Zzzzzz!
October 7, 2010 9:33 AM
For the past two weeks, I have been sleeping (or wanting to sleep) 14+ hours a day! Could this really be the fault of my epilepsy medication?
Female, late 30s, parent of one, freelance worker (thank goodness!), part-time student in danger of sleeping this semester away...
Last year, I was diagnosed with epilepsy, and treating it has changed my life. I take generic Topamax (topiramate), and I have noticed that when the pharmacy changes manufacturers, I sometimes go back to some degree of the side effects I had shed when I first acclimated to this drug.
For the past two weeks, I am really sleepy, all the time. Two weeks and a few days ago, I got a new bottle of topiramate pills by a different manufacturer from the ones I was taking before.
But it's not that simple! For the past 6 months, I have been tapering down my dose of Lexapro. I had been taking 20mgs; I'm now on 5mgs. The decrease from 10mgs to 5mgs also falls in the "2 weeks ago" timeframe.
Or maybe I have mono or something.
Or something more serious?
Is it even possible that the change in topiramate pills could make me feel this sleepy all of a sudden? I went from holy insomnia to this -- sleeping 14 OR MORE hours a day.
I will see my primary care doctor when I can, but he's kind of perfunctory. My neurologist is very expensive, so I'd rather he be the last resort.
Other may-be-pertinents:
History of iron deficiency anemia, but I take my iron, as well as calcium/magnesium, B-12, and vitamin D. Nutrition as good as it can be for someone with the zero appetite that topiramate sometimes leaves one with. Pretty sedentary these days. Much stress with a sick elderly parent. Definitely, absolutely not pregnant.
Has anyone else in the history of the world slept this much for a good reason?
Female, late 30s, parent of one, freelance worker (thank goodness!), part-time student in danger of sleeping this semester away...
Last year, I was diagnosed with epilepsy, and treating it has changed my life. I take generic Topamax (topiramate), and I have noticed that when the pharmacy changes manufacturers, I sometimes go back to some degree of the side effects I had shed when I first acclimated to this drug.
For the past two weeks, I am really sleepy, all the time. Two weeks and a few days ago, I got a new bottle of topiramate pills by a different manufacturer from the ones I was taking before.
But it's not that simple! For the past 6 months, I have been tapering down my dose of Lexapro. I had been taking 20mgs; I'm now on 5mgs. The decrease from 10mgs to 5mgs also falls in the "2 weeks ago" timeframe.
Or maybe I have mono or something.
Or something more serious?
Is it even possible that the change in topiramate pills could make me feel this sleepy all of a sudden? I went from holy insomnia to this -- sleeping 14 OR MORE hours a day.
I will see my primary care doctor when I can, but he's kind of perfunctory. My neurologist is very expensive, so I'd rather he be the last resort.
Other may-be-pertinents:
History of iron deficiency anemia, but I take my iron, as well as calcium/magnesium, B-12, and vitamin D. Nutrition as good as it can be for someone with the zero appetite that topiramate sometimes leaves one with. Pretty sedentary these days. Much stress with a sick elderly parent. Definitely, absolutely not pregnant.
Has anyone else in the history of the world slept this much for a good reason?
Sleepiness would not be an unusual side-effect of an anti-epileptic drug. One strategy for coping with this is to take the drug only when you are about to go to sleep anyway. By the time you wake up, the soporific effect will have largely worn off. However, if that is not enough of a remedy, you will need to talk to your doctor.
posted by grizzled at 10:02 AM on October 7, 2010
posted by grizzled at 10:02 AM on October 7, 2010
Excessive tiredness is a side-effect of topiramate, and there are side-effect cautions about prescribing it with Lexapro, so a perfunctory PCP is not a good choice, in my opinion. I can't get a good read on branded Topamax costs vs. generic, but if it's any use, when I took branded Dilantin for epilepsy, I did not have have varying results as with generic phenytoin. I don't know whether it'd be way too expensive to switch to the branded medication. I'd recommend going to the neurologist (maybe has a lesser rate for a medication check than a full examination). Sorry I can't be more help.
posted by nj_subgenius at 10:21 AM on October 7, 2010
posted by nj_subgenius at 10:21 AM on October 7, 2010
Topiramate is notorious for its side effects. Sleepiness may or may not be one of them for you, but it's certainly a possibility. There are plenty of other anticonvulsant drugs with fewer and less severe side effects.
Although there are plenty of anecdotal reports of people responding differently to new formulations of drugs, one should keep in mind that FDA regulations require drug purities to exceed 99.9%, and all impurities above a given threshold must be identified, justified, and known to be nontoxic. In other words, it's pretty unlikely that there are clinically significant differences between the various formulations.
posted by dephlogisticated at 10:35 AM on October 7, 2010
Although there are plenty of anecdotal reports of people responding differently to new formulations of drugs, one should keep in mind that FDA regulations require drug purities to exceed 99.9%, and all impurities above a given threshold must be identified, justified, and known to be nontoxic. In other words, it's pretty unlikely that there are clinically significant differences between the various formulations.
posted by dephlogisticated at 10:35 AM on October 7, 2010
Topomax's side effects were so strong for me that I wasn't able to stay on it for more than three days. It was awful.
This very well could be your medication - either the generic Topomax (I take anti-convulsants and my neuro warned me that when they switch generics, sometimes the side effects change as well) or the interaction. Or it could be your depression coming back. From the info you provided, there's no way to narrow that down. The only way to eliminate what's going on is to isolate each factor and see when it gets better. Since this would involve changing your medication routine (either stop taking Topomax, stop taking Lexapro, or both) - do not do this without consulting your doctor.
The easiest thing to try is to take the Topomax before bed and see if you're less sleepy during the day. If that by itself doesn't help, the only solutions (changing dose, changing medications) require the intervention of your neurologist.
In other words, it's pretty unlikely that there are clinically significant differences between the various formulations.
While this is true, it is widely known that for whatever reason, different generics can make side effects worse. My neurologist and pharmacist have both inquired about this whenever I've switched between one generic to another to make sure that the meds are #1) still working and #2) not having increased side effects.
posted by sonika at 10:47 AM on October 7, 2010
This very well could be your medication - either the generic Topomax (I take anti-convulsants and my neuro warned me that when they switch generics, sometimes the side effects change as well) or the interaction. Or it could be your depression coming back. From the info you provided, there's no way to narrow that down. The only way to eliminate what's going on is to isolate each factor and see when it gets better. Since this would involve changing your medication routine (either stop taking Topomax, stop taking Lexapro, or both) - do not do this without consulting your doctor.
The easiest thing to try is to take the Topomax before bed and see if you're less sleepy during the day. If that by itself doesn't help, the only solutions (changing dose, changing medications) require the intervention of your neurologist.
In other words, it's pretty unlikely that there are clinically significant differences between the various formulations.
While this is true, it is widely known that for whatever reason, different generics can make side effects worse. My neurologist and pharmacist have both inquired about this whenever I've switched between one generic to another to make sure that the meds are #1) still working and #2) not having increased side effects.
posted by sonika at 10:47 AM on October 7, 2010
Nthing the Topamax hate. My wife was on it for epilepsy, and it made her sleepy *and* really stupid. There are a lot of different epilepsy meds out there; see if your doc will switch you to another if symptoms persist.
posted by the dief at 10:48 AM on October 7, 2010
posted by the dief at 10:48 AM on October 7, 2010
it's pretty unlikely that there are clinically significant differences between the various formulations.
In spite of FDA regulations, it's clear that sometimes generics can be significantly different from the name brand drug. It's best to ask the pharmacy to pick one manufacturer and stick to it.
posted by Ery at 10:54 AM on October 7, 2010
In spite of FDA regulations, it's clear that sometimes generics can be significantly different from the name brand drug. It's best to ask the pharmacy to pick one manufacturer and stick to it.
posted by Ery at 10:54 AM on October 7, 2010
In addition to the useful advice here, you could also call or visit your pharmacist to see what he or she thinks. Pharmacists are not just the people who dole out 30 pills per bottle; they have a ridiculously huge amount of knowledge about drugs, side effects, interactions, etc. And since you're getting your meds from them, they should be willing to talk to you for free about your concerns. That's the first place I would go if I were in your shoes.
posted by vytae at 11:04 AM on October 7, 2010
posted by vytae at 11:04 AM on October 7, 2010
It's best to ask the pharmacy to pick one manufacturer and stick to it.
FWIW, my pharmacist has flat out offered to carry one specific "flavor" of my medication if that particular version works best for me. My pharmacist is also made of magic, but yours should be able to accommodate this request if you find one generic whose side effects are more tolerable than others.
posted by sonika at 11:04 AM on October 7, 2010
FWIW, my pharmacist has flat out offered to carry one specific "flavor" of my medication if that particular version works best for me. My pharmacist is also made of magic, but yours should be able to accommodate this request if you find one generic whose side effects are more tolerable than others.
posted by sonika at 11:04 AM on October 7, 2010
Pharmacists are not just the people who dole out 30 pills per bottle; they have a ridiculously huge amount of knowledge about drugs, side effects, interactions, etc.
Yes, this is absolutely good advice in general. However, the one thing your pharmacist can't do is adjust your dosage and/or prescribe a different medication. For that, you will still need to see your neurologist. All roads pretty much lead to "See your doctor" on this one.
If the co-pay is too much, you can always call ahead, speak to the office nurse and make sure the appointment *is* necessary before committing to it. While you can't always get the doctor on the phone, the nurse also is a great source of information when it comes to trouble shooting. Your primary care doctor, while cheaper co-pay, will probably just tell you to see your neurologist. They really don't like to mess with medication that they are not the ones prescribing.
posted by sonika at 11:10 AM on October 7, 2010
Yes, this is absolutely good advice in general. However, the one thing your pharmacist can't do is adjust your dosage and/or prescribe a different medication. For that, you will still need to see your neurologist. All roads pretty much lead to "See your doctor" on this one.
If the co-pay is too much, you can always call ahead, speak to the office nurse and make sure the appointment *is* necessary before committing to it. While you can't always get the doctor on the phone, the nurse also is a great source of information when it comes to trouble shooting. Your primary care doctor, while cheaper co-pay, will probably just tell you to see your neurologist. They really don't like to mess with medication that they are not the ones prescribing.
posted by sonika at 11:10 AM on October 7, 2010
While this is true, it is widely known that for whatever reason, different generics can make side effects worse. My neurologist and pharmacist have both inquired about this whenever I've switched between one generic to another to make sure that the meds are #1) still working and #2) not having increased side effects.
In spite of FDA regulations, it's clear that sometimes generics can be significantly different from the name brand drug. It's best to ask the pharmacy to pick one manufacturer and stick to it.
The problem here is that the drugs most reported in these incidents are for the treatment of neuropsychiatric conditions, which are known to sometimes exhibit spontaneous recurrence of symptoms, even after years of successful maintenance therapy. Thus, the "Prozac poop-out" phenomena, where people become convinced they've developed tolerance to their medication because it no longer seems to work (regardless of formulation). The fact is that these drugs do not provide complete protection against recurrence. Anticonvulsants, for example, lower the frequency of seizures, often to the point where they no longer occur, but people can and do have seizures while on anticonvulsants.
As far as side effects go, again the fact that these are generally neuropsychiatric drugs is important to emphasize. The most common side effects for these drugs are usually very general—fatigue, weight gain, headache, nausea, etc. Which is why they're so often reported in placebo groups of drug trials. It really takes a controlled study to sort out the significance of self-reported effects.
While it's certainly possible that formulation changes are behind these reports, I think it's a popular assumption without much evidence to support it.
posted by dephlogisticated at 11:38 AM on October 7, 2010
In spite of FDA regulations, it's clear that sometimes generics can be significantly different from the name brand drug. It's best to ask the pharmacy to pick one manufacturer and stick to it.
The problem here is that the drugs most reported in these incidents are for the treatment of neuropsychiatric conditions, which are known to sometimes exhibit spontaneous recurrence of symptoms, even after years of successful maintenance therapy. Thus, the "Prozac poop-out" phenomena, where people become convinced they've developed tolerance to their medication because it no longer seems to work (regardless of formulation). The fact is that these drugs do not provide complete protection against recurrence. Anticonvulsants, for example, lower the frequency of seizures, often to the point where they no longer occur, but people can and do have seizures while on anticonvulsants.
As far as side effects go, again the fact that these are generally neuropsychiatric drugs is important to emphasize. The most common side effects for these drugs are usually very general—fatigue, weight gain, headache, nausea, etc. Which is why they're so often reported in placebo groups of drug trials. It really takes a controlled study to sort out the significance of self-reported effects.
While it's certainly possible that formulation changes are behind these reports, I think it's a popular assumption without much evidence to support it.
posted by dephlogisticated at 11:38 AM on October 7, 2010
More knowledgeable people than I have already spoken, but it's certainly possible that there was an interaction between the mood stabilizing effects of the topamax and the antidepressant effects of the lexapro. Changing one may well have altered the effective dose of the other, and either brought on somnolence as a previously mitigated side effect or left you in some kind of rebound effect depression.
If it's not totally disabling, and you're not having seizures, it's got to be worth having a word with your GP about it before bringing in the neurologist. There may well be a simple solution.
posted by Ahab at 11:39 AM on October 7, 2010
If it's not totally disabling, and you're not having seizures, it's got to be worth having a word with your GP about it before bringing in the neurologist. There may well be a simple solution.
posted by Ahab at 11:39 AM on October 7, 2010
I am on Topirimate currently, and I guess I am one of the few who has never had any trouble with it. Seizure meds can be funny that way; you have to find the one that works for you. My guess is that too many things are happening at once - cutting down on the Lexapro and changing to a different generic at the same time - and your body isn't coping well.
I would echo the advice to talk to the nurse at your neurologist's office, and to talk to your pharmacist. See if you can get back on the original generic, if it was working for you. And I know this is a huge pain in the ass, but don't be too hasty about quiting a med. I recently started a medicine which took nearly a month for the worst side effects to fade, but now I can't imagine my days without it. Our bodies take time to adjust, unfortunately.
posted by backwards compatible at 11:41 AM on October 7, 2010
I would echo the advice to talk to the nurse at your neurologist's office, and to talk to your pharmacist. See if you can get back on the original generic, if it was working for you. And I know this is a huge pain in the ass, but don't be too hasty about quiting a med. I recently started a medicine which took nearly a month for the worst side effects to fade, but now I can't imagine my days without it. Our bodies take time to adjust, unfortunately.
posted by backwards compatible at 11:41 AM on October 7, 2010
This thread is closed to new comments.
posted by desjardins at 9:40 AM on October 7, 2010