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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Jay2112 on January 7, 2023, at 21:38:32
I am restarting lamotragine. Just wondering:
a) do I have to taper up again?
b) dose once or twice a day?
Also curious, it seemed to work well with methadone, helping with my rapid-metabolism problem. I zip through, metabolically, drugs very quick, methadone alone within anywhere from 2 to about 14 hours. (Through our estimates. He had me sit in his office after a dose, at about the 2 week mark, and my subjective estimate of effect was about 4 hours. I know...I know...much more is dependent.)
The literature doesn't mention a lot about lamotragine use in concurrent disorders.
Jay
Posted by NKP on January 8, 2023, at 15:11:25
In reply to Lamictal (lamotragine) dose 1 or 2 x a day?, posted by Jay2112 on January 7, 2023, at 21:38:32
In order to reduce the risk of SJS, lamotrigine must be re-titrated from scratch when restarting it, even after only a few days of not having taken it.
I take mine twice daily in order to reduce spikes in blood and tissue concentrations, so as to reduce the risk of SJS. I don't know if this is the best way to take it however.
Posted by rjlockhart37 on January 8, 2023, at 16:32:26
In reply to Lamictal (lamotragine) dose 1 or 2 x a day?, posted by Jay2112 on January 7, 2023, at 21:38:32
I usually take my first dose in the morning with Prozac and then another about 6 hours later. There are times when i just take all of it at once, but i heard that's not so good. But, definitely start lamotrigine at a low dose, it needs to be started around 25-50mg. Too much will increase risks of side effects and the rash symptom some people experience.
Posted by SLS on January 21, 2023, at 8:50:36
In reply to Lamictal (lamotragine) dose 1 or 2 x a day?, posted by Jay2112 on January 7, 2023, at 21:38:32
> I am restarting lamotragine. Just wondering:
>
> a) do I have to taper up again?Yes. I would.
Lamotrigine is capable of producing Stevens-Johnson Syndrome (SJS), which can be fatal. As many as 10% of people starting lamotrigine will develop a rash, but only 0.04% will be due to SJS. SJS can show up with a latency of eight weeks after taking the first dose.
If lamotrigine therapy is to be restarted, even after a brief period of abstention, some guidelines mandate that you restart it as if it were your time taking it. One can restart lamotrigine, even if the first exposure precipitated a rash. In this case, it is recommended to wait eight weeks before restarting it. Not all rashes are Stevens-Johnson Syndrome. However, it can show up with a latency of eight weeks from the first dose. The dosage recommendations for treating bipolar depression is 100-400 mg/day. In my estimation, 200 mg/day is the sweet-spot that most people with bipolar depression. The recommended maximum dosage to treat seizure disorders is 500 mg/day. However, some people need as much as 700 mg/day. I need 300 mg/day. I have no side effects at this dosage. My memory and cognition seem to be unaffected now, but they did appear at the very beginning of treatment as a startup side effect.
> b) dose once or twice a day?I would recommend twice-a-day dosing, although once-a-day is an option offered by the drug company. For bipolar depression, I think most clinicians will use a twice-a-day regimen. For me, at 300 mg/day, once a day dosing leaves me deteriorating into depression before each dose. Teva makes an extended release "Lamotrigine XR". I know nothing about its clinical dosing frequency.
> Also curious, it seemed to work well with methadone, helping with my rapid-metabolism problem. I zip through, metabolically, drugs very quick, methadone alone within anywhere from 2 to about 14 hours. (Through our estimates. He had me sit in his office after a dose, at about the 2 week mark, and my subjective estimate of effect was about 4 hours. I know...I know...much more is dependent.)> Valproate inhibits the metabolism of lamotrigine quite a bit. I don't know at what dosage you would need to take it in order to match your metabolism. Is there any positive therapeutic effect of methadone that makes it an ideal adjunct?
> The literature doesn't mention a lot about lamotrigine use in concurrent disorders.
Which ones?
- Scott
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