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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 C5 on July 28, 2006, at 9:37:27
is there anyone there who can advise(from experience etc.)on the dose range for Valproate(long)if to be administered together with the (optimal dose range)for Lamictal due to the fact that these 2 are synergistically affecting each other?
Posted by SLS on July 28, 2006, at 9:51:37
In reply to Valproate + Lamictal for BP2-doses, posted by C5 on July 28, 2006, at 9:37:27
> is there anyone there who can advise(from experience etc.)on the dose range for Valproate(long)if to be administered together with the (optimal dose range)for Lamictal due to the fact that these 2 are synergistically affecting each other?
Generally speaking, you go with the dosage of Valproate that you think is best according to your doctor's experience and cut the dosage of Lamictal in half. If the target dosages of each drug separately would be Depakote 1500mg and Lamictal 200mg, the combination would result in dosages of:
Depakote 1500mg + Lamictal 100mg
If you are taking Depakote at the same time, you would need to start the Lamictal at a low dosage and raise it gradually to avoid provoking a dangerous rash reaction:
12.5mg x 2 weeks
25mg x 2 weeks
50mg x 1 week
100mg* For the first 2 weeks, the current package insert says to take 25mg every other day. The original package insert said to take 12.5 each day. I don't know why the change was made.
- Scott
Posted by C5 on July 28, 2006, at 9:59:53
In reply to Re: Valproate + Lamictal for BP2-doses, posted by SLS on July 28, 2006, at 9:51:37
>
> Generally speaking, you go with the dosage of Valproate that you think is best according to your doctor's experience and cut the dosage of Lamictal in half. If the target dosages of each drug separately would be Depakote 1500mg and Lamictal 200mg, the combination would result in dosages of:
>
> Depakote 1500mg + Lamictal 100mg
>
> If you are taking Depakote at the same time, you would need to start the Lamictal at a low dosage and raise it gradually to avoid provoking a dangerous rash reaction:
>
> 12.5mg x 2 weeks
> 25mg x 2 weeks
> 50mg x 1 week
> 100mg
>
> * For the first 2 weeks, the current package insert says to take 25mg every other day. The original package insert said to take 12.5 each day. I don't know why the change was made.
>
>
> - Scottthanks Scott for your prompt reaction ;
I have well understood your point as far as the Lamictal doses are concerned,but a little bit surprised about the dose exemple you have provided for the Valproate,as I am on just 600mg Orfiril(Long) known to be a "typical" dose for a soft bipolarity(Cyclothimia)?! what is your opinion? does it seem to you being too low?
Posted by SLS on July 28, 2006, at 11:20:41
In reply to Re: Valproate + Lamictal for BP2-doses, posted by C5 on July 28, 2006, at 9:59:53
> >
> > Generally speaking, you go with the dosage of Valproate that you think is best according to your doctor's experience and cut the dosage of Lamictal in half. If the target dosages of each drug separately would be Depakote 1500mg and Lamictal 200mg, the combination would result in dosages of:
> >
> > Depakote 1500mg + Lamictal 100mg
> >
> > If you are taking Depakote at the same time, you would need to start the Lamictal at a low dosage and raise it gradually to avoid provoking a dangerous rash reaction:
> >
> > 12.5mg x 2 weeks
> > 25mg x 2 weeks
> > 50mg x 1 week
> > 100mg
> >
> > * For the first 2 weeks, the current package insert says to take 25mg every other day. The original package insert said to take 12.5 each day. I don't know why the change was made.
> >
> >
> > - Scott
>
> thanks Scott for your prompt reaction ;
> I have well understood your point as far as the Lamictal doses are concerned,but a little bit surprised about the dose exemple you have provided for the Valproate,as I am on just 600mg Orfiril(Long) known to be a "typical" dose for a soft bipolarity(Cyclothimia)?! what is your opinion? does it seem to you being too low?
I really haven't looked into it enough to form an opinion. I see that there is some thought that low dosages are sufficient to stabilize mood in cyclothymia.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8331092&dopt=Abstract
I think it depends on how much of a problem mania is. Acute manic episodes usually require dosages of 1000mg and higher. I believe blood levels are usually kept in the range of 50-100 mcg/mL for prophylaxis. That probably translates into a dosage range of 750-1500mg.
I am guessing from your questions that valproate 600mg monotherapy is not sufficient to treat your condition. Are you a rapid cycler? Can you describe your cycle and symptoms?
- Scott
Posted by Phillipa on July 28, 2006, at 11:30:01
In reply to Re: Valproate + Lamictal for BP2-doses, posted by SLS on July 28, 2006, at 9:51:37
Oh so there are two starter kits one for a combo of meds for bipolar and another for depression as mine is 25mg for two weeks , then 50mg for two weeks , then l00. Scott I always learn something new from you thanks. Love Phillipa
Posted by C5 on July 28, 2006, at 13:09:41
In reply to Re: Valproate + Lamictal for BP2-doses, posted by SLS on July 28, 2006, at 11:20:41
w?
>
>
> I really haven't looked into it enough to form an opinion. I see that there is some thought that low dosages are sufficient to stabilize mood in cyclothymia.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8331092&dopt=Abstract
>
> I think it depends on how much of a problem mania is. Acute manic episodes usually require dosages of 1000mg and higher. I believe blood levels are usually kept in the range of 50-100 mcg/mL for prophylaxis. That probably translates into a dosage range of 750-1500mg.
>
> I am guessing from your questions that valproate 600mg monotherapy is not sufficient to treat your condition. Are you a rapid cycler? Can you describe your cycle and symptoms?
>
>
> - Scott
thanks again Scotyes,you have very well guessed : I am a rapid cycler, cycling between absolutely "normal" periods (of 2 or sometimes more weeks)and depressive ones(not the atypical type,but rather agitative and/or anxious)
These depre.periods last for approx.2-3 weeksthe hypo periods are significantly reduced in intensity mainly since being on Valproate ; I am also on 20mg Escitalopram which proved to be essential in my case as trying a monotherapy with just Lamictal has totally failed
for the time being,it seems that the most beneficial effect I have obtained from the MS(Valproate) and the AD(e.citalopram) administration,but some less benefit from Lamictal(100mg) ; this has been the reason for asking you about the Valproate dose thinking about a possibility that by eventually increasing a little the dose(up the 600mg),I shall face less cycling and automatically pass through less depress.phases being much more debilitating than the so called hypo(I am sure that you well know this aspect)
Cfive
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