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Is Dilantin Level Of 24 After A Breakthrough Seizure A Cause For Concern?
Question: I recently had a breakthrough seizure and the dr. in er increased my dosage of dilantin to 400 mg per day as at the time of seizure my # was 8.? It has gone up as high as 24 and I have not gone back to feeling normal as usual after this seizure. I think I am takng too much but the neurologist says lots of people tolerate # is the 20s. I don't think I am one of them.Thoughts?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Dilantin levels are usually aimed at levels between 10-20 mg/dl. Those values are used to aid decision making but they are not absolute, there are patients controlled with values under 10 and others who need to go more than 20.
Side effects also can vary they can appear under 20 in some patients and not be felt at over 20 in some others. Naturally the higher the greater the likelihood of side effects.
So decisions should be made based on the individual patient taking into account side effects. If it is confirmed that this new dosage is related to increased side effects, adding to that values higher than 20, I think the dosage should be taken back to 300 daily.
However you say that this is only the first day you have tried this new dosage. Also you still feel not to have recovered from the seizure and it is common for generalized seizures to have some muscle pain and fatigue for some days after. For that reason before rushing into saying that this new dosage is responsible for how you are feeling, I would give it some more time, at least a week during which dilantin level should be measured again. If values remain over 20 and symptoms persist then I would consider returning to previous dose.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Dilantin levels are usually aimed at levels between 10-20 mg/dl. Those values are used to aid decision making but they are not absolute, there are patients controlled with values under 10 and others who need to go more than 20.
Side effects also can vary they can appear under 20 in some patients and not be felt at over 20 in some others. Naturally the higher the greater the likelihood of side effects.
So decisions should be made based on the individual patient taking into account side effects. If it is confirmed that this new dosage is related to increased side effects, adding to that values higher than 20, I think the dosage should be taken back to 300 daily.
However you say that this is only the first day you have tried this new dosage. Also you still feel not to have recovered from the seizure and it is common for generalized seizures to have some muscle pain and fatigue for some days after. For that reason before rushing into saying that this new dosage is responsible for how you are feeling, I would give it some more time, at least a week during which dilantin level should be measured again. If values remain over 20 and symptoms persist then I would consider returning to previous dose.
I remain at your disposal for other questions.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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