![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by lepus on June 6, 2004, at 22:52:26
I am on 300mg of Trileptal taken 150mg at dinner and 150mg before going to bed. I have been on the drug about a week. The past couple of days I have been noticing my heart racing frequently. I don't see this side effect listed in any literature I have been able to find. Does anyone else have any experience with this side effect or with this drug? I will be calling my psychiatrist in the morning but since I suffer from panic attacks I fear she is going to dismiss my symptoms as simply a part of them. Will this side effect pass and is this normal? It is very disconcerting.
Thank you for all your help.
Lep
Posted by psychosage on June 7, 2004, at 1:55:11
In reply to Help - Trileptal/Heart racing, posted by lepus on June 6, 2004, at 22:52:26
> I am on 300mg of Trileptal taken 150mg at dinner and 150mg before going to bed. I have been on the drug about a week. The past couple of days I have been noticing my heart racing frequently. I don't see this side effect listed in any literature I have been able to find. Does anyone else have any experience with this side effect or with this drug? I will be calling my psychiatrist in the morning but since I suffer from panic attacks I fear she is going to dismiss my symptoms as simply a part of them. Will this side effect pass and is this normal? It is very disconcerting.
>
> Thank you for all your help.
> LepTrileptal is usually titrated very slowly, so did you start for a few days on just one 150mg? That may have helped you become accustomed to it unless you have experience with anticonvulsants.
Anyhow, I think that the dizzy drunken feeling can be stimulating to a certain degree for a brief period, and that is what happened to me. I felt an odd compulsion to keep walking and walking while my head was in this weird perceptive bubble brain state. That happened in the very beginning when i went from 300 to 600mg a day. I hit 1200mg eventually, but I am down to 600mg now.
Does your heart race in any other circumstance while sedated on other meds or alcohol if you drink?
There are no cardiovascular issues that I've read of.
Could it be sodium related?
Good luck finding out and share with us your conclusion.
Posted by lepus on June 7, 2004, at 2:17:09
In reply to Re: Help - Trileptal/Heart racing » lepus, posted by psychosage on June 7, 2004, at 1:55:11
>
> Trileptal is usually titrated very slowly, so >did you start for a few days on just one 150mg? >That may have helped you become accustomed to it >unless you have experience with anticonvulsants.No, my psychiatrist started me out 300mg. I think she was trying to knock me out because I hadn't been sleeping for a long time. Funny thing is the Trileptal is not knocking me out and I feel like it is actually making my sleep worse. I do sleep but usually from 4am until about 2pm. It is delightful.
>
> Does your heart race in any other circumstance >while sedated on other meds or alcohol if you >drink?YES! How odd that you bring that up! I was started on 100mg of Seroquel by an idiot psychiatrist once and ended up in the ER with heart palpitations. Alcohol makes my heart race whenever I have drunk it and therefore I don't drink at all. What does that mean? I did OD on Tofranil during a suicide attempt and I wonder if that has had more lasting effects than the doctors said it would. But alcohol and other sedatives made my heart race long before that incident so I am not sure how relevant it is. These days I am finding myself wishing that suicide attempt had worked. I just can't seem to find any relief and it seems like things have gotten worse. Okay, I will quit rambling about that now and move on to answering the rest of your reply.
>
> There are no cardiovascular issues that I've read of.I read of tachycardia being a side effect although rare. Perhaps I am just having one of the rare side effects. Wouldn't be the first time I get a side effect that only .1% of people get.
> Could it be sodium related?
I am not sure. I have been finding myself craving salt. I have been eating a lot of spanish olives! Also, a lot of foods taste strange. I ate a boiled egg tonight, a food I usually love and it tasted very strange and I didn't enjoy it.
> Good luck finding out and share with us your >conclusion.
Thank you. I just don't know if I should stick it out with this drug or not. I do seem to running out of options. There are few drugs I haven't been on. I do seem to have that "drunk" feeling of which you spoke. My gait is a bit unsteady. But you think this is just a problem of being started on the drug too quickly and perhaps it will subside? I do want to give it a chance.
Thank you for your help.
Posted by crazychickuk on June 7, 2004, at 4:54:20
In reply to Re: Help - Trileptal/Heart racing, posted by lepus on June 7, 2004, at 2:17:09
Hi i have never taking trileptal before, but i can relate with the heart racing, ever time i try an ssri snri my heart is beating faster, i am currently on remeron 30mg only and i must admit this is the only drug that hasnt given me that side affect..
I ended up in hospital when i was on celexa god my heart was like in the 200's and my bp was very high too..
Maybe ask for another drug thats not related to trileptal ? i am not sure was family this drug belongs to..
Best of luck
Posted by lepus on June 7, 2004, at 18:12:44
In reply to Re: Help - Trileptal/Heart racing, posted by crazychickuk on June 7, 2004, at 4:54:20
> Hi i have never taking trileptal before, but i can relate with the heart racing, ever time i try an ssri snri my heart is beating faster, i am currently on remeron 30mg only and i must admit this is the only drug that hasnt given me that side affect..
>
> I ended up in hospital when i was on celexa god my heart was like in the 200's and my bp was very high too..
>
> Maybe ask for another drug thats not related to trileptal ? i am not sure was family this drug belongs to..
>
> Best of luckSorry about hte problems you have had with the drugs. I called my doctor today and have heard nothing back. So, I don't know if I should keep taking it or what.
Trileptal is a mood stabilizer and I have no idea what to go on next as I have been on so many drugs. My biggest problem is anxiety, which the SSRIs don't touch. I have been dxd as BPII as well but I am not sure how much I agree with that diagnosis. I think I am depressed with panic attacks. Oh well whatever. My life seems to be over as I know it anyway so what do I really care if this drug causes a stroke or whatever because my idiot psychiatrist can't get back in touch with me.
I am about to throw in the towel, go off all meds and just forget about ever having a normal life.
Posted by Vanillintabaktöne on June 7, 2004, at 19:28:49
In reply to Re: Help - Trileptal/Heart racing (nm), posted by Vanillintabaktöne on June 7, 2004, at 6:40:08
The exact same thing happened to me with carbamazepine @ 200 mg CR twice a day.
Carbamazepine [Tegretol] and oxcarbazepine [Trileptal] are chemically related to the Tricyclic Antidepressants. They too had the same effect on me in terms of heart racing, although lesser with Imipramine. Even the older antihistamines like diphenhydramine [Benadryl] Dimenhydrinate [Gravol] and Chlorpheniramine [Piriton] all do that.
This effec is because of the tertiary amine on the molecule resulting in anticholinergic effects. Anticholinergic and sympathomimetic [adrenergic] effects are somewhat similar in that the both oppose vagal tone resulting in tachycardia, although with anticholinergics there is the clear distinction of sedation and memory loss amongst other things. In otherwards ZOMBIE!!
The only difference between Tegretol and Trileptal was the addition of an oxygen to the former to lessen hepatic effects with the resulting Trileptal. However, Trileptal still possessess anticholinergic properties which MAY explain why users experience tachycardia. The Na+ channel blockade may also be the reason. But whether selectivity exists for different channels [cerebral or extracerebral]
, I dont know. It is interesting to note that the Na+ channel blockade property is one that all the mood stabilizers possess, and that Na+ valproate also causes cardiac effects in some individuals including myself especially at doses exceeding 500 mg per day. So this may be a more plausible explanation.It is important to realize that stimulation of the 5-HT-2 receptor by endogenous serotonin or other ligands this receptor has affinity for can result in considerable anxiety. It makes sense that the net increase in 5-HT availability secondary to reuptake inhibition by the SSRI's can result in anxiety [paradoxic] and nausea through stimulation of 5-HT-3 receptors. Although Prozac, Paxil, Zoloft, Celexa and Lexapro OBVIOUSLY increase serotonin, each agent exhibits secondary binding affinities, with maybe the exception of citalopram and escitalopram [which still bind to histaminergic receptors in the CNS], and produce unwanted side effects or welcomed benefits.
IMPORTANTLY TOO, CONSIDER THAT ALL ANTIDEPRESSANTS RESULT IN DOWNREGULATION AND INCREASE SENSITIVITY OF CNS ADRENERGIC RECEPTORS AND THROUGH REGULATION OF ADENYL CYCLASE.
Case in point Paxil which is the most sedating SSRI because of intrinic affinty for muscarinic receptors, FURTHER opposing vagal tone and potentially producing the tachycardia, and the 'zombie', 'zonked' demeanour in your case.
In my opinion, NOT A GOOD COMBO.
Further it should also make pharmacologic sense that SSRI's not be a good choice to add to bipolars. Although it does seem to work in some individuals, for which I have no theories on. Considering 5-HT receptor stimulation effects especially by acute stimulation can result in deleterious effects. Just consider that the antipsychotics, the atypicals especially, exhibit considerably more blockade at 5-HT-2 receptors than at D-2 and are more often than not effectively used to treat Bipolar Affective Disorder states.
So maybe in your case, combining a less antimuscarinic SSRI's or even an atypical antidepressant Be combined with a low dose of an atypical antipsychotic like Seroquel be better for you. It would produce a nefazodone-like effect without stewing your liver.
It is food for thought.
P.S. I think there is a combo out there that consists of Prozac and an atypical Antipsychotic in one pill. Cant remember the name.
Posted by lepus on June 7, 2004, at 22:49:36
In reply to Re: Help - Trileptal/Heart racing, MY THEORY, posted by Vanillintabaktöne on June 7, 2004, at 19:28:49
Your theory makes a lot of sense. Since TCAs are known to cause irregular heart rhythms and are therefore very dangerous in overdose then if Trileptal is similar to the TCAs it doesn't seem very surprising that I am having an adverse reaction.
I hope I understand your post correctly. Biochemistry always made my head swim and now that my IQ has been reduced to that of a bush it is even more difficult.
But I thank you for your reply and will even bring up the points you made to my doctor provided she ever calls!
Posted by crazychickuk on June 8, 2004, at 4:10:09
In reply to Re: Help - Trileptal/Heart racing, MY THEORY » Vanillintabaktöne, posted by lepus on June 7, 2004, at 22:49:36
Dont be down plse, think of it as an of day, call your doc again and again and again till she answers u, then tell her whats going on, u have every right, SOmetimes the secertary dont allways pass the messages on, thats the case in my town anyways, there is something out there for you,the tca's in my case just made me feel as if my heart was gonna stop, only remeron has ever been any good for me.. it blocks a certain recepter that causes your heart to race or something i am not all that famillier with chemistry...maybe you could ask for that? you sound to me exactly like me, but your depression is worse than mine, i get severe anxiety and panick attacks and a few days of being depressed (but not as bad as anxiety) plse dont give up, keep ringing your doctor go down there if you can, and ask for something else. maybe try remeron ?
Posted by lepus on June 8, 2004, at 20:17:56
In reply to Re: Help - Trileptal/Heart racing, LEPUS, posted by crazychickuk on June 8, 2004, at 4:10:09
Thanks for your words. I did speak to the pdoc through my case worker and apparently the pdoc says she has never heard of these symptoms before and to just take the full 300mg at bedtime. Brilliant! She is a genius though isn't she? So I get no explanation of my symptoms and am just told to "tough it out" basically? Plus, my case worker said if I needed to speak to the pdoc any time between now and my appt on the 9th of July then I will have to start coming to outpatient everyday to speak to the psychiatrists there. It just doesn't make sense. I am having a bad reaction to a med and they want to make me pay for outpatient to see a psychiatrist? I wish I would win the lotto or something so I could go to private mental health care. Instead I am stuck with semi-private through the area I live in.
I am so fed up I could just spit. To have my symptoms disregarded because the doctor doesn't think they are in the literature is ridiculous and made even more ridiculous by the fact that I FOUND them in the literature! Why do I bother to keep fighting when no one is helping me and just putting me down further? There is a serious problem in psychiatry these days. It is an age of barbarism and profits before people.
Posted by katia on June 13, 2004, at 15:13:07
In reply to Re: Help - Trileptal/Heart racing, MY THEORY, posted by Vanillintabaktöne on June 7, 2004, at 19:28:49
Interesting post. Too bad I didn't understand much of it! Can you re-explain in layman's terms please? I am on Triletpal 450mg, Seroquel 25mg, and Paxil 25mg. I don't feel too sedated. What were you saying about dangerous liver functioning? I didn't quite understand...I also drink 1-2 glasses of wine 5x a week; so if there is danger with the liver with these three then maybe I need to take notice.
Katia> The exact same thing happened to me with carbamazepine @ 200 mg CR twice a day.
>
> Carbamazepine [Tegretol] and oxcarbazepine [Trileptal] are chemically related to the Tricyclic Antidepressants. They too had the same effect on me in terms of heart racing, although lesser with Imipramine. Even the older antihistamines like diphenhydramine [Benadryl] Dimenhydrinate [Gravol] and Chlorpheniramine [Piriton] all do that.
>
> This effec is because of the tertiary amine on the molecule resulting in anticholinergic effects. Anticholinergic and sympathomimetic [adrenergic] effects are somewhat similar in that the both oppose vagal tone resulting in tachycardia, although with anticholinergics there is the clear distinction of sedation and memory loss amongst other things. In otherwards ZOMBIE!!
>
> The only difference between Tegretol and Trileptal was the addition of an oxygen to the former to lessen hepatic effects with the resulting Trileptal. However, Trileptal still possessess anticholinergic properties which MAY explain why users experience tachycardia. The Na+ channel blockade may also be the reason. But whether selectivity exists for different channels [cerebral or extracerebral]
> , I dont know. It is interesting to note that the Na+ channel blockade property is one that all the mood stabilizers possess, and that Na+ valproate also causes cardiac effects in some individuals including myself especially at doses exceeding 500 mg per day. So this may be a more plausible explanation.
>
> It is important to realize that stimulation of the 5-HT-2 receptor by endogenous serotonin or other ligands this receptor has affinity for can result in considerable anxiety. It makes sense that the net increase in 5-HT availability secondary to reuptake inhibition by the SSRI's can result in anxiety [paradoxic] and nausea through stimulation of 5-HT-3 receptors. Although Prozac, Paxil, Zoloft, Celexa and Lexapro OBVIOUSLY increase serotonin, each agent exhibits secondary binding affinities, with maybe the exception of citalopram and escitalopram [which still bind to histaminergic receptors in the CNS], and produce unwanted side effects or welcomed benefits.
>
> IMPORTANTLY TOO, CONSIDER THAT ALL ANTIDEPRESSANTS RESULT IN DOWNREGULATION AND INCREASE SENSITIVITY OF CNS ADRENERGIC RECEPTORS AND THROUGH REGULATION OF ADENYL CYCLASE.
>
> Case in point Paxil which is the most sedating SSRI because of intrinic affinty for muscarinic receptors, FURTHER opposing vagal tone and potentially producing the tachycardia, and the 'zombie', 'zonked' demeanour in your case.
>
> In my opinion, NOT A GOOD COMBO.
>
> Further it should also make pharmacologic sense that SSRI's not be a good choice to add to bipolars. Although it does seem to work in some individuals, for which I have no theories on. Considering 5-HT receptor stimulation effects especially by acute stimulation can result in deleterious effects. Just consider that the antipsychotics, the atypicals especially, exhibit considerably more blockade at 5-HT-2 receptors than at D-2 and are more often than not effectively used to treat Bipolar Affective Disorder states.
>
> So maybe in your case, combining a less antimuscarinic SSRI's or even an atypical antidepressant Be combined with a low dose of an atypical antipsychotic like Seroquel be better for you. It would produce a nefazodone-like effect without stewing your liver.
>
> It is food for thought.
>
> P.S. I think there is a combo out there that consists of Prozac and an atypical Antipsychotic in one pill. Cant remember the name.
Posted by Vanillintabaktöne on June 13, 2004, at 19:31:20
In reply to Re: Help - Trileptal/Heart racing, MY THEORY » Vanillintabaktöne, posted by katia on June 13, 2004, at 15:13:07
Well it was a very good idea for your Pdoc to add Seroquel along at that dose to your Paxil. Makes the SSRI more tolerable while alleviating the cycling tendency.
My theory might help explain the original poster's complaint. Its NOT a generalization because everyone reacts differently to the same meds.
Trilpetal is EASIER on the liver. However, it is not a very good idea to drink with medication. Although wine isn't a bad choice especially red. Talk to your doc about it.
Good Luck
Posted by katia on June 14, 2004, at 0:44:35
In reply to Re: Help - Trileptal/Heart racing, MY THEORY » katia, posted by Vanillintabaktöne on June 13, 2004, at 19:31:20
**Hey V,
What country are you from? Germany? Sweden?> Well it was a very good idea for your Pdoc to add Seroquel along at that dose to your Paxil. Makes the SSRI more tolerable while alleviating the cycling tendency.
**I've been on Seroquel for about a year now for sleep. 25mgs of Paxil is quite low, no? The Paxil was added two months ago for anxiety and depression - catching it in the beginning stages - preventive like.
>
> My theory might help explain the original poster's complaint. Its NOT a generalization because everyone reacts differently to the same meds.
>
> Trilpetal is EASIER on the liver. However, it is not a very good idea to drink with medication. Although wine isn't a bad choice especially red. Talk to your doc about it.
>
> Good LuckI have talked with him about it. He always says one or two probably will be ok. It's red wine, btw. But some white. I've been drinking since being on all meds. What is the real danger? Everyone always says no drinking. But why I wonder? Is it just a blanket thing to say with anyone on meds? I don't think one or two will hurt. It's just occasionally I'll imbibe beyond one or two and boy do I feel the hangover!
Katia
Posted by Vanillintabaktöne on June 14, 2004, at 17:46:40
In reply to Re: Help - Trileptal/Heart racing, MY THEORY » Vanillintabaktöne, posted by katia on June 14, 2004, at 0:44:35
Hi again Katia,
No I am not from Scandinavia. I live where the tropical sun bathes me in his rays most of the day and where hurricanes threaten from June to November.
That is true that when health professionals tell you not to drink alcohol with meds, in most cases its a blanket thingy. However, there are cases where alcohol consumption can have serious effects with meds. In persons with mental illness, alcohol can have weird effects especially during the hangover, which can be REALLY bad. You might also notice that for a few days after your drinking binge, your meds seem not to work as well or produce intense side effects.
A few in your case couldn't hurt though.
Yes 25 mg of paroxetine is along the low dose range. Nonetheless, seroquel is a good addition.
Posted by katia on June 15, 2004, at 13:36:03
In reply to Re: Help - Trileptal/Heart racing, MY THEORY » katia, posted by Vanillintabaktöne on June 14, 2004, at 17:46:40
Sounds great. East coast of USA? Where did you get your name?
correction: I am on 12.5mg of Paxil - a very low dose. It's so hard to determine what doses will work. and what's what. I have been told, and also feel it myself, that my system is sensitive and less is better for me in regards to meds AND alcohol.
Does anyone know? What exactly happens when drinking alcohol on meds? Besides feeling crappy the next day(s). Specifically, chemically, what happens? Anything that is highly dangerous? or just the added process for the liver?
Katia
Posted by PrettyLady on October 29, 2012, at 13:29:55
In reply to Help - Trileptal/Heart racing, posted by lepus on June 6, 2004, at 22:52:26
I was wondering if this issue ever got sorted out for you?? Did the palpitations go away/did you stop the medication?
Did you switch to anything else?
I just started trileptal also and am noticing some heart stuff. I also have panic. The heart stuff got worse when I added 25 mg of seroquel to sleep. Thanks!
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.