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What Are The Interactions When Keppra, Solian, Lexapro And Klonopin Are Taken Together?
Question: Hi,
I would like to do the following question.
I am on Keppra 1000 mg since six weeks and a half and also on Solian (amisulpride) 100mg, Lexapro 5 mg and Klonopin 2 mg. Since past friday i have moments of full recovery with Keppra (I mean, 100 %), but, according to information which says that the full effect is in 6 weeks, it's still not like that. I still have during some moments in the day "downs", i mean with the chemistry (not psychological downs) and the return of some symptoms (due PROBABLY to chemistry of Solian in my brain). I would like to say that i am not feeling all the time anxious and it's just that i would like to have a absolutely sustained recovery. I would like to know then if this full recovery is possible in very few days or if i have to wait more (remembering that i am close to a 98-99 % recovery so maybe i don't have to wait till week 8), because i worry (and it's NORMAL) because of my work and some travels i have to do (because of work). I understand that it's not possible to know exactly the day and so on, but in think probability exists.
I would like also to know if there is some kind of interaction of Keppra with the other meds and with coffee.
Thanks beforehand XXXXXXX
I would like to do the following question.
I am on Keppra 1000 mg since six weeks and a half and also on Solian (amisulpride) 100mg, Lexapro 5 mg and Klonopin 2 mg. Since past friday i have moments of full recovery with Keppra (I mean, 100 %), but, according to information which says that the full effect is in 6 weeks, it's still not like that. I still have during some moments in the day "downs", i mean with the chemistry (not psychological downs) and the return of some symptoms (due PROBABLY to chemistry of Solian in my brain). I would like to say that i am not feeling all the time anxious and it's just that i would like to have a absolutely sustained recovery. I would like to know then if this full recovery is possible in very few days or if i have to wait more (remembering that i am close to a 98-99 % recovery so maybe i don't have to wait till week 8), because i worry (and it's NORMAL) because of my work and some travels i have to do (because of work). I understand that it's not possible to know exactly the day and so on, but in think probability exists.
I would like also to know if there is some kind of interaction of Keppra with the other meds and with coffee.
Thanks beforehand XXXXXXX
Brief Answer:
The exact information about this is not possible
Detailed Answer:
Hello,
Thanks for contacting me.
As we discussed in last interaction keppra generally takes foor to six weeks to have its full effect for majority of cases. Despite the fact it is not possible to know when it will offer 100% stability. From my clinical experience I know people who had good effects within two weeks and other set of people who took more than six weeks.
There is one obvious limitation of research which is unable to answer your legitimate query convincingly. Medical research is done with select criteria. In case of keppra studies are aimed to recovery of 70-90% symptoms and that level you achieved long back. There are no studies which can differentiate between 98 and 100% in regard of keppra.
As you know day today fluctuations are impossible to knw and that holds true for keppra. We can just hope that in few days you will be more stable in compare to today but that can not be predicted as per available literature.
Although minor interaction reported with coffee but there is no evidence of significant interactions with coffee. Due to these facts it is advised to use no more than three cup of coffee per day.
Since coffee is a stimulant of CYP it increases metabolism of Keppra and Clonazepam. But if you limit your coffee intake for two to three cups you should not cause a problem.
I hope this answers your question.
Thanks and regards
The exact information about this is not possible
Detailed Answer:
Hello,
Thanks for contacting me.
As we discussed in last interaction keppra generally takes foor to six weeks to have its full effect for majority of cases. Despite the fact it is not possible to know when it will offer 100% stability. From my clinical experience I know people who had good effects within two weeks and other set of people who took more than six weeks.
There is one obvious limitation of research which is unable to answer your legitimate query convincingly. Medical research is done with select criteria. In case of keppra studies are aimed to recovery of 70-90% symptoms and that level you achieved long back. There are no studies which can differentiate between 98 and 100% in regard of keppra.
As you know day today fluctuations are impossible to knw and that holds true for keppra. We can just hope that in few days you will be more stable in compare to today but that can not be predicted as per available literature.
Although minor interaction reported with coffee but there is no evidence of significant interactions with coffee. Due to these facts it is advised to use no more than three cup of coffee per day.
Since coffee is a stimulant of CYP it increases metabolism of Keppra and Clonazepam. But if you limit your coffee intake for two to three cups you should not cause a problem.
I hope this answers your question.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Thanks a lot for your clear answer, and especially about coffee, i'll follow your advice, i already noticed that there is interaction between Klonopin and coffee.
I was on Keppra since 2009 to 2012, The change was due in 2012 to the fact that my psychiatrist decided to try with the biosimilar Exitelev (by Sandoz). So, since 2013 to 2015, i was on the biosimilar. The first time, Keppra acted very quickly, maybe in few days and i had a 100 % absolutely full effect for those years, without any symptoms. I was before on Lamotrigine (before 2009). This time, Keppra is entering the week 7 and i still wait the full effect. I've been told by two psychiatrists that Keppra has to fight in receptors with the old biosimilar. I would like if this possibility exists and it explains that Keppra is not acting so fast as in the first time. I just would like to know if this possibility exists and it explains that Keppra has shown this time -and not the FIRST time, in 2009- a more slowly effect. Thanks beforehand if it's possible to know more about this subject.
The difference between 98 % and 100 % for me is the effect in my eyes, since mi vision is disturbed with open windows in cars, an absolutely strange symptom according to my psychiatrist and a symptom that finally cannot be explained by OCD (it "looks like", but also like a "phobia" and so on). I guess it's a dopaminergic effect of Solian 100 mg that Keppra cannot yet fight at 100 %. Without a full effect of Keppra, my vision is still distracted/disturbed by this stimulus in the street and since it is a matter of chemistry, it don't depends on me and is not pleasant. Keppra acts as far as i know trough calcium channels and they modulate dopaminergic activity, so maybe there is here another problem. Thanks also if i can have your opinion about this.
I would be very glad to have your opinion. I understand that the problem seems strange, not easy and disturbing (making me also a disturbing patient!)
Best regards, XXXXXXX
Thanks a lot for your clear answer, and especially about coffee, i'll follow your advice, i already noticed that there is interaction between Klonopin and coffee.
I was on Keppra since 2009 to 2012, The change was due in 2012 to the fact that my psychiatrist decided to try with the biosimilar Exitelev (by Sandoz). So, since 2013 to 2015, i was on the biosimilar. The first time, Keppra acted very quickly, maybe in few days and i had a 100 % absolutely full effect for those years, without any symptoms. I was before on Lamotrigine (before 2009). This time, Keppra is entering the week 7 and i still wait the full effect. I've been told by two psychiatrists that Keppra has to fight in receptors with the old biosimilar. I would like if this possibility exists and it explains that Keppra is not acting so fast as in the first time. I just would like to know if this possibility exists and it explains that Keppra has shown this time -and not the FIRST time, in 2009- a more slowly effect. Thanks beforehand if it's possible to know more about this subject.
The difference between 98 % and 100 % for me is the effect in my eyes, since mi vision is disturbed with open windows in cars, an absolutely strange symptom according to my psychiatrist and a symptom that finally cannot be explained by OCD (it "looks like", but also like a "phobia" and so on). I guess it's a dopaminergic effect of Solian 100 mg that Keppra cannot yet fight at 100 %. Without a full effect of Keppra, my vision is still distracted/disturbed by this stimulus in the street and since it is a matter of chemistry, it don't depends on me and is not pleasant. Keppra acts as far as i know trough calcium channels and they modulate dopaminergic activity, so maybe there is here another problem. Thanks also if i can have your opinion about this.
I would be very glad to have your opinion. I understand that the problem seems strange, not easy and disturbing (making me also a disturbing patient!)
Best regards, XXXXXXX
Brief Answer:
Yes there is possibility of interference due to existing molecule in body
Detailed Answer:
Hello,
Thanks for reverting back to me.
Your psychiatrist is right in saying about the interaction of keppra with biosimilar at receptor level. I like to clarify further.
Although there is possibility but I do not think it should cause interference upto six weeks. Lvetiracetam has half life of just eight hours and it remains in body for less than one week when discontinued. As the possible interference can last upto two weeks but I do not think it will last for six weeks.
I hope this clarifies in one aspect.
Yes it is strange at the chemical level we do not have any explanation. You also rightly pointed out about the differences in chemical action of keppra and solian and they do not have any interaction as per available literature.
Disturbance of vision cannot be explained but there is evidence of double vision as a side effect of Keppra (2%). It is possible that your visual disturbance can be explained on this side effect if it started after initiation of keppra.
I hope this clarifies your doubts.
Thanks and regards
Yes there is possibility of interference due to existing molecule in body
Detailed Answer:
Hello,
Thanks for reverting back to me.
Your psychiatrist is right in saying about the interaction of keppra with biosimilar at receptor level. I like to clarify further.
Although there is possibility but I do not think it should cause interference upto six weeks. Lvetiracetam has half life of just eight hours and it remains in body for less than one week when discontinued. As the possible interference can last upto two weeks but I do not think it will last for six weeks.
I hope this clarifies in one aspect.
Yes it is strange at the chemical level we do not have any explanation. You also rightly pointed out about the differences in chemical action of keppra and solian and they do not have any interaction as per available literature.
Disturbance of vision cannot be explained but there is evidence of double vision as a side effect of Keppra (2%). It is possible that your visual disturbance can be explained on this side effect if it started after initiation of keppra.
I hope this clarifies your doubts.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Thanks a lot for your clear answer about biosimilar. I just have a last question.
The disturbance is not due to Keppra (i have it before Keppra and since i was on Solian 200 mg and then 100 mg, it was not like that with Solian 400 mg a lot of years ago) even if when i take Keppra i do have double vision. I've been told that Solian al low dosage has dopaminergic effect, i guess in prefrontal cortex, right?: can this cause an "ocd like" or "phobia like" symptom, since my disturbance is like that and very specific?
Best regards, XXXXXXX
Thanks a lot for your clear answer about biosimilar. I just have a last question.
The disturbance is not due to Keppra (i have it before Keppra and since i was on Solian 200 mg and then 100 mg, it was not like that with Solian 400 mg a lot of years ago) even if when i take Keppra i do have double vision. I've been told that Solian al low dosage has dopaminergic effect, i guess in prefrontal cortex, right?: can this cause an "ocd like" or "phobia like" symptom, since my disturbance is like that and very specific?
Best regards, XXXXXXX
Brief Answer:
OCD like effect is possible but no evidence of phobic symptoms
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
To be XXXXXXX we are in new territory to discuss few effects. There is evidence of ocd like symptoms with Solian but to my best of knowledge there is no significant evidence of phobic like symptoms as side effect.
I must acknowledge that by considering the mechanism of action this is possible (both ocd and phobic like symptoms) but in my almost 10 years of experience I am yet to see any phobic side effects due to solian.
I am sorry I can not clarify the situation here because I never encountered. We must understand that few things are beyond the limit of science and hopeful of answered things become answered in near future.
Thanks and regards
OCD like effect is possible but no evidence of phobic symptoms
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
To be XXXXXXX we are in new territory to discuss few effects. There is evidence of ocd like symptoms with Solian but to my best of knowledge there is no significant evidence of phobic like symptoms as side effect.
I must acknowledge that by considering the mechanism of action this is possible (both ocd and phobic like symptoms) but in my almost 10 years of experience I am yet to see any phobic side effects due to solian.
I am sorry I can not clarify the situation here because I never encountered. We must understand that few things are beyond the limit of science and hopeful of answered things become answered in near future.
Thanks and regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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