Hi Donna

been missing you...

how are things going with Derrick, any better?

how have you been? drop us a note when you can.

~ waves ~

Everyone


Hi, Derrick's dilantin is very high. So he is off it right now.

We go again tomorrow in the morning to get a status draw again.

SO we will see what it is like. He had another seizure yesterday
at school.

Dad had to go get him. He is now yelling at me right now. Guessing
he is off again.

Hmmm, we will see.

Oh well I'm watching. Hubby got laid off again Monday. ANd I'm
working again, school is in full session it seems.

Donna

Dear Donna

thanks for the update.

hmmmm. i'm surprised the Zonegran level didn't dip then... i wonder if it maybe did a little, even if not technically below the therapeutic level.... because i'd expect the phenytoin (Dilantin) to induce Zonegran metabolism via the CYP3a4/5 pathways.

i am wondering now if maybe the Zonegran was never the problem then... maybe the problem was the Dilantin being too high. Either directly or because it somewhat lowered the Zonegran.

glad he will be doing another draw.

i am sorry. this sounds so hard on both of you.

sorry about your hubby. i hope you are enjoying work. i recall that you love what you do.

please keep checking in with us, when you can.

~ waves ~

Thanks Waves

Oh I check in usually daily. I just don't always comment.

Derrick's dilantin is down to 24.5 today. But I'm not sure they
want us to go back on tonight. 200 evening 200 in the mornings.


Its still high. So I'm not sure whether we should wait one more
evening to start back on.


What do you think. My husband suggested waiting. I had already
thought of it.

We had already know about 2 months ago, the dilantin was very
low. So now its high. This one is going to be watched now.
I'm wondering if the zonegran brand name, and the seroquel
going off made this change.

The zonegran is just barely theurapeutic. So I'm not even sure
I want him left on this one.

Donna

Dear Donna,

sorry hi i just woke up...

if you're still deciding... i would wait. and maybe call the doc in the morning. sounds like he was expecting it to come down to where it needs to be by now, and if that isn't the case, you should call him and see how he wants you to go forward.

You won't know if the Zonegran is helping or not until the Dilantin level comes down.

Seroquel and Zonegran do not affect each other, and do not affect Dilantin.

Conversely, Dilantin affects BOTH Seroquel and Zonegran, increasing clearance of both.

Seroquel is not a seizure drug - in fact, it can even cause increased szs esp if one is susceptible - all antipsychotics lower the sz threshold to varying degrees. When the Dilantin was low, the Seroquel might have got too high. That probably didn't happen overnight, so it's not likely to have caused big problems. Nonetheless, it complicates the picture.

Currently with the Dilantin too high, the Zonegran might be lower than it needs to be, even if it is still within the therapeutic window (you said barely). The Zonegran level might go up more, when the Dilantin comes down.

Dilantin is a messy drug, interaction-wise. It affects bunches of hepatic enzymes and consequently bunches of other drugs. Good idea to keep an eye on it.

Wait until the Dilantin level is where it should be. At that point, make dose adjustments to the other meds if necessary. Only then will you be able to evaluate if the other drugs are helpful.

~ waves ~

Waves

Thanks i knew you would know this answer.

It was one of the doctor's in the practice saying to go back
on the medicine.

I have to ask him if he went back on this morning or not.

You can see I'm not to concerned at this point. I personally
see a change in him. So I like to watch more.

So I think tonight is a good choice because I can watch tomorrow
and then have a idea.

Donna

Dear Donna

glad you are seeing a change in Derrick (i'm assuming you mean he is improving )

i think you have a good plan as far as restarting the med so you can observe. i had not thought about it in terms of you being home... that too is a consideration. maybe talk to your hubby about keeping an eye on Derrick monday... if going back on the Dilantin causes problems, things may not precipitate for a few days.



~ waves ~

Thought I would let everyone know.

Derrick seems to be having a great week.

He is going back to work tomorrow, he had Saturday and Tuesday off,
they were closed.

He has been sore the last two days because of strength training.
But that is usual this time of year.

I think we are doing well. Good for that, because I have a weekend away
from home.

Donna

This is so good to read, Donna. i hope he stays well.

keep an eye on him this weekend as the Dilantin level will have come back up since he has resumed taking it. and it could knock everything else out of whack. it remains a mystery how it got too high, in the first place. i take it the doc reduced his Dilantin dosage now?

~ waves ~

Waves

Yes, the doc reduced it 100mg. And we are still watching him.

He goes for another draw tomorrow.

I will be gone on Saturday, but he will be with a provider and
my husband.

But I personally think it will be next week before it rises if it does.

Donna