medication question...when is it too much???

[mattsmum]

Update...

difficult child was released (per my request) from inpatient facility on a 5-day pass. They are all done adjusting medications for now and they were just keeping him there so they could transition him to day program. If things go well on the visit, he will be discharged. :smile:

It looks like the day program transition may not happen for 3 more weeks and I wanted him home. His home visits have been going well.

He has been home for two days now without ANY problems. He is also doing very well in public school with a 1:1 Special Education teacher in their own room all day.

Here is my question...
difficult child is now on
.25mg Clonidine (.05 taken 5x/day)
1500mg Depakote
700mg Seroquel (plus 200mg if needed)
The pharmacist told me as well as the Special Education Teacher that these are unusually high doses...even in the adult range. The psychiatrist explained that they adjusted them to the level where they felt they needed to be for difficult child. Once he is stable, they can work on reducing some of them.

Are they unusually high doses? Should I be concerned...or just happy he seems to be stable now?

 

[mekki]

I have always felt uncomfortable with the medications and doses that my boy has been on. However, if that's what it takes to help them live a happy life, then what can you do? How much is too much?

hmmm, I just realized that all of my comments I've left tonight are flaky :smile:

Oh, and I'm so glad to hear that the residential facility has helped. My son is on his way to one soon (fingers crossed).

 

[smallworld]

Your difficult child's doses are on the high end. However, it does depend somewhat on how his liver metabolizes medications. How does your difficult child seem? Does he seem unusually sleepy or lethargic? Is he having any side effects that you're aware of?

Depakote is dosed by blood level -- some kids with BiPolar (BP) do well on a blood level of 80 to 90, while others require a level of 100 to 125. Higher than 125 can be toxic to the liver. Has your difficult child had a recent blood draw to determine his Depakote blood level? That would definitely help determine whether his dose is too high. When my kids were on Depakote, they never took higher than 1000 mg.

Most adolescents take up to 600 mg Seroquel a day, but I have heard of some children taking 800 mg. Is your difficult child experiencing any unsual involuntary movements or is his appetite so ravenous that he is gaining weight rapidly. Those would be two side effects to be concerned about. Cholesterol, triglycerides and glucose levels should be checked at least every six months (and should have been checked prior to beginning Seroquel). All of the atypical antipsychotics can lead to diabetes and high cholesterol.

Clonidine is a blood pressure medication. Because your son is on a high dose of Clonidine, you should have his blood pressure checked to make sure it isn't getting too low. In addition, there was a little girl in the Boston area who died of a Clonidine overdose. I don't know how much she was given, but I would be sure to ask the psychiatrists if they're concerned about your difficult child's dose.

 

[Sara PA]

There are only adult dosages for Seroquel because it isn't approved for use by children. However, many children do take it and the prescribed dose is usually in the same range that adults take it. Depending on the diagnosis, the Seroquel range is between 150 and 800 mg/day, higher for bipolar mania (400-800 mg than for bipolar depression (300-600 mg). The range for schizophrenia is 150-750 mg. Doses above 800/day are not recommended and have not been studied. Seroquel can cause drops in blood pressure.

Children under 10 clear Depakote faster than adults do so it isn't unusual for children to take higher doses than adults in order to achieve the same blood levels. The dose range for the treatment of bipolar went as high as 2500 mg/day in order for the clinical trial subjects to maintain the target blood levels.