Current Medications

8 medications

Tegretol

Carbamazepine

Active

Dose

300mg BID (600mg/day)

Timing

AM + PM

Purpose

Anticonvulsant

Class

Antiepileptic (sodium channel blocker)

Can be crushedTegretol 200mg (regular) can be crushed

Drug Level

7.77 (ref: 4-12)

CYP3A4 inducer

CYP3A4 inducer - reduces quetiapine & donepezil levels. Likely causing neutropenia (ANC 0.7). Level: 7.77 (therapeutic 4-12). Causing SIADH (osm 279).

Keppra

Levetiracetam

Active

Dose

500mg BID (1000mg/day)

Timing

AM + PM

Purpose

Anticonvulsant

Class

Antiepileptic (SV2A binding)

Can be crushedFilm-coated but can be crushed if needed

Keppra Rage - possible cause of screaming/irritability (~13% of adults). Level NEVER checked. Add B6 50-100mg. Risk factors: TBI with frontal involvement, pre-existing disinhibition.

Depakine Chrono

Valproic Acid / Sodium Valproate

Tapering

Dose

250mg evening only (tapering to stop)

Timing

Evening

Purpose

Anticonvulsant (TAPERING → STOP)

Class

Antiepileptic (GABA enhancer)

DO NOT CRUSHNEVER crush Depakine Chrono - destroys controlled-release → dose dumping → toxicity

Drug Level

23.1 (ref: 50-100)

Mildly boosts quetiapine levels

Per Prof. Hassan Hosny (07 Mar 2026): Reduce to 250mg evening only starting 17 Mar 2026 for 3 weeks, then STOP completely (by ~7 Apr 2026). Level 23.1 (sub-therapeutic). DO NOT CRUSH — prolonged-release formulation.

Quitapex (Seroquel)

Quetiapine

Stopped

Dose

25mg

Timing

Bedtime

Purpose

Mood/Sleep

Class

Atypical antipsychotic

Can be crushed

CYP3A4 substrate - affected by CBZ

STOPPED per Prof. Hassan Hosny (07 Mar 2026). Was 25mg bedtime — sedative-only dose. Replaced by Escitalopram for mood.

Lioresal

Baclofen

Tapering

Dose

7.5mg AM + 10mg PM (tapering to stop)

Timing

AM + PM

Purpose

Muscle relaxant (spasticity)

Class

GABA-B agonist (antispastic)

Can be crushedCan be crushed

Per Prof. Hassan Hosny (07 Mar 2026) — Gradual taper starting 17 Mar 2026: • 17 Mar – 31 Mar: 7.5mg AM + 10mg PM • 31 Mar – 14 Apr: 5mg AM + 10mg PM • 14 Apr – 28 Apr: 2.5mg AM + 10mg PM • After 28 Apr: STOP completely Separate from whey protein by 1-2 hours (LAT1 transporter competition). DO NOT stop abruptly (risk of seizure — Feb 2024 incident).

Aricept

Donepezil HCL

Tapering

Dose

5mg (tapering to stop)

Timing

Morning

Purpose

Memory/Cognition

Class

Cholinesterase inhibitor

Can be crushedCan be crushed; also available as ODT

CYP3A4 substrate

Per Prof. Hassan Hosny (07 Mar 2026): Reduce to 5mg for 2 weeks (17 Mar – 31 Mar 2026), then STOP completely. Previously 10mg. CBZ reduces its level via CYP3A4 induction.

Crestor

Rosuvastatin

Active

Dose

10mg

Timing

Bedtime

Purpose

Cholesterol (LDL 101)

Class

HMG-CoA reductase inhibitor (statin)

DO NOT CRUSHFilm-coated statin - check with pharmacist before crushing

LDL 101 (target <100). Creatine may protect against statin myopathy. Depletes CoQ10. SEPARATE from Mg by 2+ hours (54% absorption reduction).

Cipralex

Escitalopram

Active

Dose

10mg

Timing

Morning

Purpose

Mood enhancement (SSRI)

Class

SSRI (Selective Serotonin Reuptake Inhibitor)

Can be crushedCan be crushed if needed

CYP2C19 substrate, minor CYP3A4

Started per Prof. Hassan Hosny (07 Mar 2026). SSRI for mood enhancement. Replaces quetiapine for mood/sleep support. Safe with current AEDs. Monitor for initial GI side effects (nausea) in first 1-2 weeks.