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Re: Lamictal restart dosage help

Posted by SLS on January 29, 2001, at 15:34:38

In reply to Lamictal restart dosage help, posted by Sulpicia on January 28, 2001, at 15:42:36

I would be surprised if you had trouble with the following schedule

25mg x 2 weeks
50mg x 2 weeks
100 x 1-2 weeks
150 x 1 week

This schedule is recommended when Lamictal is used without any other anticonvulant. The only recognized use of Lamictal by the FDA is as an add-on to things like Depakote, phenytoin, and phenobarbital. Therefore, the only schedule recommended in the drug label is for this approved drug combination use. Each of these drugs interact with the others to produce different blood levels.

Oh, by the way HI.

- Scott

> Sorry in advance to anyone who's read this b4; I posted this earlier on the kiddie forum.
> Hi Folks --
> I have one horribly depressed 15 y/o with bipolar II dx. She was doing really well on wellbutrin and lamictal. Alas:
> a week or so after we moved to 150mgs during a nice slow and by the books increase, she developed an actinic
> rash and mouth ulcers. We took her off for nine frantic days while I tracked down and read *everything* written
> about lamictal, lamictal and wellbutrin, SJS, TENS, actinic rashes, restarts, you name it. Rash went away w/in 24
> hrs of starting prednisone. No biopsy [I read the derm stuff last like an idiot] so no confirmation other than
> hypersensitivity. In view of the facts that: she didn't respond to depakote at all [8 wks therapeutic level] and was
> rendered unconscious after 36 hrs by starting dose of lithium, had 4 p-hospitalizations and nearly died, we
> decided to restart the lamictal. There is virtually no data here for us to work with. I know the rule: start low and go
> slow. So far so good and up to 25mgs w/out problems. Am checking temp, lymph nodes, and skin. *Frequently*
> Her severe depression returned w/in 24 hrs of stopping lamictal and has not shown any signs of letting up. Terrible
> hypersomnia, 22 hrs per day, sadness, apathy, hunger, unable to eat, bathe or do anything. Once last week she
> was able to stay awake for 24 hrs straight and made it to school. For one day out of the last 2 wks. Not a bad
> strategy to use sleep deprivation to combat depression. Anyway, at the safe rate of increase she will be at the
> level were she got relief in about 6 wks. She'll never make it. Pdoc tried provigil to no effect. This morning we
> were down to 2 choices: try adding adderall [tricky at best w/ BP II and recent substance abuse remission] , or
> exceed the traditional increase rate and pray. Started adderall 20mgs this AM; couldn't get up until severely
> harrassed and threatened, and only managed 4 hrs awake. No mania tho or drug cravings. Thank god for AA.
> So, here's the question: I need experiential, or best guess, or even ethical calculus input here -- how fast can we
> increase the lamictal?
> And yes, just in case you're wondering, I *do* realize that we're playing with fire but the situation is dire. Pdoc is
> fabulous, highly experienced but there is simply no available data on which to make a decision. We're reluctant to
> do a faster increase but also horrified of relapse. Between a rock and hard place indeed.
> Any and all input appreciated.




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