Q:  Trileptal Dosing

My 15 year old son has become obese by taking depakote. His mood is stable at 2000 of depakote.  We are trying to switch him to trileptal.  Currently he is on 1200mg of Trileptal and 1500 of Depakote.  He doing some rapid cycling again.  I don't want to give up on the trileptal.  He weights 220 lbs at 5'7" tall. What is the maximum dose of Trileptal that be given to someone like him?

Thank you.  Please do not post my identity on the internet.  I would appreicate a quick response.

Hello Anon -- 
Trileptal dosing is defined primarily based on its use in epilepsy, where the "maximum" according to the manufacturer is 2400 mg.  I've heard of one patient taking 2600 (not mine).  However, in my experience, patients start not liking this medication at about 1800 and I've only had one patient up higher than that, briefly.  But up to that dose, it seems generally very well tolerated.  

Another thought for you and your son:  research on this is just beginning, but there is one very small "open trial" (no control group) which looked at Glucophage as a sort of "antidote" for weight gain on Depakote, or Zyprexa, or  Risperidone.^Morrison  Read more about Glucophage if you wish in an essay about weight gain on psychiatric medications.  

Dr. Phelps