again the last couple of times I have been tested my level was around the mid 50s to low 60s.
I'm still having seizures occasionally even though I'm basically at the same dose as a few years ago, and my blood level of medication is significantly lower than in the past. Also, the last couple of times I had blood drawn I had it done before I took my AM dose. Any idea on why the medication level would be so low? I'll see my dr in a couple of weeks, but wanted to get other people's feedback in case you have seen big fluctuations with Depakote or any other seizure medication.
Thanks in advance!
Christine

 

[Chelsea]

Hi Christine! It's nice to meet you. You may have....ta da....a super liver! My physician told me that sometimes our bodies get accustomed to processing medications, especially if they are routed through the liver, hence the medications we take are 'rapidly metabolized'. I've never been able to keep a 'therapeutic level' of Tegretol, Lamictal, or Dilantin for this reason. My neuro told me that the 'levels are not so much an indicator of seizure response as to determine if the patient is taking the drug or not'. I disagree. If there is a range established, and I am not in the range and having seizures. . . then there is a problem I would think. One of the many problems with taking anticonvulsant drugs. They also call this honeymooning, I believe. Hope this helps. Have a great morning.