How long for meds to settle - roughly?

[Freda]

Carly's been on Levetiracetam since July, started on 250mgs twice daily and now at 1250mgs morn and 1500mgs night. The meds are making her feel strange a lot of the time, hard to explain but deja vu, nervousness, panic at times and crying uncontrollably - had to come home from work today because of crying and feeling of panic which led to breathlessness.
She doesn't want to give up on this med because it is stopping her Tonic Clonics but she's regularly having these feelings and dizzy, slightly confused spells on occasion too - which she has to take a 10mg Clobazam after the latter.
Is it still early days because the med was increased to the current dose just three weeks ago? Her neuro said she will likely add Lamictal if her partials aren't controlled but Carly doesn't want to contact her yet and has an appointment in early December - she said she'd rather wait until she sees her neuro and give the new dose a good chance of settling into her system.

Thanks for reading my usual long post.

 

[Nakamova]

I think a month at a stable dose is considered a decent interval by which to judge a med for efficacy and side effects. For me, I think it was at least a month after I'd been at the full dose of Lamictal before some of the side effects lessened.

But reactions to meds are truly different for each individual. I hope her brain adjusts to the levetiracetam and things settle down. But if if it turns out that seizure control comes at the price of problematic or intolerable side effects, then it might be worth looking for a med that's a better overall match, or trying an add-on like the Lamictal. There are a lot of different meds out there. Finding the right one can be a bit like trying different keys until you find the one that opens the door...

 

[Sabbo]

I agree that it takes a month at a stable dose to see if the drug is working and what the side effects actually are.

 

[resaebiunne]

I disagree. Assuming you're taking your medication at regular intervals and not missing any doses, you will notice side effect much sooner than a 1 month period.

 

[Freda]

I think they meant it takes around a month for the meds to get into your system and for side effects to lessen a bit resaebiunne, Carly has side effects quite soon after upping her dose but she's hoping that soon they will dwindle a bit - just wanted to know how long that may be likely to take.

Thanks you all for your replies, really helps loads.

 

[Nakamova]

Yes, it's not the time period for noticing the side effects, it's the time period for gauging whether they are "permanent" or [hopefully] are only related to the adjustment the brain is making while still transitioning on or off a med.

 

[valeriedl]

My neuro told me that when I first start taking a med I might have side effects but after 2 or 4 weeks, everyone is different on the time period, the side effects will lessen or go away. If the side effects are still bad after that, or kept increasing instead of going away, then to let him know and he might change the dosage or take me off the med. My neuro had put me on a med once that I basically stopped eating, my mom had to force me to eat saltine crackers and dry toast. I didn't have any energy and the only time I got out of bed was to go to the bathroom, which wasn't that often since I wasn't eating. I'm not sure how much they were helping with my seizures but after a little after 2 weeks things didn't get any better with the side effects, they just kept getting worse, so we called the neruo and he took me off of it right away.

I know that my neuro has upped a dosage of meds that were working before and side effects started or if I had been having them they got worse so he'll go back to the original dosage. I would suggest letting her know her neuro what's going on. I don't know how much the Levetiracetam was helping at the original dosage or how bad side effects were and if she was able to deal with them but she might want to go back to that doasge.

 

[masterjen]

I've had adjustment periods take as long as 6-8 weeks especially once I've tapered onto higher doses of a medication. Overall my body adjusts more quickly when I am in a position to taper onto a medication very slowly.

 

[Freda]

That makes sense masterjen and I wonder about the half life of Keppra, as in to avoid a 'see saw' effect wouldn't it be better to take doses three times a day instead of two which may leave a gap in the 24 hour period.

Not the same I know but with hypothyroidism in a dog it's recommended by a world leading expert on the condition - Dr Jean Dodds - to dose twice a day when most vets recommend just once a day.

I wonder if studies have been done to see if this affects epilepsy meds in the same way.

 

[Nakamova]

Keppra does have a relatively short half-life compared to some of other epilepsy meds, so it's possible that some people might benefit from more frequent dosing. I've read several anecdotal posts here and elsewhere where taking it more frequently throughout the day has been beneficial in terms of side effects and/or seizure control. You could certainly ask the neuro about that option. Is she taking extended release Keppra? That needs to be factored in as well.

 

[Freda]

Thanks Nakamova for the reply. She doesn't take extended release Keppra and avoiding the 'see saw effect' in dogs made me wonder if the same could happen in people - I don't see why it wouldn't eh?
We must write down the questions we want to ask her neuro before we forget. Isn't it so frustrating when you walk out of the clinic and suddenly remember the very question you so wanted to ask? Her neuro is an epileptologist and hopefully will have some advice.

Thanks again and I'll post what she says.