Tegretol levels too low

  Damian is a 7 yr. old boy who has suffered from seizures following a high fever at 3 yrs. of age. In 12/98 his mother was murdered. He receives counselling but is in denial claiming his mother is not dead. As a result he is now suffering extreme stress. His aunt is his guardian and loves him so he is in a stable, loving home. No other children are in the home. Seizures had been controlled by 400mg Tegretol(tablets), BID (morning and bedtime). He has started to have seizures again. Drug levels taken at the ER were very low. There has been no identified cause for this. Damian is compliant with his meds and observed to swallow them. He has not been ill, and takes no other meds, including OTCs. He has not had any significant weight gain. Do you know of any other reasons that blood levels could fall so greatly? Could stress be a factor in this? Family's financial stuation prevents further medical investigation. He lives in Evansville, IN. Thank you.

[CCF neurology MD MM]

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There are a number of reasons which can lead to a low Tegretol level,
probably the most relevant is that Tegretol causes a phenomenon called
autoinduction, in which the drug stimulates the production of the liver
enzymes which break it down.
This means that initially it is possible to maintain high blood levels
on relatively low doses, but eventually higher doses are required as the
drug is broken down faster.
Levels can also be effected by other drugs which stimulate faster
breakdown of Tegretol.
Growing children often need doses to be adjusted upwards as they grow.
Stress is associated with more frequent seizures but it has not been shown
to effect blood levels of anticonvulsant drugs.

[tiny1031]

A related discussion, epilsey was started.