sleeping

Dr. Garcia,
I am up to 75mg of topa. I also take 1 mg of klonopin at night for restless leg syndrome, which I have taken for many years for this condition. I am also on a .4 mg nitro dur patch for vascular spasms. I am in great shape and completed a walk/run half marathon recently.
I cannot go to my doctor as my relationship with my ins. co. is tenuous. But, at 75 mg of topa, I am very sleepy.I am taking it 25 mg in the am and 50 mg around 5pm, which results in barely making it through dinner. When I wait and take it at 7 pm I am in bed by 9 (or sleeping on the couch). At 50 mg of topa, I still am craving a drink, at 75 I am not. What to do?

Thanks

Hi Sleepy,

I would continue to take the medication later (7 pm) and see if, after a week or so, this doesn't resolve. Use this opportunity to sleep more again, anticipating your body will get used to the dose and not be so sleepy but still have a noted anti-craving effect. If not, try some loose gun powder green tea: one heaping teaspoon per cup with near boiling water poured over, allowing it to steep for no longer than four minutes. (If longer, it will become bitter.) This is a real energizing without the jangles associated with coffee/caffeine. You may wish to add some honey, as it is brisk.

If you are still low on energy, consider Provigil, 100 mg. early in the day. That should override the evening dose of Topamax but wear off by 2300 so you can get some sleep.

Hope this helps. Good work with controlling that craving and let me know how you are doing in a week or so.

--Dr. Garcia