Keppra at high doses

[Loopy Lou]

Well, i saw on another thread that another person is on well above 3000mg keppra a day, and i've heard of people being on more than that, yet my neurologist says that he can't safely increase mine above 3000mg, as that is the upper limit allowed.

Does anyone have an idea why?

Keppra is the only epilepsy medication that i've tolerated fairly well, and for the past few years i've been trying to find an adjunct medication that works well with it, with varying levels of success (current drug du jour is 200mg topamax a day but i should be increasing it, have chosen not to for now).

Do you think this may be because i have multiple seizure types? For those above 3000mg, have you been warned that those levels are quite strong or advised against it? I think i would rather try more Keppra, which i tolerate, than other ones, which i apparently don't.

I'm curious, thanks in advance for any replies

 

[lindsayschu2]

It's tough to say--it could either be that your doctor is following the strict guidelines of the advisable upper limit, or he may be making that decision in part because of your blood work. Some drugs effect white cell count, kidney or liver function or other markers, and different people will have different med levels on the same dose--it's possible he is being conservative based on other data. Or, you could get a second opinion and see what another neuro says.

 

[txtiger]

I am and have been on 4000 mg/day of Keppra, then Keppra XR since, I think, the latter part of 2011. I have been on Keppra for probably almost 15 years, since well before my surgery. When I started having breakthroughs, my neurologist would increase my dosage, then when I got to 4000 on Keppra, he switched me to XR, then added an adjunct med. He has not warned me about the strength of the medicine, but 4000 does seem to be his upper limit.

Like you, I have had negligable side effects on Keppra compared to other meds I tried, thus the reason I've been on it longer than any other. I will ask him next time I see him if I should be concerned about long-term effects.

 

[Nakamova]

Lou, it sounds like you should discuss raising the dose with your neuro, at least to find out what he believes the risks might be if you increased your dose. 3000mg is max the recommended daily dose, because what they used as the upper end in initial clinical trials. But plenty of people find that their therapeutic doses fall outside the recommended ranges, and if there are no contraindications it may be worth a try at the higher dose. Refer your neuro to this article/study: http://www.ncbi.nlm.nih.gov/pubmed/11074181 which concludes:

Levetiracetam in doses from 1000 to 4000 mg per day is effective. Somnolence and asthenia were more frequent with the highest dose, suggesting that 4000 mg per day may be the upper limit in some patients, although individual susceptibility to somnolence was variable.

 

[Loopy Lou]

Ah.... i think you may have hit the nail on the head there Nakamova. I do have problems with somnolence, and have had sleep studies etc done which came back as borderline for a sleep disorder.

Maybe he's hedging his bets in case it's the Keppra that's causing me to be a snoozy Lou >.<

 

[EDBRAD]

Hello Lou
I have been on 3750 mg daily for I think a couple of years now. I was told I was near the upper limit with that. I have had a lot fewer side effects with keppra than with some of the older meds I had been on, although I am still having simple partials on a weekly basis. About a year ago my secondary med was switched to Aptiom. The partials are still occurring but all of the awful after effects like the extreme confusion, headaches & depression that used to follow the seizures have disappeared. I refuse to go up any further on the meds at least for now. I think I am chasing my tail trying to achieve any better control than i have already.
The only problem I have had with the keppra was I saw a little bit of the rage issues early on, but after adding vitamin b6 daily that disappeared completely. I do find myself sleeping a bit longer these days.
Good luck with everything
Ed