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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest alternative medication in place of Oxcarbazepine

Answered by
Dr. Prasanna Heijebu

General & Family Physician

Practicing since :2010

Answered : 1423 Questions

Posted on Fri, 23 Oct 2015 in Mental Health
Question: Hi. I found out that I went without coristol for two yrs and dr said I should be dead. I passed out and dr started me on 30 mg hydrocortisone. I am also on 300 mg three times a day for high manic depressive. I have already been sweating five yrs(not related to any manupause at all. Can't sleep and lost memory but not like dementia or the other one that u can't remember name starts with a A. I'm born deaf so stress is the high manic depressive. For the depressive I take oxcarbazepine. When I take the coristol and the antidepressant I end up in ER sweating like I got out of shower and vomit violently for three to four hours with nothing coming out. I hospital stopped my hydrocortisone for a week and I calmed down then I had to start at one then I went to dr he got mad and said go on 30 or I'll be dead. I'm trying but he said go see someone else. For 30 yrs no one can find nothing. I'm trying to slowly go off the antidepressant and go on the hydrocortisone but I'm afraid. I can't get in to see my dr and when I do I'm ignored. I can't sleep and sweat and night all the time. Sweat in day. It's not even worth living. Now my heart is involved. My memory is like I can't remember what I said a half hour ago and I'm very high energy. Hardly sleep. What do I do. Now my coristol is back at 1.4 and I'm taking one trying to take two to slowly go back on three but I get so sick and sweat and pass out and end up in ER and they stabilize me and send me home. Now headaches r 24/7 for two weeks now and had them since January of 15 cuz was in hospital for cluster headache. I'm deaf which makes it worse cuz I'm afraid. That makes me more stressful and how can I get more stressed if I have no coristol and only can get away with being on one. Heart dr now is going to monitor my heart cuz the other dr didn't care but I got the report that I flatline at night. Now I'm on oxygen and keep forgetting. I don't know how to take my meds and Drs r not listening. I'm deaf and they don't understand that. No patience and I feel I'm dying. I now don't even want to live this way anymore. I'm so misunderstood. I don't even look sick. I try to care for myself. The sweating is so bad. I had my whole uterus out in 1986 and already went thru menopause. This is not menopause. I already was told by three Drs. What do I do with the antidepressant and the coristol meds cuz it seems they don't go together but yet I need something. Do I just die slowly or what?? My heart , never has problems before and one the coristol when I take 30 mg my great rate goes to high and unstable so I stay at one till someone can help but no one I'd listening. My new heart dr is going to start over but in meantime I feel I'm not going to make it. What do I do??
I haven't slept for so long. Sweating for 5 yrs. gotten worse. So u r saying I don't need to be on 30 mg for coristol. That's a relief. Yes I'm high manic depressive and on meds for that. But now my heart and lungs r affected. I'm deaf and always under stress. I don't know how I lived without coristol for two yrs till they found out. I don't get tired at all. That's a problem. The coristol dr Is frustrated with me and will not let me talk so he said to find another. No dr will listen. I'm deaf. The new heart dr is going to start over with me. I'm not being monitored. For 39 yrs the Drs have misdignosed me. I just want to live. No one is listening and letting me die. Which I almost did. I'm high depressive and take antidepressant. But the coristol I cannot take 39 mg without getting more sweating , vomiting, dizziness and no sleep. I'm scared. Been deaf so there is no patience from Drs. The heart dr said at least stay on one but I only say him once and is suppose to be good. I don't understand why I can't get anyone to do a work over once and for all after being misdignosed for 30 yrs. I somehow lost my memory. Not like what u think. It's like I can't remember what I said it did or what some else said or did an hour before. I can only go day to day trying to live but forget conversations. When I talk to friend my mind cuts right off in the middle of the conversation. It's strange. Who or where can I go to get this taken care of once and for all.
Answered by Dr. Prasanna Heijebu 7 hours later
Brief Answer:
Drug dosage modification alone will improve your well being

Detailed Answer:
Hello, Madam.

I understand your concern.

Many of your symptoms are DIRECTLY related to the side effects of both medications.

You are currently on wrong medications as well as their doses.

The normal blood levels of cortisol to be maintained in the blood-

Morning--->5-23 micrograms per deciliter (mcg/dL) or 138-635 nanomoles per liter(nmol/l).

Afternoon---->3-16 mcg/dL or 83-441 nmol/L.

It is important that you maintain Cortisol in these levels only.

The dose of cortisol required on you case should be determined after having the therapeutic drug monitoring.

The usual maintenance dose of hydrocortisone in chronic adrenal insufficiency is 15-25 mg /day to be given in divided doses as 2-3 times a day.

In your case, it is better is maintain it as 15 mg/day to be taken as 7.5 mg q12hrly.

With regards to treatment for depression and manic episodes, it is advisable to prefer Carbamazepine to Oxcarbamazepine, since the later is associated with high side effect profile and is an off-label drug.

Likewise, it is good to keep the drug dose under 800 mg of CARBAMAZEPINE.This will minimize the side effects.

Please check with your physician if he shares my view and if can prescribe them to you.

Post your further queries if any.

Thank you.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

The User accepted the expert's answer

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