Joined: 24 Oct 2005 Posts: 1 Location: New Jersey, USA
Help....... Posted: 10-24-05 14:32pm
My daughter was diagnosed as bi-polar.
She is on new meds (lamictal) and i'm
looking for info about this.
Specifically worried about depends as
there is a long family line of addiction.
Any help gladly accepted.
|
BPjoe23
Experienced User , Rather EHEALTHy
Joined: 11 Oct 2005 Posts: 111 Location: dfw tx
Posted: 10-26-05 16:44pm
No there no case of addication. But you
need to make sure she start out slow on
it,and the doctor builds up the dose
slowly. Because in some case people can
develop a serious rash that will put them
in the hospital.
I was on lamictal and it did wonders for
me.. But onces I took it with
wellburtrin aha I had to start over.
Muscle cramps and restless legs.
Easist thing to do is just do a search for
it on google.Com
hope some of this stuff will help you.
1. What is lamotrigine (lamictal)?
Lamotrigine is an anticonvulsant that is
chemically unrelated to any other
anticonvulsant or mood regulating
medication.
2. When was lamotrigine approved for
marketing in the usa and for what
indications may it be promoted?
Lamotrigine received final approval for
marketing in the usa on 27 december 1994
and was labeled for use as an
anticonvulsant. In 2003 it was approved
by the fda for use as a treatment for
people with bipolar disorder.
5. What, if anything, uniquely
distinguishes lamotrigine from
carbamazepine and valproate?
Lamotrigine has had been successful in
controlling rapid cycling and mixed
bipolar states in people who have not
received adequate relief from lithium,
carbamazepine and/or valproate. It also
appears that lamotrigine has significantly
more antidepressant potency than either
carbamazepine or valproate.
Lamotrigine is also be useful as part of
the treatment of some people with major
(unipolar) depression.
Lamotrigine has recently been reported to
be a useful treatment for some people with
post-traumatic stress disorder (ptsd)
and/or borderline personality disorder
(bpd).
6. People with what sorts of psychiatric
disorders are candidates for treatment
with lamotrigine?
It is too early to be very specific about
which mood disorders are most likely to
respond to treatment with lamotrigine.
Patients with hard-to-treat bipolar
syndromes and with schizoaffective
disorder have been treated more often than
patients with "treatment-resistant"
unipolar disorders. Some people with such
hard to treat unipolar depressions have
been treated with good results. Some
patients diagnosed with borderline
personality disorder, a disorder that many
psychiatrists believe is a variant of
bipolar disorder, have responded to
treatment with lamotrigine. Patients with
post-traumatic stress disorder and with
depersonalization disorder have also
responded well to lamotrigine therapy.
7. Is lamotrigine useful for the
treatment of acute depressed, manic and
mixed states, and can it also be used to
prevent future episodes of mania and/or
depression?
The initial use of lamotrigine was to
treat people with depressed, manic and
mixed states that did not respond to
existing medications. Some patients are
now being maintained on lamotrigine on a
long term basis in an attempt to prevent
future episodes. Evidence regarding the
effectiveness of lamotrigine as a
long-term prophylactic agent is
increasing.
8. Are there any laboratory tests that
should precede the start of lamotrigine
therapy?
Before lamotrigine is prescribed the
patient should have a thorough medical
evaluation, including blood and urine
tests, to rule out any medical condition,
such as thyroid disorders, that may cause
or exacerbate a mood disorder.
In people not taking carbamazepine or
valproate, lamotrigine is usually
initially prescribed at an initial dose of
12.5 or 25 mg a day and the dose increased
by 12.5 or 25 mg every week or two.
In people taking valproate the initial
dose of lamotrigine is often 12.5 mg/day
and the drug is increased by 12.5 mg every
ten days or two weeks.
In people taking carbamazepine somewhat
larger initial doses and more rapid
increases in dose are possible.
10. Are there any special problems
prescribing lamotrigine for people taking
lithium, tegretol, or depakote?
An interaction between lithium and
lamotrigine has not been reported.
Carbamazepine induced enzymes that
facilitate the metabolism of lamotrigine.
Because of that, blood levels of
lamotrigine are somewhat lower in people
taking carbamazepine than in those not
taking carbamazepine.
Valproate has the ability to double plasma
levels of lamotrigine. Because of that,
when lamotrigine is started in people
taking valproate, the initial dose should
be approximately one-half as much as is
usually initially prescribed.
11. What is the usual final dose of
lamotrigine?
When used as an antidepressant or as a
mood-stabilizing agent the final dose of
lamotrigine is most often between 100 and
200 mg/day. Some people require doses as
high as 600 mg/day to achieve a good
antidepressant effect. Such doses should
be avoided in patients taking valproate
because of the pharmacokinetic effect of
valproate that increases plasma levels of
lamotrigine, and the accompanying
increased risk of serious dermatological
side effects.
12. How long does it take for lamotrigine
to 'kick-in?'
while some people notice the antimanic and
antidepressant effects early in treatment,
others have to take a therapeutic amount
of lamotrigine for up to a month before
being aware of a significant amount of
improvement.
13. What are the side-effects of
lamotrigine?
Here is a listing of lamotrigine's side
effects that affected 10% or more of the
711 people taking the drug during clinical
trials and the frequency of those side
effects in the 419 people treated with
placebo in those trials
side-effects are most noticeable the few
days after an increase in dose and then
usually fade.
14. Which side-effects are severe enough
to force people to discontinue
lamotrigine? Are sexual side-effects a
problem?
The side-effect of lamotrigine that most
often causes the drug to be discontinued
is a rash. Rashes can be mild, similar to
a slight sunburn, or can be quite severe
resembling a severe case of poison-ivy.
The more severe the rash the less likely
it is that the individual will be able to
continue the medication. All rashes
should be immediately reported to the
physicians prescribing the lamotrigine.
About one in ten people taking lamotrigine
develops a mild rash and about 1 in a
thousand develop a severe rash requiring
treatment. Many people with a mild rash
can continue to take lamotrigine,
sometimes together with an antihistamine.
A rash is more likely to develop when the
initial doses of lamotrigine are high or
when lamotrigine is too rapidly started
when someone is taking valproate.
It is important that people taking
lamotrigine who develop a rash immediately
contact their physician as there have been
a few deaths in people who have developed
lamotrigine-induced rashes
(stevens-johnson syndrome).
Sexual side-effects are not a problem with
lamotrigine.
15. Does lamotrigine have any psychiatric
side effects?
Among the rarely reported side effects of
lamotrigine are agitation, anxiety,
concentration problems, confusion,
depression, emotional instability,
irritability, and mania.
Mania or hypomanic induced by lamotrigine
responds well to treatment with lithium or
small doses of topiramate.
16. How does lamotrigine interact with
prescription and over-the-counter
medications?
Only a few interactions between
lamotrigine and other drugs have been
identified. Lamotrigine increases the
plasma level of carbamazepine and its
metabolites. Carbamazepine lowers the
concentration of lamotrigine in the blood.
Valproate doubles the plasma level of
lamotrigine, and the level of valproate is
decreased by about 25% in people taking
lamotrigine.
Phenobarbital and primidone lower the
plasma level of lamotrigine by about 40%.
Interactions with other prescription and
over-the-counter drugs are not known at
this time.
18. Is lamotrigine safe for a woman who
is about to become pregnant, pregnant or
nursing an infant?
Lamotrigine is has been placed in the fda
pregnancy category c
"animal studies have shown an adverse
effect on the fetus but there are no
adequate studies in humans; the benefits
from the use of the drug in pregnant women
may be acceptable despite its potential
risks . . . ."
an increasing nujber of women with
epilepsy are continuing lamotrigine
throughout their pregnancies. Research on
the effects of lamotrigine on their
children is underway.
19. Is lamotrigine safe for children and
adolescents?
While lamotrigine has been used with
children and young adolescents in other
countries. In the usa, because of the
increased risk of fatal side-effects in
the young, lamotrigine is only approved
for use in those over the age of 16.
Older people seem to handle lamotrigine
similarly to younger ones. There is
little experience using lamotrigine for
the treatment of psychiatric disorders in
the elderly.
21. Do symptoms develop if lamotrigine is
suddenly discontinued?
There are no specific symptoms that have
been described following the abrupt
discontinuation of lamotrigine, other than
the seizures that sometimes follow the
rapid discontinuation of any
anticonvulsant. Only when necessary
because of a serious side effect, should
lamotrigine be suddenly discontinued.
22. Is lamotrigine toxic if taken in
overdose?
Data on overdoses are scarce. Two
individuals who took over 4,000 mg of
lamotrigine survived without long-lasting
effects.
23. Can lamotrigine be taken along with
mao inhibitors?
Yes, the combination has been used without
any special problems
24. What does lamotrigine cost?
As of 10 september 2005, the per tablet
cost of lamotrigine, when ordered in lots
of 100 tablets from a well-known
mail-order pharmacy (drugstore.Com) was
Lamotrigine seems to be effective in about
two-thirds of people with bipolar mood
disorders that have not responded to
lithium or other mood-stabilizers. Some
people who have not been able to tolerate
any antidepressant because of switches to
mania or increased speed or intensity of
cycling, or because of the development of
mixed states, have been able to tolerate
therapeutic doses of anti- depressants
when taking lamotrigine.
For most people, lamotrigine has minimal
side effects and can be taken once a day.
Lamotrigine is also useful as a
potentiating agent for antidepressants
being used to treat people with major
(unipolar) depression.
27. What are the disadvantages of
lamotrigine?
As lamotrigine has only been available for
a relatively short time, it was first
marketed in 1990, there is no information
about long term side-effects. As its use
with people with mood disorders started
even more recently, it is not known if
people who initially do well on
lamotrigine continue to do so after many
years of treatment.
As with other medications with
antidepressant activity, lamotrigine
occasionally causes people to become
hypomanic or manic. This can usally be
controlled by small doses of lithium or
topiramate.
There is a small chance of a serious, and
in some cases life-threatening, rash
developing in people taking lamotrigine.
This side effect is more frequently seen
in those under the age of 16 than in older
persons.
28. Why should physicians prescribe, and
patients take, lamotrigine, when there are
mood regulating medications that have been
available for many years?
There are two major reasons why physicians
prescribe and patients take lamotrigine
rather than older medications. They are
that not everyone benefits from treatment
with the older, better known drugs, and
that some people find the side effects of
the older drugs to be unacceptable.
29. Is lamotrigine available in countries
other than the usa?
Lamotrigine is currently available in
about 60 countries.
us brand name: lamictal
a link here will take you to the official
website for the drug.
Other brand names: lamictin (south
africa), lamogine (israel)
generic name: lamotrigine
other forms: chewable tablets
class: anticonvulsant
read up on these sections if you haven't
done so already, because they cover a lot
of information about multiple medications
that i'm not going to repeat on many
pages. I'm just autistic that way about
not repeating myself.
Fda approved uses: conversion to
monotherapy for some forms of epilepsy
from some types of aeds (it is so
complicated), adjunctive therapy for other
forms of epilepsy with other types of aeds
(because lamictal is the prima donna of
anticonvulsants), lennox-gastaut syndrome,
bipolar 1 disorder. Lamictal is approved
for adults and children.
Off-label uses: other forms of bipolar
disorder. Depression (the only studies I
could find were using it to augment
antidepressants. Here's one with just
unipolar participants.) schizoaffective
disorder. Sunct syndrome headaches.
Neuralgia after nerve section. Diabetic
neuropathy.
Lamictal's pros and cons:
pros: the best medication on the market to
deal with bipolar depression without the
risks of mania or lowering the seizure
threshold associated with antidepressants.
Weight neutral. Appears to be
"relatively safe" to use during
pregnancy.
Cons: takes forever to get up to a
therapeutic dosage for mania or seizure
control. "will interact with medications
you aren't even taking." - cliff from the
about.Com bipolar forum.
Lamictal's typical side effects: the usual
for anticonvulsants. More so than any
other anticonvulsant lamictal
(lamotrigine) is going to give you rashes.
This is a real problem, because
stevens-johnson syndrome and assorted
other serious rashes are bigger concerns
with lamictal (lamotrigine) than any other
anticonvulsant, so often lamictal
(lamotrigine) therapy will end at the
first sign of any rash. While any rash
with lamictal (lamotrigine) needs to be
closely watched, it's the combination of
an itching rash and fever with any
anticonvulsant that needs immediate
attention from a doctor, any doctor.
Lamictal (lamotrigine) + itching rash +
fever = trip to the emergency room with
all of your meds in their original
bottles. Otherwise it's just call your
regular doctor for the soonest appointment
possible. Still, I wish everyone would
just calm the hell down about the rash.
Yes, it can be fatal, but it usually takes
forever to kill you! And I don't mean in
a movie-of-the-week, slow, painful death
way, I mean that the symptoms show up
early and you usually have plenty of time
to take action before it's too late. One
member of a bipolar support group walked
around with an itchy rash and a fever for
two weeks before she saw a doctor and
she's fine. That was stupid, but not
really all that stupid. The rash is slow
to kill. Once you see the first symptoms
and stop taking lamictal (lamotrigine),
the rash goes away and you're safe!
Problem solved! Ok, you'll have truly
sucky problem of not being able to take
lamictal (lamotrigine), but that's
something else altogether. That doesn't
mean you should be lax about any itchy
rash and fever, because these skin things
have no fixed rate. But the math is
pretty simple - if you live in a country
where lamictal is available, you live
where the hospitals can deal with the rash
without it being a big deal. Really!
I've received two e-mails from people who
have had to be hospitalized because of
stevens-johnson syndrome. One sent
repeatedly in an awful blue font on
fuchsia (to either get my attention or
just give me a headache) relating how this
person ignored the combination of itchy
rash and fever for more than three days
and wound up in the hospital. And of
course blamed lamictal for all of her
woes. The other person is the reason why
there are black-box warnings. He added a
single 25mg dose of lamictal to his
regimen of depakote and had to be
hospitalized immediately because the rash
hit swiftly. His is the one case in many
tens of thousands where it happens that
rapidly. In very rare cases the rash can
be a big doing it deal. That's why
there's a black box warning on the pi
sheet. More often than not it's
stupidity that is the main problem people
have. Be annoying with your doctor about
rashes and lamictal. Better safe than
sorry.
Now when you look at the pi sheet and
actually look at the odds you have a 1 in
10 chance of getting some kind of rash
with lamictal (lamotrigine). Not
necessarily the rash, just some random
rash. So don't go trying out any new
skin products. In fact you may want to
start getting all hypoallergenic before
even starting therapy, getting rid of
scented soaps, fabric softeners and such
like.
The other infamous side effect is the
lamictal headache. While most
anticonvulsants are good for curing
headaches, lamictal (lamotrigine) is great
for giving you headaches. These range
from something you can ignore to
full-blown migraines. There is no telling
if this side effect will go away or not.
Sometimes it does, sometimes it doesn't.
Like everything with lamictal
(lamotrigine), a change in any other
medications, a change in the dosage or
pattern of taking it, a change in your
diet, a change in your tv viewing patterns
(i'm not sure if i'm kidding about this
one or not), and a woman's monthly cycle
will influence this side effect.
For tips on how to cope with these side
effects, please see our side effects
page.
Lamictal's not so common side effects:
lamictal (lamotrigine) is earning a
reputation for muscle aches, everything
from just a twinge in your neck or back to
full-body aches that make you wonder if
you were possessed by some spirit that
made you participate in a triathalon the
day before and have no memory of it. Keep
the water handy, because lamictal
(lamotrigine) can give you a really dry
mouth. Don't be surprised if you get
anxious or have other hypomanic effects if
taking it for bipolar disorder. Another
not-so-common effect is a type of insomnia
where you're tired, but you can't sleep.
These may or may not happen to you don't,
so don't be surprised one way or the
other.
Lamictal's freaky rare side effects:
going deaf and the hiccups that won't
stop.
You aren't going to get these. I
promise.
Interesting stuff your doctor probably
won't tell you: this prima donna
medication is even picky about your
ethnicity. If you're not white, you might
get up to a 25% discount in how much
lamictal (lamotrigine) you might need.
In the clinical trials women had side
effects more often than men. This bears
out in anecdotal evidence gathered from
online support groups. Given the way that
birth control pills can sometimes
interfere with lamictal's effectiveness,
or can make it consistently effective
throughout the month, my guess is that
girly hormones do a number on lamictal
(lamotrigine). Unlike most other
anticonvulsants and antipsychotics, where
the opposite is the case.
Lamictal's dosage and how to take
lamictal: as usual i'm going to deal only
with adults.
Between the freak-out over the rashes and
lamictal (lamotrigine) having the most
variable pharmacokinetic data i've seen,
especially when mixed with other
medications, it has the most complicated
dosing schedule for a psychiatric
medication. Still, at least
glaxosmithkline have put a lot of work
into seeing how well lamictal
(lamotrigine) plays with other meds, and
they've come up with some of the more
honest statements published in a pi sheet:
"the effect of aeds (anti-epileptic drugs)
other than eiaeds (enzyme-inducing
anti-epileptic drugs) and valproate (i.E.
Depakote, depakene or depacon) on the
metabolism of lamictal is not currently
known. Therefore, no specific dosing
guidelines can be provided in that
situation. Conservative starting doses
and dose escalations (as with concomitant
valproate) would be prudent; maintenance
dosing would be expected to fall between
the maintenance dose with valproate and
the maintenance dose without valproate,
but with an eiaed."
and, "a therapeutic plasma concentration
range has not been established for
lamotrigine. Dosing of lamictal should be
based on therapeutic response."
if you really read the pharmacokinetics
section you can see that they tried, they
really tried to pin some numbers down, but
the half-life and plasma concentrations
would vary too wildly.
You know what? If your doctor is
following glaxo's recommendations as
spelled out in the latest pi sheet, you
really can't be doing much better than
that. I certainly can't improve on them
that much, other than starting at 12.5mg
the first week and just being a bit more
conservative in the titration for bipolar.
But lamictal (lamotrigine) is complicated
enough, so if your doctor just goes along
with what's on the pi sheet, that is far
from dangerous. I just tend to be
conservative with these meds, and I think
doing so helps prevent side effects.
However you decide to go with your
titration, keep a detailed record of how
you proceeded, you'll need it for future
reference.
How often you should take lamictal
(lamotrigine) depends on what other meds
you're taking. If you're taking an
enzyme-inducing anticonvulsant such as
trileptal (oxcarbazepine) or tegretol
(carbamazepine usp) you must take it twice
a day. If you're taking a valproate
medication (depakene (valproic acid),
depakote (divalproex sodium) or depacon
(valproate sodium)) you must take it once
a day. If you're just taking it by itself
or with any other medication once-a-day
dosing is recommended, but with the wildly
variable half-life you may want to
experiment with that to see how it works.
What's the minimum effective dose? The
antidepressant effects can start at 25mg a
day, although it usually hits around 100mg
a day. No, really, at 25mg a day you may
get a lift from lamictal (lamotrigine).
Plenty of people have reported that. Mood
stabilization effects begin somewhere
between 100 and 200mg a day. Cut those
numbers in half if you're taking depakene
(valproic acid), depakote (divalproex
sodium) or depacon (valproate sodium) and
double them if you're taking dilantin
(phenytonin), trileptal (oxcarbazepine) or
tegretol (carbamazepine usp). The maximum
dose for bipolar is 400mg a day, as long
as you're not taking depakene (valproic
acid), depakote (divalproex sodium) or
depacon (valproate sodium), in which case
you max out at 200mg a day.
Glaxosmithkline reports that their
clinical studies show no effective
difference for bipolar disorder above
200mg a day (as monotherapy). In the real
world 200mg a day is a standard dosage,
but plenty of people do feel a difference
when taking more, and often do have to go
up to 400mg a day. Lamictal's
antidepressant effects tend to diminish
between 150-200mg. That is, you still get
an antidepressant effect, it's just that
as you increase the dosage above that
point you don't get that much more of an
increase in effect as you increase your
dosage.
Note that if you were taking an
enzyme-inducing anticonvulsant such as
trileptal (oxcarbazepine), tegretol
(carbamazepine usp) or dilantin
(phenytonin) and had to suddenly stop
taking them, you'll need to decrease the
amount of lamictal (lamotrigine) you take,
otherwise you'll find that you have way
too much lamictal (lamotrigine) in your
system all of a sudden. And if you have
to suddenly stop taking a valproate
medication (depakene (valproic acid),
depakote (divalproex sodium) or depacon
(valproate sodium)), you'll have to
increase the amount of lamictal
(lamotrigine) to compensate. If you had
a discontinuation plan for those other
meds, of course, and it was all planned,
then never mind. Lamictal (lamotrigine)
was designed to convert from one of those
meds after all.
Epilepsy - it is so damn complicated!
What type of epilepsy? Monotherapy or
adjunctive therapy? What other meds are
you taking? Which medication were you
converting from? You're talking to your
doctor about this one. And read the pi
sheet carefully. The same basic rule
applies as for bipolar, take it slow and
steady. And watch out for any changes to
any other medications you're taking. The
therapeutic range for lamictal
(lamotrigine) with a valproate medication
is 100-200mg a day, without a valproate
it's 300-500mg a day.
Depression - follow the guidelines for
bipolar, but you may as well stop at 200mg
a day. There's rarely a point in going
above that amount. Again, as soon as you
stop feeling depressed, hold at whatever
dosage you're at. Even if it's just 25mg
a day. You can wait to move up when
symptoms return. A return of symptoms
doesn't mean that the drug has stopped
working. Hardly. You're always
tweaking the dosage of anticonvulsants.
That's the nature of them. You'll be
going up and down on the dosage here and
there all the time. This is way more
complicated than rocket science.
For all other applications - as your
doctor instructs you, I don't have a
clue.
Days to reach a steady state: hah!
Ha-hah. Oh, that's a good one.
When you're fully saturated with the
medication and less prone to peaks and
valleys of effects. You still might have
peaks of effect after taking many meds,
but with a lot of the meds you'll have
fewer valleys after this point. In theory
anyway.
How long lamictal takes to work: like all
anticonvulsants it works best once you
reach the proper dosage, but the proper
dosage is especially variable with
lamictal (lamotrigine). Its
antidepressant properties will kick in
somewhere between 25 and 100mg a day,
depending on what other meds you might be
taking. Its mood stabilization and
anti-epileptic effects will take place
between 100 and 400mg a day, again
depending on what other medications you're
taking. So it all depends on the
titration schedule you and your doctor
work out to reach those dosages.
Lamictal's half-life & average time to
clear out of your system: get out a
dartboard or some percentile dice, because
a random number is going to be just as
good as anything. The folks at gsk really
tried to pin down a number for lamictal
(lamotrigine), but it so depends on what
other medications you're taking, if you
take it once a day or twice a day, how
much you're taking, how old you are and
where a woman is in her monthly cycle.
Taking lamictal (lamotrigine) once a day
with no other medications produced a range
of half-lives from 14 to 103 hours with an
average of 32.8 hours. Taking it twice a
day produced a range 12 to 62 hours with
an average of 25.4 hours. The aggregate
half-life given for lamictal is 26 hours.
If you're taking a valproate medication
(depakene (valproic acid), depakote
(divalproex sodium) or depacon (valproate
sodium)) the half-life shoots up to 70
hours. If you're taking an
enzyme-inducing anticonvulsant like
dilantin (phenytoin), tegretol
(carbamazepine usp), trileptal
(oxcarbazepine), mysoline (primidone) or
good old phenobarbital the half-life is
cut to about 13 hours.
How to stop taking lamictal: like
everything about this drug, it's
complicated.
So a very simple rule of thumb was
developed. If you're not presenting
symptoms of a nasty rash, allergic
reaction, weird bruising that can't be
explained or anything else that requires
you to stop taking it any faster, you
reduce lamictal (lamotrigine) the same way
you increased it. This is where the
detailed record of how you increased your
dosage comes in.
Gsk's base recommendation for
discontinuation is 50% per week, as long
as you have something else in place.
If all else fails, 50mg per day every
week.
For more information, please see the page
on how to safely stop taking these crazy
meds.
Like any anticonvulsant, if you've been
taking lamictal (lamotrigine) for more
than a couple months and you're up to or
above 100mg a day (give or take, depending
on other meds you might be taking) you
just can't stop cold turkey if you're not
at the therapeutic dosage for another
anticonvulsant that you know works for
you, otherwise you risk partial-complex,
absence seizures or even tonic-clonic
grand mals, despite your never having had
a seizure disorder before! The risk is
worse if you're taking a lithium variant,
and/or any antidepressant, especially
wellbutrin (bupropion hydrochloride).
Even if you are taking something else
lamictal (lamotrigine) has its own set of
issues with sudden discontinuation, namely
intense headaches and sudden, intense and
sometimes suicidal depression. That's
right, lamictal (lamotrigine) will give
you headaches when you take it and it will
give you headaches it you suddenly stop
taking it. Anyone with a history of a
seizure disorder who needs to stop taking
an anticonvulsant cold turkey needs to be
discussing that with two neurologists and
not getting your information from some
stupid web site. Get off your computer
and start making appointments!
If you've worked your way up to a
particular dosage, it's usually best to
spend this many days at the next lowest
dosage before going down the next lowest
dosage before that and so forth. This is
the least sucky way to avoid problems when
stopping any psychiatric medication.
Presuming you have the option of slowly
tapering off them.
How lamictal works in your brain:
lamictal (lamotrigine) works on binding to
voltage sensitive sodium and maybe calcium
channels in the brain. The calcium bit
is a matter for debate. It also invokes
glutamate which is a major excitatory
neurotransmitter in the brain which is
responsible for sending messages from
neuron to neuron in 85% of the brain. It
also lightly brushes the 5-ht3 serotonin
receptor and the sigma opioid receptors,
which probably account for its lovely
antidepressant properties. Nothing like a
combined serotonin and opiate reaction.
As to precisely where in your brain
lamictal does its sodium and calcium
channel magic, that's a mystery.
Comments: be sure to read the section on
anticonvulsants if you haven't done so
already.
Approved by the fda to treat epilepsy in
1994 and to treat bipolar disorder in
2003, lamictal (lamotrigine) is probably
the last of the anticonvulsants you'll see
approved to treat bipolar, because all the
money is in atypical antipsychotics.
Lamictal (lamotrigine) joins lithium in
being one of only two meds to date
approved to treat both the manic and
depression phases of bipolar disorder and
essentially to treat the mood swings
themselves.
Lamictal (lamotrigine) is the prima donna
of anticonvulsants / mood stabilizers.
Besides lithium, lamictal is the only
official mood stabilizer proven to have
any results with bipolar depression.
Personally I find it odd that it's
approved for bipolar 1 when lamictal
(lamotrigine) is really the med for
bipolar 2! Its cgi-i scores were better
than many antidepressants on the market
today. Little wonder why lamictal is
becoming popular as a treatment for
otherwise treatment-resistant depression.
Lamictal is proven to be the best
medication for rapid cycling, but it
doesn't handle the nasty ultradian rapid
cycling as well as topamax (topiramate)
does. If ultradian rapid cycling is an
issue, it's best to combine lamictal
(lamotrigine) with one of the temporal
lobe affecting meds, such as topamax
(topiramate), trileptal (oxcarbazepine) or
tegretol (carbamazepine usp), although you
need to adjust the dosage with the latter
two meds.
So that's why lamictal (lamotrigine) is
worth dealing with. Despite all the
rashes, headaches, muscle aches and pains,
and slow titration schedule, when lamictal
works people just love it.
You're just not going to find a pickier,
or wackier medication in the psychiatric
pharmacopoeia. Anticonvulsants are
notorious for reacting to other
medications and foods, but lamictal
(lamotrigine) reacts to everything.
That's why you have to titrate so slowly.
And if you're planning on a cocktail of
some kind that's going to include lamictal
(lamotrigine) it's going to make your life
a lot easier if you're up to whatever
dosages you plan on being at with whatever
other meds first and then add lamictal
(lamotrigine). Otherwise you have to deal
with lamictal's variable plasma levels and
half-lives. Oh, sure, you and your doctor
can check the pi sheet for what supposedly
does or doesn't affect lamictal
(lamotrigine), but too many things do have
an effect. I'd just rather put up with
whatever I was dealing with, stabilize on
the other meds and then add lamictal
(lamotrigine) into the mix.
Where other anticonvulsants can mess with
your girly hormones, your girly hormones
are more likely to mess with lamictal
(lamotrigine). This means that lamictal's
efficacy can vary throughout the month.
Isn't that fun? So, no, it's not your
imagination if it seemed to work better
last week. If you've stabilized at a
dosage and you're noticing a variation
throughout the month you may want to
consider taking an oral contraceptive to
standardize lamictal's effect. It may
require a dosage adjustment after you
start the pill, but that's how things are
with this med.
There are no good data yet as to whether
or not you can stop and start lamictal
again. One small study with epilepsy
showed that it might be ok, if you didn't
wait too long. But that's hardly a
real-world application for discontinuation
and restarting the med. The anecdotal
evidence coming in is that it doesn't seem
to work as well the second time around,
but some real evidence is needed
as to the lamictal (lamotrigine) muscle
ache that is becoming popular, I have a
guess as to what that is about. Lamictal
(lamotrigine) is one of the few meds
approved for lennox-gastaut syndrome, an
uncommon form of epilepsy that, among
other symptoms, presents the atonic
seizure, where all your muscles go utterly
limp. You're having yet another
relationship argument and you fall into a
big pile of being the human turd, unable
to move or even look away from the stain
on the carpet. I've been there with the
atonic seizures. Anyway, people seem to
like lamictal (lamotrigine) for
lennox-gastaut. So if you've got a med
that keeps your muscles from going limp
and normally your muscles don't go limp
all the time, it would follow that muscle
aches and pains could be a result.
Like other anticonvulsants, lamictal
carries the rare but possible risk for
aplastic anemia. Mouse had to deal with
it when trying lamictal (lamotrigine), and
we know one person who had to stop taking
tegretol (carbamazepine usp) because of
it. So if you see lots of weird bruises
that you can't explain, see your doctor
immediately!
Link for that one
http://www.Crazymeds.Org/
lamictal.Html
i hope that stuff can help you and your
doctor.
Good luck if have more questions just ask,
if she wants to talk to other bipolar
people she's more then welcome to send me
a message.
Also going to n.A.M.I. And d.B.S.A.
Support meetings would help her in my
opinion.Because she would get to me other
people just like her who have bipolar
disorder(manic-depression).
|
BPjoe23
Experienced User , Rather EHEALTHy
Joined: 11 Oct 2005 Posts: 111 Location: dfw tx
Posted: 10-26-05 16:45pm
No there no case of addication. But you
need to make sure she start out slow on
it,and the doctor builds up the dose
slowly. Because in some case people can
develop a serious rash that will put them
in the hospital.
I was on lamictal and it did wonders for
me.. But onces I took it with
wellburtrin aha I had to start over.
Muscle cramps and restless legs.
Easist thing to do is just do a search for
it on google.Com
hope some of this stuff will help you.
1. What is lamotrigine (lamictal)?
Lamotrigine is an anticonvulsant that is
chemically unrelated to any other
anticonvulsant or mood regulating
medication.
2. When was lamotrigine approved for
marketing in the usa and for what
indications may it be promoted?
Lamotrigine received final approval for
marketing in the usa on 27 december 1994
and was labeled for use as an
anticonvulsant. In 2003 it was approved
by the fda for use as a treatment for
people with bipolar disorder.
5. What, if anything, uniquely
distinguishes lamotrigine from
carbamazepine and valproate?
Lamotrigine has had been successful in
controlling rapid cycling and mixed
bipolar states in people who have not
received adequate relief from lithium,
carbamazepine and/or valproate. It also
appears that lamotrigine has significantly
more antidepressant potency than either
carbamazepine or valproate.
Lamotrigine is also be useful as part of
the treatment of some people with major
(unipolar) depression.
Lamotrigine has recently been reported to
be a useful treatment for some people with
post-traumatic stress disorder (ptsd)
and/or borderline personality disorder
(bpd).
6. People with what sorts of psychiatric
disorders are candidates for treatment
with lamotrigine?
It is too early to be very specific about
which mood disorders are most likely to
respond to treatment with lamotrigine.
Patients with hard-to-treat bipolar
syndromes and with schizoaffective
disorder have been treated more often than
patients with "treatment-resistant"
unipolar disorders. Some people with
such hard to treat unipolar depressions
have been treated with good results.
Some patients diagnosed with borderline
personality disorder, a disorder that many
psychiatrists believe is a variant of
bipolar disorder, have responded to
treatment with lamotrigine. Patients
with post-traumatic stress disorder and
with depersonalization disorder have also
responded well to lamotrigine therapy.
7. Is lamotrigine useful for the
treatment of acute depressed, manic and
mixed states, and can it also be used to
prevent future episodes of mania and/or
depression?
The initial use of lamotrigine was to
treat people with depressed, manic and
mixed states that did not respond to
existing medications. Some patients are
now being maintained on lamotrigine on a
long term basis in an attempt to prevent
future episodes. Evidence regarding the
effectiveness of lamotrigine as a
long-term prophylactic agent is
increasing.
8. Are there any laboratory tests that
should precede the start of lamotrigine
therapy?
Before lamotrigine is prescribed the
patient should have a thorough medical
evaluation, including blood and urine
tests, to rule out any medical condition,
such as thyroid disorders, that may cause
or exacerbate a mood disorder.
In people not taking carbamazepine or
valproate, lamotrigine is usually
initially prescribed at an initial dose of
12.5 or 25 mg a day and the dose increased
by 12.5 or 25 mg every week or two.
In people taking valproate the initial
dose of lamotrigine is often 12.5 mg/day
and the drug is increased by 12.5 mg every
ten days or two weeks.
In people taking carbamazepine somewhat
larger initial doses and more rapid
increases in dose are possible.
10. Are there any special problems
prescribing lamotrigine for people taking
lithium, tegretol, or depakote?
An interaction between lithium and
lamotrigine has not been reported.
Carbamazepine induced enzymes that
facilitate the metabolism of lamotrigine.
Because of that, blood levels of
lamotrigine are somewhat lower in people
taking carbamazepine than in those not
taking carbamazepine.
Valproate has the ability to double plasma
levels of lamotrigine. Because of that,
when lamotrigine is started in people
taking valproate, the initial dose should
be approximately one-half as much as is
usually initially prescribed.
11. What is the usual final dose of
lamotrigine?
When used as an antidepressant or as a
mood-stabilizing agent the final dose of
lamotrigine is most often between 100 and
200 mg/day. Some people require doses as
high as 600 mg/day to achieve a good
antidepressant effect. Such doses should
be avoided in patients taking valproate
because of the pharmacokinetic effect of
valproate that increases plasma levels of
lamotrigine, and the accompanying
increased risk of serious dermatological
side effects.
12. How long does it take for
lamotrigine to 'kick-in?'
while some people notice the antimanic and
antidepressant effects early in treatment,
others have to take a therapeutic amount
of lamotrigine for up to a month before
being aware of a significant amount of
improvement.
13. What are the side-effects of
lamotrigine?
Here is a listing of lamotrigine's side
effects that affected 10% or more of the
711 people taking the drug during clinical
trials and the frequency of those side
effects in the 419 people treated with
placebo in those trials
side-effects are most noticeable the few
days after an increase in dose and then
usually fade.
14. Which side-effects are severe enough
to force people to discontinue
lamotrigine? Are sexual side-effects a
problem?
The side-effect of lamotrigine that most
often causes the drug to be discontinued
is a rash. Rashes can be mild, similar
to a slight sunburn, or can be quite
severe resembling a severe case of
poison-ivy. The more severe the rash the
less likely it is that the individual will
be able to continue the medication. All
rashes should be immediately reported to
the physicians prescribing the
lamotrigine.
About one in ten people taking lamotrigine
develops a mild rash and about 1 in a
thousand develop a severe rash requiring
treatment. Many people with a mild rash
can continue to take lamotrigine,
sometimes together with an antihistamine.
A rash is more likely to develop when the
initial doses of lamotrigine are high or
when lamotrigine is too rapidly started
when someone is taking valproate.
It is important that people taking
lamotrigine who develop a rash immediately
contact their physician as there have been
a few deaths in people who have developed
lamotrigine-induced rashes
(stevens-johnson syndrome).
Sexual side-effects are not a problem with
lamotrigine.
15. Does lamotrigine have any
psychiatric side effects?
Among the rarely reported side effects of
lamotrigine are agitation, anxiety,
concentration problems, confusion,
depression, emotional instability,
irritability, and mania.
Mania or hypomanic induced by lamotrigine
responds well to treatment with lithium or
small doses of topiramate.
16. How does lamotrigine interact with
prescription and over-the-counter
medications?
Only a few interactions between
lamotrigine and other drugs have been
identified. Lamotrigine increases the
plasma level of carbamazepine and its
metabolites. Carbamazepine lowers the
concentration of lamotrigine in the blood.
Valproate doubles the plasma level of
lamotrigine, and the level of valproate is
decreased by about 25% in people taking
lamotrigine.
Phenobarbital and primidone lower the
plasma level of lamotrigine by about 40%.
Interactions with other prescription and
over-the-counter drugs are not known at
this time.
18. Is lamotrigine safe for a woman who
is about to become pregnant, pregnant or
nursing an infant?
Lamotrigine is has been placed in the fda
pregnancy category c
"animal studies have shown an adverse
effect on the fetus but there are no
adequate studies in humans; the benefits
from the use of the drug in pregnant women
may be acceptable despite its potential
risks . . . ."
an increasing nujber of women with
epilepsy are continuing lamotrigine
throughout their pregnancies. Research
on the effects of lamotrigine on their
children is underway.
19. Is lamotrigine safe for children and
adolescents?
While lamotrigine has been used with
children and young adolescents in other
countries. In the usa, because of the
increased risk of fatal side-effects in
the young, lamotrigine is only approved
for use in those over the age of 16.
Older people seem to handle lamotrigine
similarly to younger ones. There is
little experience using lamotrigine for
the treatment of psychiatric disorders in
the elderly.
21. Do symptoms develop if lamotrigine
is suddenly discontinued?
There are no specific symptoms that have
been described following the abrupt
discontinuation of lamotrigine, other than
the seizures that sometimes follow the
rapid discontinuation of any
anticonvulsant. Only when necessary
because of a serious side effect, should
lamotrigine be suddenly discontinued.
22. Is lamotrigine toxic if taken in
overdose?
Data on overdoses are scarce. Two
individuals who took over 4,000 mg of
lamotrigine survived without long-lasting
effects.
23. Can lamotrigine be taken along with
mao inhibitors?
Yes, the combination has been used without
any special problems
24. What does lamotrigine cost?
As of 10 september 2005, the per tablet
cost of lamotrigine, when ordered in lots
of 100 tablets from a well-known
mail-order pharmacy (drugstore.Com) was
Lamotrigine seems to be effective in about
two-thirds of people with bipolar mood
disorders that have not responded to
lithium or other mood-stabilizers. Some
people who have not been able to tolerate
any antidepressant because of switches to
mania or increased speed or intensity of
cycling, or because of the development of
mixed states, have been able to tolerate
therapeutic doses of anti- depressants
when taking lamotrigine.
For most people, lamotrigine has minimal
side effects and can be taken once a day.
Lamotrigine is also useful as a
potentiating agent for antidepressants
being used to treat people with major
(unipolar) depression.
27. What are the disadvantages of
lamotrigine?
As lamotrigine has only been available for
a relatively short time, it was first
marketed in 1990, there is no information
about long term side-effects. As its use
with people with mood disorders started
even more recently, it is not known if
people who initially do well on
lamotrigine continue to do so after many
years of treatment.
As with other medications with
antidepressant activity, lamotrigine
occasionally causes people to become
hypomanic or manic. This can usally be
controlled by small doses of lithium or
topiramate.
There is a small chance of a serious, and
in some cases life-threatening, rash
developing in people taking lamotrigine.
This side effect is more frequently seen
in those under the age of 16 than in older
persons.
28. Why should physicians prescribe, and
patients take, lamotrigine, when there are
mood regulating medications that have been
available for many years?
There are two major reasons why physicians
prescribe and patients take lamotrigine
rather than older medications. They are
that not everyone benefits from treatment
with the older, better known drugs, and
that some people find the side effects of
the older drugs to be unacceptable.
29. Is lamotrigine available in
countries other than the usa?
Lamotrigine is currently available in
about 60 countries.
us brand name: lamictal
a link here will take you to the official
website for the drug.
Other brand names: lamictin (south
africa), lamogine (israel)
generic name: lamotrigine
other forms: chewable tablets
class: anticonvulsant
read up on these sections if you haven't
done so already, because they cover a lot
of information about multiple medications
that i'm not going to repeat on many
pages. I'm just autistic that way about
not repeating myself.
Fda approved uses: conversion to
monotherapy for some forms of epilepsy
from some types of aeds (it is so
complicated), adjunctive therapy for other
forms of epilepsy with other types of aeds
(because lamictal is the prima donna of
anticonvulsants), lennox-gastaut syndrome,
bipolar 1 disorder. Lamictal is approved
for adults and children.
Off-label uses: other forms of bipolar
disorder. Depression (the only studies
I could find were using it to augment
antidepressants. Here's one with just
unipolar participants.) schizoaffective
disorder. Sunct syndrome headaches.
Neuralgia after nerve section. Diabetic
neuropathy.
Lamictal's pros and cons:
pros: the best medication on the market to
deal with bipolar depression without the
risks of mania or lowering the seizure
threshold associated with antidepressants.
Weight neutral. Appears to be
"relatively safe" to use during
pregnancy.
Cons: takes forever to get up to a
therapeutic dosage for mania or seizure
control. "will interact with medications
you aren't even taking." - cliff from the
about.Com bipolar forum.
Lamictal's typical side effects: the usual
for anticonvulsants. More so than any
other anticonvulsant lamictal
(lamotrigine) is going to give you rashes.
This is a real problem, because
stevens-johnson syndrome and assorted
other serious rashes are bigger concerns
with lamictal (lamotrigine) than any other
anticonvulsant, so often lamictal
(lamotrigine) therapy will end at the
first sign of any rash. While any rash
with lamictal (lamotrigine) needs to be
closely watched, it's the combination of
an itching rash and fever with any
anticonvulsant that needs immediate
attention from a doctor, any doctor.
Lamictal (lamotrigine) + itching rash +
fever = trip to the emergency room with
all of your meds in their original
bottles. Otherwise it's just call your
regular doctor for the soonest appointment
possible. Still, I wish everyone would
just calm the hell down about the rash.
Yes, it can be fatal, but it usually takes
forever to kill you! And I don't mean
in a movie-of-the-week, slow, painful
death way, I mean that the symptoms show
up early and you usually have plenty of
time to take action before it's too late.
One member of a bipolar support group
walked around with an itchy rash and a
fever for two weeks before she saw a
doctor and she's fine. That was stupid,
but not really all that stupid. The
rash is slow to kill. Once you see the
first symptoms and stop taking lamictal
(lamotrigine), the rash goes away and
you're safe! Problem solved! Ok,
you'll have truly sucky problem of not
being able to take lamictal (lamotrigine),
but that's something else altogether.
That doesn't mean you should be lax about
any itchy rash and fever, because these
skin things have no fixed rate. But the
math is pretty simple - if you live in a
country where lamictal is available, you
live where the hospitals can deal with the
rash without it being a big deal.
Really!
I've received two e-mails from people who
have had to be hospitalized because of
stevens-johnson syndrome. One sent
repeatedly in an awful blue font on
fuchsia (to either get my attention or
just give me a headache) relating how this
person ignored the combination of itchy
rash and fever for more than three days
and wound up in the hospital. And of
course blamed lamictal for all of her
woes. The other person is the reason
why there are black-box warnings. He
added a single 25mg dose of lamictal to
his regimen of depakote and had to be
hospitalized immediately because the rash
hit swiftly. His is the one case in
many tens of thousands where it happens
that rapidly. In very rare cases the
rash can be a big doing it deal. That's
why there's a black box warning on the pi
sheet. More often than not it's
stupidity that is the main problem people
have. Be annoying with your doctor
about rashes and lamictal. Better safe
than sorry.
Now when you look at the pi sheet and
actually look at the odds you have a 1 in
10 chance of getting some kind of rash
with lamictal (lamotrigine). Not
necessarily the rash, just some random
rash. So don't go trying out any new
skin products. In fact you may want to
start getting all hypoallergenic before
even starting therapy, getting rid of
scented soaps, fabric softeners and such
like.
The other infamous side effect is the
lamictal headache. While most
anticonvulsants are good for curing
headaches, lamictal (lamotrigine) is great
for giving you headaches. These range
from something you can ignore to
full-blown migraines. There is no
telling if this side effect will go away
or not. Sometimes it does, sometimes it
doesn't. Like everything with lamictal
(lamotrigine), a change in any other
medications, a change in the dosage or
pattern of taking it, a change in your
diet, a change in your tv viewing patterns
(i'm not sure if i'm kidding about this
one or not), and a woman's monthly cycle
will influence this side effect.
For tips on how to cope with these side
effects, please see our side effects
page.
Lamictal's not so common side effects:
lamictal (lamotrigine) is earning a
reputation for muscle aches, everything
from just a twinge in your neck or back to
full-body aches that make you wonder if
you were possessed by some spirit that
made you participate in a triathalon the
day before and have no memory of it.
Keep the water handy, because lamictal
(lamotrigine) can give you a really dry
mouth. Don't be surprised if you get
anxious or have other hypomanic effects if
taking it for bipolar disorder. Another
not-so-common effect is a type of insomnia
where you're tired, but you can't sleep.
These may or may not happen to you don't,
so don't be surprised one way or the
other.
Lamictal's freaky rare side effects:
going deaf and the hiccups that won't
stop.
You aren't going to get these. I
promise.
Interesting stuff your doctor probably
won't tell you: this prima donna
medication is even picky about your
ethnicity. If you're not white, you
might get up to a 25% discount in how much
lamictal (lamotrigine) you might need.
In the clinical trials women had side
effects more often than men. This bears
out in anecdotal evidence gathered from
online support groups. Given the way
that birth control pills can sometimes
interfere with lamictal's effectiveness,
or can make it consistently effective
throughout the month, my guess is that
girly hormones do a number on lamictal
(lamotrigine). Unlike most other
anticonvulsants and antipsychotics, where
the opposite is the case.
Lamictal's dosage and how to take
lamictal: as usual i'm going to deal only
with adults.
Between the freak-out over the rashes and
lamictal (lamotrigine) having the most
variable pharmacokinetic data i've seen,
especially when mixed with other
medications, it has the most complicated
dosing schedule for a psychiatric
medication. Still, at least
glaxosmithkline have put a lot of work
into seeing how well lamictal
(lamotrigine) plays with other meds, and
they've come up with some of the more
honest statements published in a pi sheet:
"the effect of aeds (anti-epileptic drugs)
other than eiaeds (enzyme-inducing
anti-epileptic drugs) and valproate (i.E.
Depakote, depakene or depacon) on the
metabolism of lamictal is not currently
known. Therefore, no specific dosing
guidelines can be provided in that
situation. Conservative starting doses
and dose escalations (as with concomitant
valproate) would be prudent; maintenance
dosing would be expected to fall between
the maintenance dose with valproate and
the maintenance dose without valproate,
but with an eiaed."
and, "a therapeutic plasma concentration
range has not been established for
lamotrigine. Dosing of lamictal should
be based on therapeutic response."
if you really read the pharmacokinetics
section you can see that they tried, they
really tried to pin some numbers down, but
the half-life and plasma concentrations
would vary too wildly.
You know what? If your doctor is
following glaxo's recommendations as
spelled out in the latest pi sheet, you
really can't be doing much better than
that. I certainly can't improve on them
that much, other than starting at 12.5mg
the first week and just being a bit more
conservative in the titration for bipolar.
But lamictal (lamotrigine) is
complicated enough, so if your doctor just
goes along with what's on the pi sheet,
that is far from dangerous. I just tend
to be conservative with these meds, and I
think doing so helps prevent side effects.
However you decide to go with your
titration, keep a detailed record of how
you proceeded, you'll need it for future
reference.
How often you should take lamictal
(lamotrigine) depends on what other meds
you're taking. If you're taking an
enzyme-inducing anticonvulsant such as
trileptal (oxcarbazepine) or tegretol
(carbamazepine usp) you must take it twice
a day. If you're taking a valproate
medication (depakene (valproic acid),
depakote (divalproex sodium) or depacon
(valproate sodium)) you must take it once
a day. If you're just taking it by
itself or with any other medication
once-a-day dosing is recommended, but with
the wildly variable half-life you may want
to experiment with that to see how it
works.
What's the minimum effective dose? The
antidepressant effects can start at 25mg a
day, although it usually hits around 100mg
a day. No, really, at 25mg a day you may
get a lift from lamictal (lamotrigine).
Plenty of people have reported that.
Mood stabilization effects begin somewhere
between 100 and 200mg a day. Cut those
numbers in half if you're taking depakene
(valproic acid), depakote (divalproex
sodium) or depacon (valproate sodium) and
double them if you're taking dilantin
(phenytonin), trileptal (oxcarbazepine) or
tegretol (carbamazepine usp). The
maximum dose for bipolar is 400mg a day,
as long as you're not taking depakene
(valproic acid), depakote (divalproex
sodium) or depacon (valproate sodium), in
which case you max out at 200mg a day.
Glaxosmithkline reports that their
clinical studies show no effective
difference for bipolar disorder above
200mg a day (as monotherapy). In the
real world 200mg a day is a standard
dosage, but plenty of people do feel a
difference when taking more, and often do
have to go up to 400mg a day. Lamictal's
antidepressant effects tend to diminish
between 150-200mg. That is, you still
get an antidepressant effect, it's just
that as you increase the dosage above that
point you don't get that much more of an
increase in effect as you increase your
dosage.
Note that if you were taking an
enzyme-inducing anticonvulsant such as
trileptal (oxcarbazepine), tegretol
(carbamazepine usp) or dilantin
(phenytonin) and had to suddenly stop
taking them, you'll need to decrease the
amount of lamictal (lamotrigine) you take,
otherwise you'll find that you have way
too much lamictal (lamotrigine) in your
system all of a sudden. And if you have
to suddenly stop taking a valproate
medication (depakene (valproic acid),
depakote (divalproex sodium) or depacon
(valproate sodium)), you'll have to
increase the amount of lamictal
(lamotrigine) to compensate. If you had
a discontinuation plan for those other
meds, of course, and it was all planned,
then never mind. Lamictal (lamotrigine)
was designed to convert from one of those
meds after all.
Epilepsy - it is so damn complicated!
What type of epilepsy? Monotherapy or
adjunctive therapy? What other meds are
you taking? Which medication were you
converting from? You're talking to your
doctor about this one. And read the pi
sheet carefully. The same basic rule
applies as for bipolar, take it slow and
steady. And watch out for any changes to
any other medications you're taking. The
therapeutic range for lamictal
(lamotrigine) with a valproate medication
is 100-200mg a day, without a valproate
it's 300-500mg a day.
Depression - follow the guidelines for
bipolar, but you may as well stop at 200mg
a day. There's rarely a point in going
above that amount. Again, as soon as
you stop feeling depressed, hold at
whatever dosage you're at. Even if it's
just 25mg a day. You can wait to move
up when symptoms return. A return of
symptoms doesn't mean that the drug has
stopped working. Hardly. You're
always tweaking the dosage of
anticonvulsants. That's the nature of
them. You'll be going up and down on
the dosage here and there all the time.
This is way more complicated than rocket
science.
For all other applications - as your
doctor instructs you, I don't have a
clue.
Days to reach a steady state: hah!
Ha-hah. Oh, that's a good one.
When you're fully saturated with the
medication and less prone to peaks and
valleys of effects. You still might have
peaks of effect after taking many meds,
but with a lot of the meds you'll have
fewer valleys after this point. In
theory anyway.
How long lamictal takes to work: like all
anticonvulsants it works best once you
reach the proper dosage, but the proper
dosage is especially variable with
lamictal (lamotrigine). Its
antidepressant properties will kick in
somewhere between 25 and 100mg a day,
depending on what other meds you might be
taking. Its mood stabilization and
anti-epileptic effects will take place
between 100 and 400mg a day, again
depending on what other medications you're
taking. So it all depends on the
titration schedule you and your doctor
work out to reach those dosages.
Lamictal's half-life & average time to
clear out of your system: get out a
dartboard or some percentile dice, because
a random number is going to be just as
good as anything. The folks at gsk
really tried to pin down a number for
lamictal (lamotrigine), but it so depends
on what other medications you're taking,
if you take it once a day or twice a day,
how much you're taking, how old you are
and where a woman is in her monthly cycle.
Taking lamictal (lamotrigine) once a day
with no other medications produced a range
of half-lives from 14 to 103 hours with an
average of 32.8 hours. Taking it twice a
day produced a range 12 to 62 hours with
an average of 25.4 hours. The aggregate
half-life given for lamictal is 26 hours.
If you're taking a valproate medication
(depakene (valproic acid), depakote
(divalproex sodium) or depacon (valproate
sodium)) the half-life shoots up to 70
hours. If you're taking an
enzyme-inducing anticonvulsant like
dilantin (phenytoin), tegretol
(carbamazepine usp), trileptal
(oxcarbazepine), mysoline (primidone) or
good old phenobarbital the half-life is
cut to about 13 hours.
How to stop taking lamictal: like
everything about this drug, it's
complicated.
So a very simple rule of thumb was
developed. If you're not presenting
symptoms of a nasty rash, allergic
reaction, weird bruising that can't be
explained or anything else that requires
you to stop taking it any faster, you
reduce lamictal (lamotrigine) the same way
you increased it. This is where the
detailed record of how you increased your
dosage comes in.
Gsk's base recommendation for
discontinuation is 50% per week, as long
as you have something else in place.
If all else fails, 50mg per day every
week.
For more information, please see the page
on how to safely stop taking these crazy
meds.
Like any anticonvulsant, if you've been
taking lamictal (lamotrigine) for more
than a couple months and you're up to or
above 100mg a day (give or take, depending
on other meds you might be taking) you
just can't stop cold turkey if you're not
at the therapeutic dosage for another
anticonvulsant that you know works for
you, otherwise you risk partial-complex,
absence seizures or even tonic-clonic
grand mals, despite your never having had
a seizure disorder before! The risk is
worse if you're taking a lithium variant,
and/or any antidepressant, especially
wellbutrin (bupropion hydrochloride).
Even if you are taking something else
lamictal (lamotrigine) has its own set of
issues with sudden discontinuation, namely
intense headaches and sudden, intense and
sometimes suicidal depression. That's
right, lamictal (lamotrigine) will give
you headaches when you take it and it will
give you headaches it you suddenly stop
taking it. Anyone with a history of a
seizure disorder who needs to stop taking
an anticonvulsant cold turkey needs to be
discussing that with two neurologists and
not getting your information from some
stupid web site. Get off your computer
and start making appointments!
If you've worked your way up to a
particular dosage, it's usually best to
spend this many days at the next lowest
dosage before going down the next lowest
dosage before that and so forth. This is
the least sucky way to avoid problems when
stopping any psychiatric medication.
Presuming you have the option of slowly
tapering off them.
How lamictal works in your brain:
lamictal (lamotrigine) works on binding to
voltage sensitive sodium and maybe calcium
channels in the brain. The calcium bit
is a matter for debate. It also
invokes glutamate which is a major
excitatory neurotransmitter in the brain
which is responsible for sending messages
from neuron to neuron in 85% of the brain.
It also lightly brushes the 5-ht3
serotonin receptor and the sigma opioid
receptors, which probably account for its
lovely antidepressant properties.
Nothing like a combined serotonin and
opiate reaction. As to precisely where
in your brain lamictal does its sodium and
calcium channel magic, that's a mystery.
Comments: be sure to read the section on
anticonvulsants if you haven't done so
already.
Approved by the fda to treat epilepsy in
1994 and to treat bipolar disorder in
2003, lamictal (lamotrigine) is probably
the last of the anticonvulsants you'll see
approved to treat bipolar, because all the
money is in atypical antipsychotics.
Lamictal (lamotrigine) joins lithium in
being one of only two meds to date
approved to treat both the manic and
depression phases of bipolar disorder and
essentially to treat the mood swings
themselves.
Lamictal (lamotrigine) is the prima donna
of anticonvulsants / mood stabilizers.
Besides lithium, lamictal is the only
official mood stabilizer proven to have
any results with bipolar depression.
Personally I find it odd that it's
approved for bipolar 1 when lamictal
(lamotrigine) is really the med for
bipolar 2! Its cgi-i scores were better
than many antidepressants on the market
today. Little wonder why lamictal is
becoming popular as a treatment for
otherwise treatment-resistant depression.
Lamictal is proven to be the best
medication for rapid cycling, but it
doesn't handle the nasty ultradian rapid
cycling as well as topamax (topiramate)
does. If ultradian rapid cycling is an
issue, it's best to combine lamictal
(lamotrigine) with one of the temporal
lobe affecting meds, such as topamax
(topiramate), trileptal (oxcarbazepine) or
tegretol (carbamazepine usp), although you
need to adjust the dosage with the latter
two meds.
So that's why lamictal (lamotrigine) is
worth dealing with. Despite all the
rashes, headaches, muscle aches and pains,
and slow titration schedule, when lamictal
works people just love it.
You're just not going to find a pickier,
or wackier medication in the psychiatric
pharmacopoeia. Anticonvulsants are
notorious for reacting to other
medications and foods, but lamictal
(lamotrigine) reacts to everything.
That's why you have to titrate so slowly.
And if you're planning on a cocktail of
some kind that's going to include lamictal
(lamotrigine) it's going to make your life
a lot easier if you're up to whatever
dosages you plan on being at with whatever
other meds first and then add lamictal
(lamotrigine). Otherwise you have to
deal with lamictal's variable plasma
levels and half-lives. Oh, sure, you and
your doctor can check the pi sheet for
what supposedly does or doesn't affect
lamictal (lamotrigine), but too many
things do have an effect. I'd just
rather put up with whatever I was dealing
with, stabilize on the other meds and then
add lamictal (lamotrigine) into the mix.
Where other anticonvulsants can mess with
your girly hormones, your girly hormones
are more likely to mess with lamictal
(lamotrigine). This means that
lamictal's efficacy can vary throughout
the month. Isn't that fun? So, no,
it's not your imagination if it seemed to
work better last week. If you've
stabilized at a dosage and you're noticing
a variation throughout the month you may
want to consider taking an oral
contraceptive to standardize lamictal's
effect. It may require a dosage
adjustment after you start the pill, but
that's how things are with this med.
There are no good data yet as to whether
or not you can stop and start lamictal
again. One small study with epilepsy
showed that it might be ok, if you didn't
wait too long. But that's hardly a
real-world application for discontinuation
and restarting the med. The anecdotal
evidence coming in is that it doesn't seem
to work as well the second time around,
but some real evidence is needed
as to the lamictal (lamotrigine) muscle
ache that is becoming popular, I have a
guess as to what that is about.
Lamictal (lamotrigine) is one of the few
meds approved for lennox-gastaut syndrome,
an uncommon form of epilepsy that, among
other symptoms, presents the atonic
seizure, where all your muscles go utterly
limp. You're having yet another
relationship argument and you fall into a
big pile of being the human turd, unable
to move or even look away from the stain
on the carpet. I've been there with the
atonic seizures. Anyway, people seem
to like lamictal (lamotrigine) for
lennox-gastaut. So if you've got a med
that keeps your muscles from going limp
and normally your muscles don't go limp
all the time, it would follow that muscle
aches and pains could be a result.
Like other anticonvulsants, lamictal
carries the rare but possible risk for
aplastic anemia. Mouse had to deal with
it when trying lamictal (lamotrigine), and
we know one person who had to stop taking
tegretol (carbamazepine usp) because of
it. So if you see lots of weird bruises
that you can't explain, see your doctor
immediately!
Good luck if have more questions just ask,
if she wants to talk to other bipolar
people she's more then welcome to send me
a message.
Also going to n.A.M.I. And d.B.S.A.
Support meetings would help her in my
opinion.Because she would get to me other
people just like her who have bipolar
disorder(manic-depression).
