![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Bob on December 12, 2000, at 23:00:15
I recently began adding Lamictal to my regimen of Celexa (20mg daily), and T3/T4 (12.5mcg each daily) I am in the middle of my second week of taking 50mg daily according to the "plan" which requires a slow buildup. My understanding is that this is required due to the risk of a possibly life threatening rash. In the days immediately following beginning this medecine I began experiencing itchiness on various areas of my body, such as my arms, hands, legs, and waist. Upon examination, I couldn't really see any rashes, and my psych said that "if you have to guess, then it's not a problem". Well, this week, the itchiness has become slightly less, but it seems that in the region of my back upper arms (triceps) there is a very slight (barely discernible) rash. Nothing I would be concerned about if circumstances were anything other than what they are. My question is: does anyone have experience with developing itchiness in the beginning of Lamictal treatment, only to have it subside later, or am I heading down an undesirable path?
Posted by JohnL on December 13, 2000, at 5:25:39
In reply to lamictal, posted by Bob on December 12, 2000, at 23:00:15
> I recently began adding Lamictal to my regimen of Celexa (20mg daily), and T3/T4 (12.5mcg each daily) I am in the middle of my second week of taking 50mg daily according to the "plan" which requires a slow buildup. My understanding is that this is required due to the risk of a possibly life threatening rash. In the days immediately following beginning this medecine I began experiencing itchiness on various areas of my body, such as my arms, hands, legs, and waist. Upon examination, I couldn't really see any rashes, and my psych said that "if you have to guess, then it's not a problem". Well, this week, the itchiness has become slightly less, but it seems that in the region of my back upper arms (triceps) there is a very slight (barely discernible) rash. Nothing I would be concerned about if circumstances were anything other than what they are. My question is: does anyone have experience with developing itchiness in the beginning of Lamictal treatment, only to have it subside later, or am I heading down an undesirable path?
Hi Bob,
You might do well to stay at your current dose before increasing further, just long enough to let things settle down. And when you do increase dose, Lamictal can be easily split in half. Increase by halftabs instead of whole tabs. I too had slight itching, a possible rash, and a slight twitch in one eye when I started Lamictal. After that, I increased in 12.5 increments instead of 25mg increments, about every four days. The symptoms all disappeared. Lamictal ended up not helping me much, and oddly when I discontinued it slowly those same symptoms reappeared and then disappeared.Try 12.5mg every 4 to 7 days.
John
Posted by SLS on December 13, 2000, at 6:56:17
In reply to lamictal, posted by Bob on December 12, 2000, at 23:00:15
> I recently began adding Lamictal to my regimen of Celexa (20mg daily), and T3/T4 (12.5mcg each daily) I am in the middle of my second week of taking 50mg daily according to the "plan" which requires a slow buildup. My understanding is that this is required due to the risk of a possibly life threatening rash. In the days immediately following beginning this medecine I began experiencing itchiness on various areas of my body, such as my arms, hands, legs, and waist. Upon examination, I couldn't really see any rashes, and my psych said that "if you have to guess, then it's not a problem". Well, this week, the itchiness has become slightly less, but it seems that in the region of my back upper arms (triceps) there is a very slight (barely discernible) rash. Nothing I would be concerned about if circumstances were anything other than what they are. My question is: does anyone have experience with developing
> I recently began adding Lamictal to my regimen of Celexa (20mg daily), and T3/T4 (12.5mcg each daily) I am in the middle of my second week of taking 50mg daily according to the "plan" which requires a slow buildup. My understanding is that this is required due to the risk of a possibly life threatening rash. In the days immediately following beginning this medecine I began experiencing itchiness on various areas of my body, such as my arms, hands, legs, and waist.
Upon examination, I couldn't really see any rashes, and my psych said that "if you have to guess, then it's not a problem". Well, this week, the itchiness has become slightly less, but it seems that in the region of my back upper arms (triceps) there is a very slight (barely discernible) rash. Nothing I would be concerned about if circumstances were anything other than what they are. My question is: does anyone have experience with developing itchiness in the beginning of Lamictal treatment, only to have it subside later, or am I heading down an undesirable path?
It is hard to know for sure what is going on, but I think caution is indicated. If it were me, I would want to maintain the dosage until this rash either disappears, or is determined to be unrelated. If you have never experienced anything like this before, you are forced to consider it as probably drug-related. To the degree you describe it, I would anticipate that it will subside quickly. Then you can continue titrating upwards, perhaps at the rate JohnL has recommended.Were you on 25mg for two weeks before moving up to 50mg? I think you are supposed to when Lamictal is not being added to the enzyme-inducing anticonvulsant drugs that tend to speed-up its metabolism. That's how I did it anyway.
25mg - > 2 weeks
50mg - > 2 weeks
100mg - > 1 week50mg-300mg: Range for depression
200mg: Average for bipolar depression
300mg-600mg: Range for epilepsy
- Scott
Posted by Bob on December 13, 2000, at 9:27:56
In reply to Re: lamictal, posted by JohnL on December 13, 2000, at 5:25:39
> > I recently began adding Lamictal to my regimen of Celexa (20mg daily), and T3/T4 (12.5mcg each daily) I am in the middle of my second week of taking 50mg daily according to the "plan" which requires a slow buildup. My understanding is that this is required due to the risk of a possibly life threatening rash. In the days immediately following beginning this medecine I began experiencing itchiness on various areas of my body, such as my arms, hands, legs, and waist. Upon examination, I couldn't really see any rashes, and my psych said that "if you have to guess, then it's not a problem". Well, this week, the itchiness has become slightly less, but it seems that in the region of my back upper arms (triceps) there is a very slight (barely discernible) rash. Nothing I would be concerned about if circumstances were anything other than what they are. My question is: does anyone have experience with developing itchiness in the beginning of Lamictal treatment, only to have it subside later, or am I heading down an undesirable path?
>
> Hi Bob,
> You might do well to stay at your current dose before increasing further, just long enough to let things settle down. And when you do increase dose, Lamictal can be easily split in half. Increase by halftabs instead of whole tabs. I too had slight itching, a possible rash, and a slight twitch in one eye when I started Lamictal. After that, I increased in 12.5 increments instead of 25mg increments, about every four days. The symptoms all disappeared. Lamictal ended up not helping me much, and oddly when I discontinued it slowly those same symptoms reappeared and then disappeared.
>
> Try 12.5mg every 4 to 7 days.
> JohnI will definitely slow it down. It is reassuring to hear that you had something similar to me and that it eventually cleared up. I am very sorry to hear it didn't help you much. Thanks.
Posted by Bob on December 13, 2000, at 9:34:01
In reply to Re: lamictal, posted by SLS on December 13, 2000, at 6:56:17
> > I recently began adding Lamictal to my regimen of Celexa (20mg daily), and T3/T4 (12.5mcg each daily) I am in the middle of my second week of taking 50mg daily according to the "plan" which requires a slow buildup. My understanding is that this is required due to the risk of a possibly life threatening rash. In the days immediately following beginning this medecine I began experiencing itchiness on various areas of my body, such as my arms, hands, legs, and waist. Upon examination, I couldn't really see any rashes, and my psych said that "if you have to guess, then it's not a problem". Well, this week, the itchiness has become slightly less, but it seems that in the region of my back upper arms (triceps) there is a very slight (barely discernible) rash. Nothing I would be concerned about if circumstances were anything other than what they are. My question is: does anyone have experience with developing
>
>
> > I recently began adding Lamictal to my regimen of Celexa (20mg daily), and T3/T4 (12.5mcg each daily) I am in the middle of my second week of taking 50mg daily according to the "plan" which requires a slow buildup. My understanding is that this is required due to the risk of a possibly life threatening rash. In the days immediately following beginning this medecine I began experiencing itchiness on various areas of my body, such as my arms, hands, legs, and waist.
> Upon examination, I couldn't really see any rashes, and my psych said that "if you have to guess, then it's not a problem". Well, this week, the itchiness has become slightly less, but it seems that in the region of my back upper arms (triceps) there is a very slight (barely discernible) rash. Nothing I would be concerned about if circumstances were anything other than what they are. My question is: does anyone have experience with developing itchiness in the beginning of Lamictal treatment, only to have it subside later, or am I heading down an undesirable path?
>
>
> It is hard to know for sure what is going on, but I think caution is indicated. If it were me, I would want to maintain the dosage until this rash either disappears, or is determined to be unrelated. If you have never experienced anything like this before, you are forced to consider it as probably drug-related. To the degree you describe it, I would anticipate that it will subside quickly. Then you can continue titrating upwards, perhaps at the rate JohnL has recommended.
>
> Were you on 25mg for two weeks before moving up to 50mg? I think you are supposed to when Lamictal is not being added to the enzyme-inducing anticonvulsant drugs that tend to speed-up its metabolism. That's how I did it anyway.
>
> 25mg - > 2 weeks
> 50mg - > 2 weeks
> 100mg - > 1 week
>
> 50mg-300mg: Range for depression
> 200mg: Average for bipolar depression
> 300mg-600mg: Range for epilepsy
>
>
> - ScottThere is little doubt to me that the symptoms are drug related.I received a manufacturer's "kit" designed to keep track of the dose increases. It tells you to start right off with 2 X 25mg per day! It sounds like even this is too much to begin with. It seems like the symptoms might be fading, so I guess I'll just hold at this dose for awhile, and then increase in 12.5mg increments. BTW, thank you for the therapeutic drug level info.
Did Lamictal end up helping you? Did you ever experience itching or a rash?
Posted by SLS on December 13, 2000, at 15:51:20
In reply to Re: lamictal, posted by Bob on December 13, 2000, at 9:34:01
Hi Bob.
> There is little doubt to me that the symptoms are drug related.I received a manufacturer's "kit" designed to keep track of the dose increases. It tells you to start right off with 2 X 25mg per day! It sounds like even this is too much to begin with.It is. Lamictal is approved only for partial epilepsy as an add-on to other anticonvulsants. As such, your Lamictal package reflects the suggested dosage guidelines when it is combined with these drugs. All of the older, major anticonvulsants, except for Depakote, speed-up the liver enzymes that are responsible for breaking down Lamictal. This accelerated rate must be accounted for when establishing dosage schedules. There is no official FDA approved use for Lamictal alone. Hence, when Lamictal is used for other unapproved "off-label" uses, the dosing schedule must be more gradual because enzymatic break-down is no longer accelerated. Being cautious, I prefer a titration rate that seems is generally accepted when using Lamictal alone.
For the sake of redundancy:
IMPORTANT! When taking Depakote (valproate), one MUST reduce these dosages by half.25mg - > 2 weeks
50mg - > 2 weeks
100mg - > 1 week50mg-300mg: Range for depression
200mg: Average for bipolar depression
300mg-600mg: Range for epilepsy
> It seems like the symptoms might be fading, so I guess I'll just hold at this dose for awhile, and then increase in 12.5mg increments. BTW, thank you for the therapeutic drug level info.> Did Lamictal end up helping you?
Yes. It provides me with a mild improvement. I suffer a very treatment-resistant bipolar depression. Therefore, that my response to Lamictal is at best minimal should not be construed as an example of its general effectiveness. It is a great drug and a fine choice.
> Did you ever experience itching or a rash?
Yes. Upon each dosage increase, my eyes itched in the corners. This usually disappeared within 48 hours.
I am happy to know that your reaction is subsiding. Even if a reaction were to occur for having been provoked by too rapid a titration, after withdrawal, one can successfully restart a more gradual schedule.
Bye the way, what is your current diagnosis?
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.