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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Cece on February 16, 2001, at 0:09:33
I want to share my experience with lamictal dosing.
I am on quite a mix of meds, developed over the last 7 years, for treatment resistant bi-polar II- including 250mg/day Depakote, 1200mg/day Neurontin, .125mg clonazepam (yes, I chop .5mg tablets into quarters!), 40mg/day nortriptyline, and 2mg/day xanax. As you can see, in some cases I've found that a smaller dose may work better for me than a larger dose- I'm pretty sensitive to med effects, both positive and negative.
I started lamictal about a year ago after resisting trying it out of fear of "the rash", but depression is a real problem for me, and I needed more stabilization. My doctor introduced it into my regime VERY slowly- much more slowly than I have seen anyone mention here. I have increased over the last year in increments of 6.25 to 12.5mg, every 2 weeks, to my present dose of 125mg/day. Even at those small increases, I often experienced flushing, energy loss, and GI disturbances the second or third day after an increase. If I had followed the PDR plan for dosing, I am sure that I would have had intolerable side effects. The side effects I did experience were mild, and they passed in a day, and from early on I found lamictal to be quite beneficial in improving the quality of my mood. I'm staying at 125mg for the time being.
I'm new to this site (since it was "remodelled"), and just beginning to explore all the information and experience available. I'm interested to have read also that other people have found Neurontin and Nortriptyline to be helpful in controlling fibromyalgia. I used to have hideously disabling bouts of it, and now have only occasional, very mild flare-ups.
Posted by SalArmy4me on February 19, 2001, at 6:00:39
In reply to Lamictal dosing (and fibromyalgia), posted by Cece on February 16, 2001, at 0:09:33
You have very little to fear about Lamictal rashes.
The fears over Lamictal (lamotrigine) rashes are unfounded. The chance of having a mild to moderate rash are 3%--according to clinical trials. But clinical trials done years ago do not necessarily predict the incidence of side-effects now. Besides, most of these rashes were due to taking a combination of Valproate and Lamictal, and they resolved without hospital stays. I believe that the chance of a seizure from Wellbutrin is much higher, and the chance of a hypertensive crisis with phenelzine is a little higher. But people aren't afraid of Wellbutrin as they are with Lamictal (because Lamictal is new, I assume).
The chance of having a severe rash leading to hospitalization is reported as 0.3%. With those odds, it is easier to get hit by
lightening than it is to have a Lamictal rash. Point in case: You never hear in the paper about someone severely harmed
by Lamictal.
I have taken Lamictal for one year with a moderate benefit and absolutely no side-effects. I believe that Lamictal will replace Lithium as the drug of choice in bipolar disorder in 10 years, due to its prominent antidepressant effect and benign side-effect profile.
Posted by SLS on February 19, 2001, at 8:10:43
In reply to Re: Lamictal dosing (and fibromyalgia), posted by SalArmy4me on February 19, 2001, at 6:00:39
Dear SalArmy4me,
> You have very little to fear about Lamictal rashes.
>
> The fears over Lamictal (lamotrigine) rashes are unfounded.> The chance of having a severe rash leading to hospitalization is reported as 0.3%. With those odds, it is easier to get hit by
lightening than it is to have a Lamictal rash. Point in case: You never hear in the paper about someone severely harmed by Lamictal.
Could you please cite the published facts that lead you to your conclusion? Is it something that I can find on the internet? It is very possible that such a low incidence of hospitalization and fatality (0.3%?) due to Lamictal-induced rash is because DOCTORS ARE SMART ENOUGH TO DISCONTINUE THE DRUG BEFORE IT GETS THAT FAR!In the meantime, I wouldn't coax mother nature to fight a battle of wits, with either Lamictal or lightning. I wouldn't encourage making such rash judgments. :-) (dumb, I know)
By the same token, I find Lamictal to be very effective and without many cognitive side effects - perhaps the lowest of the anticonvulsants. I would not hesitate to recommend it to anyone so long as they follow the prescribed schedule of dosage titration.
--------------------------------------------------
Schedule of Lamictal (lamotrigine) dosing for depression when not combined with any other anticonvulsant-type mood-stabilizer:
weeks 1-2 - > 25mg
weeks 3-4 - > 50mg
weeks 5 - > 100mg
thereafter + 50mg every one to two weeks.--------------------------------------------------
This schedule somewhat conservative, but is still more rapid than many doctors are willing to use for certain individuals. If one develops a rash with Lamictal during an attempt at a very rapid titration, the drug can be discontinued and successfully restarted using a more conservative schedule.
Good luck all...
- Scott
Posted by john bower on September 4, 2001, at 20:50:30
In reply to Re: Lamictal dosing (and fibromyalgia), posted by SalArmy4me on February 19, 2001, at 6:00:39
is lamictal or geodon monotherapy for bipolar-1.
aripiprazole is.
do you need sleeping medicenes with lamictal or geodon.
you don't need with aripiprazole.
i'm down to 0.75 mg ativan -- withdrawing off it.john
> I have taken Lamictal for one year with a moderate benefit and absolutely no side-effects. I believe that Lamictal will replace Lithium as the drug of choice in bipolar disorder in 10 years, due to its prominent antidepressant effect and benign side-effect profile.
Posted by john bower on September 5, 2001, at 0:40:10
In reply to Lamictal v/s aripiprazole v/s keppa v/s geodon, posted by john bower on September 4, 2001, at 20:50:30
are you completely functional on lamictal.
I am completely functional on aripiprazole.
can you sleep with lamictal.
i'm glad there is an alternative to lithium.john
> is lamictal or geodon monotherapy for bipolar-1.
> aripiprazole is.
> do you need sleeping medicenes with lamictal or geodon.
> you don't need with aripiprazole.
> i'm down to 0.75 mg ativan -- withdrawing off it.
>
> john
>
> > I have taken Lamictal for one year with a moderate benefit and absolutely no side-effects. I believe that Lamictal will replace Lithium as the drug of choice in bipolar disorder in 10 years, due to its prominent antidepressant effect and benign side-effect profile.
This is the end of the thread.
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