Keppra and Zonisamide a good combo?

[Parker26]

I have been taking 3,000 mgs of Keppra daily, but have been having more tonic clonics. I usually have one or two a year on average, but in the last year had 5, so the dr. thought we should tried zonisamide. She thought about lowering the Keppra to 500 mgs morning and night while raising the zonisamide to 400 mgs. It didnt work well and I had 2 tc's in one day. She bumped my keppra up to 2000mgs. I haven't had a seizure on this combo for the last month. Not saying much since keppra does an alright job of regulating me. I haven't heard of many people on this combo before? Also, it seems like a high dosage.

 

[Junebug]

Keppra (2000mg) and Zonisamide (400mg) combo didn't work for me and my Zonisamide levels went through the roof and made my levels toxic (normal range is 10 - 30 and my levels were 43!) YIKES! My dr decided to put me on Depakote and take me off the Zonisamide.
I felt horrible and had more seizures with the high levels so I am tempted to ask my dr if my increased sz. could have been caused by the toxic levels.

 

[Nakamova]

In general it's better if you can find one drug that will work rather than two -- it makes it easier to changes doses and to evaluate side effects. But if the Keppra/Zonisamide combo works for you then that's great. The maximum recommended Keppra dose is 3000mg per day, and the standard Zonisamide dose is 200 to 400mg per day, so those levels seem okay unless you are experiencing side effects. Zonisamide can potentially cause "metabolic acidosis", so you and your neuro should be aware of this. In theory, you should have had your serum bicarbonate levels tested before and after going on the Zonisamide. You can read about it here:

http://www.medscape.com/viewarticle/588603

 

[Parker26]

My dr never tested my levels and never mentioned anything about levels or zonisamide affecting my levels. My last neurologist put me on keppra and never tried anything else. She told me I would always have seizures no matter what. I was fed up and waited months for an appointment to Barrows which is considered one of the best. Is testing usually common for zonisamide? She mentioned Depakote, but told me to try it last because all of the side effects.

 

[Nakamova]

The warning about Zonisamide and serum bicarb levels came out in 2009, so it's possible your neurologist isn't aware of it. I definitely had problems with Zonisamide -- unfortunately I tried it in 2007, before they were aware of some of its issues. If you are feeling fine on the Zonisamide, then it may not be worth worrying about, just maybe a chat with the neuro at some point.

 

[Parker26]

You would think neurologists would be aware of it by now, this is what they do for a living. Unfortunately, my next appointment isn't until November, but im definitely going to pay closer attention to how im feeling. I will bring it up to her and see how she responds. Sometimes she just shrugs things off and moves on like its no big deal. I feel alright on the combo, but after being on 3,000 mgs of Keppra for 5 years, feeling like crap is normal.I have never felt good on any seizure medicine. Thanks for responding because the neurologist made it seem like it was the safest aed out on the market. The side effects are just as bad as Keppras for me.