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Lamictal and addiction ?

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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.
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First Helper BPjoe23
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replied October 26th, 2005
Experienced User
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.



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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.



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3. Is a generic version of lamotrigine available?

There is no generic lamotrigine in the usa as the manufacturer has patent protection. Generic lamotrigine is available in canada.


4. How does lamotrigine differ from other mood stabilizing drugs?

Lamotrigine differs from other mood stabilizing drugs in two major ways

1. Lamotrigine's frequent effectiveness for patients who have failed to respond to antidepressants or mood stabilizers;

2. Lamotrigine's relatively benign side-effect profile.

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).



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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.



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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.



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9. How is treatment with lamotrigine initiated?

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.



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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.



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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

adverse reactions (%)

adverse reaction lamotrigine placebo

dizziness 38 13
headache 29 19
double vision 28 7
unsteadiness 22 6
nausea 19 10
blurred vision 16 5
sleepiness 14 7
rash 10 5
vomiting 10 4

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.



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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.



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17. Is there an interaction between lamotrigine and alcohol?

Alcohol may increase the severity of the side-effects of lamotrigine.



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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.



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20. Can lamotrigine be used in elderly people?

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.



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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



25 mg - $3.11
100 mg - $3.56
150 mg - $3.64
200 mg - $3.94



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25. Might lamotrigine be effective in people who have failed to receive benefit from other psychopharmacologic agents?

The major psychiatric use of lamotrigine is with people who have mood disorders that have not been adequately controlled by other medications.



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26. What are the advantages of lamotrigine?

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.



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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.

For more to the questions here's the link.
Http://www.Psycom.Net/depression.Central.L amotrigine.Html


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 !**@! 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).
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replied October 26th, 2005
Experienced User
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.



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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.



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3. Is a generic version of lamotrigine available?

There is no generic lamotrigine in the usa as the manufacturer has patent protection. Generic lamotrigine is available in canada.


4. How does lamotrigine differ from other mood stabilizing drugs?

Lamotrigine differs from other mood stabilizing drugs in two major ways

1. Lamotrigine's frequent effectiveness for patients who have failed to respond to antidepressants or mood stabilizers;

2. Lamotrigine's relatively benign side-effect profile.

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).



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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.



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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.



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9. How is treatment with lamotrigine initiated?

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.



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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.



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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

adverse reactions (%)

adverse reaction lamotrigine placebo

dizziness 38 13
headache 29 19
double vision 28 7
unsteadiness 22 6
nausea 19 10
blurred vision 16 5
sleepiness 14 7
rash 10 5
vomiting 10 4

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.



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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.



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17. Is there an interaction between lamotrigine and alcohol?

Alcohol may increase the severity of the side-effects of lamotrigine.



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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.



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20. Can lamotrigine be used in elderly people?

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.



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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



25 mg - $3.11
100 mg - $3.56
150 mg - $3.64
200 mg - $3.94



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25. Might lamotrigine be effective in people who have failed to receive benefit from other psychopharmacologic agents?

The major psychiatric use of lamotrigine is with people who have mood disorders that have not been adequately controlled by other medications.



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26. What are the advantages of lamotrigine?

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.



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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.

For more to the questions here's the link.

Http://www.Psycom.Net/depression.Central.L amotrigine.Html


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 !**@! 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).


Http://www.Google.Com/search?Hl=en&q=l amictal

also this is what lamictal looks like in different doses
http://www.Drugs.Com/pdr/images/pills/p053 16d1.Jpg
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