Help! Levecetracetim overdose????

[dzivko]

Help! I'm ready to stop taking meds or cutting down myself. Had a heat related incident and now neurologist has put me up to 4000 mg. of Levetracetim a day. I have read that this med has not shown any additional benefits beyond 3000 mg a day. Also read that more seizures can occur when antidepressants are also given--and I am on two antidepressants, effexor and trazodone. I also have heart problems. This is so ridiculous--a year ago I was taking 1500 mg. of L and now, after two episodes after 4 years seizure free, he wants me up to 4000 mg? Anyone have any experience with this...I have complex partial epilepsy and cardiomyopathy.

 

[Endless]

Hi, Dzivko,

I'm sorry you are going through all this right now. It sounds like your medication is a bit of a puzzle right now. Have you sat down with your neuro and asked him some of your very specific and direct questions? Seeing a new doctor might help if you've lost faith in the abilities of your current neuro.

We aren't doctors and can't advise you about specific dosages and prescriptions. But I bet somebody in here has been on high doses of Keppra and can at least share their experiences.

In the meantime, your pharmacist can be a wealth of information. Especially a very good, experienced one. They can shed light on dosage ranges and interactions. They can't prescribe for you, though. Seeing an epi (a seizure specialist) might help. They are more knowlegable about seizure meds than most neuros, and might do a better job for you. A regional epilepsy center is a good place to find one: http://www.naec-epilepsy.org/find.htm

About the Keppra. You are right about doses above 3000mg being unproven:

In clinical trials, daily doses of 1000 mg, 2000 mg, and 3000 mg, given as twice-daily dosing, were shown to be effective. Although in some studies there was a tendency toward greater response with higher dose (see CLINICAL STUDIES), a consistent increase in response with increased dose has not been shown.

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=34937#nlm34068-7


Looking at the clinical studies listed in the package insert, it looks like they just didn't study amounts over 3000mg/day. Not that they studied high doses and found them no more effective. So the higher dose may work. I wonder if they've studied the safety at that dose, though??? I'd definitely talk it over with your doc.

About antidepressants, AEDs, and increased seizures:

The risk of seizures in patients taking antidepressant drugs depends on three factors:41–44

the intrinsic epileptogenic or antiepileptic potential of the antidepressant42
the amount of active drug that enters the brain, which depends on the dose, pharmacokinetics, and transport across the blood-brain barrier, the patient’s seizure threshold, which depends on genetic factors, remote brain injury, previous febrile or acute symptomatic seizures, and use of alcohol or other substances...

...The overall incidence of seizures in patients taking antidepressants at reasonable doses and presumed therapeutic ranges is 0.1–4.0%; this can be compared to an incident seizure risk of 0.073–0.086% in the general population of Rochester, Minnesota.41 By class of drug, the highest risk of seizures has been reported with:

the heterocyclic antidepressant clomipramine (0.5% incidence, up to 2.1% with doses of 350 mg per day or greater)
the dopamine- or norepinephrine-specific reuptake inhibitor bupropion (0.4%, up to 2.2% with doses higher than 450 mg per day)
the quaternary antidepressant maprotiline (0.4%)
The tricyclic antidepressants (TCAs) have the next highest seizure risk (which is increased by toxic levels). The newer selective serotonin reuptake inhibitors (SSRIs)—fluoxetine, sertraline, fluvoxamine, citalopram, and paroxetine—and serotonin receptor modulators—trazodone and nefazodone—are intermediate in risk, as is venlafaxine, a combined norepinephrine and serotonin reuptake inhibitor. The monoamine oxidase inhibitors (MAOIs) carry the least risk.

http://professionals.epilepsy.com/page/drugs_antidepress.html

 

[bazpa]

Endless-you must have dealt with this for a long time. You seem to be so educated in this area, and do your home work! You are are a wealth of information, and I have learned so much just from reading your posts. Thank-you.

 

[Endless]

Thanks, Bazpa,

I was diagnosed about a year or two ago. My philosphy was if I understand it, I will conquer it. I've been a little disappointed to find out that seizures don't work that way. It's a lot more complicated than that. But knowlege is still power, it still helps us get the right treatment.

The best tools in the world:

Coping-with-epilepsy
Google!
epilepsy.com
epilepsyfoundation.org
pubmed

 

[petero]

Help! I'm ready to stop taking meds or cutting down myself. Had a heat related incident and now neurologist has put me up to 4000 mg. of Levetracetim a day. I have read that this med has not shown any additional benefits beyond 3000 mg a day. Also read that more seizures can occur when antidepressants are also given--and I am on two antidepressants, effexor and trazodone. I also have heart problems. This is so ridiculous--a year ago I was taking 1500 mg. of L and now, after two episodes after 4 years seizure free, he wants me up to 4000 mg? Anyone have any experience with this...I have complex partial epilepsy and cardiomyopathy.

I was on Lev. for a short while which coincided with a horrific span including an ER trip
I myself can't say A=B as such but there was definitely no personal benefit to taking it
and I can say that during the time I was taking it I experienced badbadbad
I still feel I'm living down these effects
I still hope also the persistent tinnitus I've had is maybe allergy related or something else as opposed to something permanent from the Lev.

my phenytoin I can say hasn't been perfect but it seems to be stable for me and my issues
phenytoin and levetiracetam are the only two Rxs I've been on since 2008

 

[drummerchica02]

I'm on 4,000 mg of Keppra (which I believe is the same thing) a day. I only respond to the brand name...the generic goes through my blood system too quickly or something, I guess. Anyway, I was concerned when my doctor upped mine too, but he said my levels were lower than normal and this stabilized them (and the seizure activity lessened, too). I just had the same side effects that I did when I first started upping my dose (feeling like a zombie, moody, etc) and they eventually went away.

As far as safety goes, I was told by poison control that they had studied the drug with doses as high as 4,000 and the only finding was that it didn't have much in the way of benefit-side effect ratio. I learned this when I was on 3,000 mg a day and had switched from 3 500mg pills at a time to 2 750mg pills at a time. I forgot and accidentally took 3 750mg pills for my evening dose, freaked out, and called poison control. OOPS! Haha. That's when they gave me the info about the clinical trials on it, and told me to just expect the side effects to feel like I was first on it. I felt odd, but was able to sleep it off.

I agree, though, that if you feel your doctor is not listening to you and just pushing more meds you should find another doctor, perhaps someone with more epilepsy experience. I should probably take my own advice, but I really like my driver's license (my job is 40 minutes from my house) and don't want to go through the trial and error process that switching meds would mean.