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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 69. This is the beginning of the thread.
Posted by Quintal on April 11, 2008, at 12:02:41
I just got back from my pdoc appointment. I saw his understudy today and he agreed that Lamictal was a good choice since it worked well in the past. He refused Parnate for now because he wants to discuss it with pdoc in chief, since it's such a powerful drug and all. He made an appointment for me to see Big pdoc in two weeks, which is very fast for the NHS. In the meantime I'm supposed to be titrating up to 100mg of Lamictal, but I think the titration rate he's given me is much too fast. Now I'm wishing I'd said something at the time, because the patient information leaflet says to alert the doctor if you've ever had a rash during previous lamotrigine treatment, and I got a rash on each occasion I tried Lamictal.
I can't remember for sure, but I think I started on something like 12.5mg the first time, and I got a rash even on that low dose. This pdoc advised me to start on 50mg tonight, then move up to 100mg tomorrow. I'm really not happy about that, but I'm afraid of being perceived as 'difficult' if I don't take the dose he has prescribed. This is what held me back from saying anything during the appointment. In any case, it's Friday evening now and they'll be closed, so I can't even ring the mental health team for advice. I'll either have to wait till Monday, risk taking the full 50mg (don't think I'll dare raise it to 100mg until I'm sure I'm having no reaction to 50mg), or split a 50mg tablet into halves, or even quarters. Decisions, decisions....
Q
Posted by Phillipa on April 11, 2008, at 12:17:40
In reply to Starting Lamictal, posted by Quintal on April 11, 2008, at 12:02:41
Q I know your pdoc prescribed it for you but normal dosing here is 25mg for two weeks then 50 two weeks and then l00. And a lot start at 12.5mg. You had a rash on l2.5mg before? What did the pdoc do then discontinue? Now I don't know the circumstances of why a dose so high so fast but personally I wouldn't. Love Phillipa
Posted by Quintal on April 11, 2008, at 12:26:05
In reply to Re: Starting Lamictal » Quintal, posted by Phillipa on April 11, 2008, at 12:17:40
I think I'm going to just take 25mg over the weekend until I can contact the mental health team. I've looked around a bit on the net, and yeah, 100mg on day 2 is much too fast. The first time I took Lamictal I had a rash within the first week, but I took some Piriton and it went away after a few days. I went on to titrate it up to 200mg, and it worked well at that dose for years.
Q
Posted by Phillipa on April 11, 2008, at 12:33:57
In reply to Re: Starting Lamictal » Phillipa, posted by Quintal on April 11, 2008, at 12:26:05
Q Please be careful and remember if it gets bad there is always an ER. Pleasant dreams to you. Phillipa
Posted by dbc on April 11, 2008, at 14:11:44
In reply to Re: Starting Lamictal » Quintal, posted by Phillipa on April 11, 2008, at 12:33:57
Lamictal will almost always cause rashes the first 100mgs or so, if you even look at a bar of scented soap you're probably going to have a rash. The freak out part is if you have an itchy rash and are running a fever. If you dont catch that the next phase is you start getting blisters around your mouth thats the "go to the ER right now do not pass go and do not collect $200" phase.
I took my temperature at least twice a day those first 150mg or so. The fact that lamictal causes these weird rashes at the begining not only drives patients crazy but also doctors because everyones so paranoid about S-J syndrome.
The actual statistics of you developing it are astronomical. I know someone will post that they had it just because they had a rash, thats not S-J syndrome.
The upside and irony of lamictal is that often during titration periods it flips people into hypomania. Its effect in higher doses during titration feels like a stimulant to me its almost identical to certain dopamine based stims.
Posted by dbc on April 11, 2008, at 14:16:18
In reply to Re: Starting Lamictal, posted by dbc on April 11, 2008, at 14:11:44
Someone screwed up on your dosing. At the most it should be only 25mg titratons every week. Week 1 25mg, week 2 50mg etc. I would get a hold of someone before messing with the drug.
Posted by Quintal on April 11, 2008, at 14:44:09
In reply to Re: Starting Lamictal, posted by dbc on April 11, 2008, at 14:11:44
Apparently 1 in 10 people will get a rash in the first few weeks on Lamictal, so it is fairly common. I remember someone who did have bona fida SJ syndrome and it sounded very nasty. I was concerned the second time I took Lamictal because I had flu-like symptoms as well as the rash, and ultimately I pulled the plug on that particular trial. Something just didn't feel right.
I just took 25mg with my tea, and yeah, I think it might be flipping me into hypomania, but it feels quite good. At least it's having a postitive effect, and I could do with the extra energy. I can tell it's going to work. I can't get in touch with anyone until Monday at the earliest, but I've decided just to limit myself to 25mg for the first week anyway, since that is what the manufacturer recommends. I don't think the pdoc's understudy is very experienced with Lamictal. I'm probably safer using my own common sense.
Q
Posted by llurpsienoodle on April 11, 2008, at 17:03:45
In reply to Re: Starting Lamictal » dbc, posted by Quintal on April 11, 2008, at 14:44:09
When I started lamictal I had 2 sample packs with exact instructions on the titration. I believe it started with 12.5 mg.
After titrating up to 100 we increased my rate of titration quite rapidly- because I was feeling very very bad- and I never had any adverse effects, like rashes.
In retrospect, it was successful as an AD, at least for a few months, but it was not so good for my anxiety.
take good care. no mania now, you hear?
-Ll
Posted by bleauberry on April 11, 2008, at 18:19:57
In reply to Starting Lamictal, posted by Quintal on April 11, 2008, at 12:02:41
My vote is to cut the pill in quarters. Since they won't be exact quarters, start with the smallest one first.
There is already a great deal more risk with Lamictal than most other meds. I don't see any rationale to increase that risk even more. While maybe the doc thinks your body is already friends with lamictal from previous use and that a high starting dose should be ok, it is often the opposite. What can happen a lot is that the body will recognize the molecule and fight it as an invader. We see it often when someone starts a drug they used to be ok with and now they can't tolerate it due to severe side effects or adverse reactions or intolerance that they never had before.
I guess it is your call, but personally I like to play it safe.
Posted by Phillipa on April 11, 2008, at 19:52:14
In reply to Re: Starting Lamictal, posted by bleauberry on April 11, 2008, at 18:19:57
Maybe that's what my autoimmune system does to most meds hence they don't work since Ana hight And Quintal please take small doses. Love Phillipa
Posted by Quintal on April 12, 2008, at 9:55:57
In reply to Re: Starting Lamictal » Quintal, posted by llurpsienoodle on April 11, 2008, at 17:03:45
I thought you were still taking Lamictal? I think they do have a titration pack here, but pdocs don't seem to use it. They don't get sample packs from drug reps though. I think we did a similar thing with Lamictal the first time - after 100mg or so the dose increments were 50mg a week. Anyway, so far so good. There's definite AD effect already, and I feel so much more stable. On the downside I had only two hours sleep last night with terrible nightmares, and woke to find hives in my groin :-( I'm hoping this is just a coincidence because I broke out in lumps while cleaning the windows a few days ago. I should probably take a Piriton.
Q
Posted by llurpsieNoOdle on April 12, 2008, at 10:01:29
In reply to Re: Starting Lamictal » llurpsienoodle, posted by Quintal on April 12, 2008, at 9:55:57
> I thought you were still taking Lamictal?
oops yes I am; sorry to give the wrong impression. I tried not taking it for a few days and I felt really strange, so I went back on it. Not quite sure what it's doing in my cocktail, but too messy right now to tweak anything.
hives? yikes. and the location! (sHoCk!!)
at least you're up for cleaning windows though. come and clean mine?
I'm glad to hear that you're feeling at least a smidgen better. (did I spell smidgen correctly?)
well, no matter, as long as Q is getting a bit of relief.
_llllll
Posted by Quintal on April 12, 2008, at 10:03:48
In reply to Re: Starting Lamictal, posted by bleauberry on April 11, 2008, at 18:19:57
I started with halves - 25mg, and so far things are good. I've already noticed a marked decrease in anger and irritability, and I feel much more 'brighter'. I hear what you're saying about the body recognizing the drug as foe rather than friend. I think he might have been thinking that since I've been on up to 300mg in the past that a fast titration will be okay, but Lamictal doesn't work like that. I think I'll just stick with 25mg for the first week anyway because I don't think it's safe to take it any faster.
Q
Posted by kaleidoscope on April 12, 2008, at 12:08:26
In reply to Re: Starting Lamictal » llurpsienoodle, posted by Quintal on April 12, 2008, at 9:55:57
>I think they do have a titration pack here, but pdocs don't seem to use it.
There is one, yes, but it's not much used (by anyone) - nor is it necessary since it's just as easy to prescribe some 25mg tablets generically. The titration pack is only available as 'Lamictal' so it's a waste of money anyway. Most people are started as per the SPC eg. 25mg/day for two weeks then 50mg/day for two weeks then 100mg/day etc. It might be a good idea to titrate even more gradually in your case.
Posted by Quintal on April 12, 2008, at 12:54:52
In reply to Re: Starting Lamictal » Quintal, posted by kaleidoscope on April 12, 2008, at 12:08:26
The tablets I got this time were brand name Lamictal anyway, so it wouldn't have mattered. At least I'd have got the right dosage! I did get a generic lamotrigine a few times , APA or APS I think, and some Spanish strawberry-flavoured orodispersible ones, but mostly it was GSK Lamitcal.
Q
Posted by kaleidoscope on April 12, 2008, at 13:32:16
In reply to Re: Starting Lamictal » kaleidoscope, posted by Quintal on April 12, 2008, at 12:54:52
Hi Q
APS/TEVA is widely used, so is Alpharma. Good look with Lamictal!
Posted by Quintal on April 12, 2008, at 17:50:13
In reply to Re: Starting Lamictal » Quintal, posted by llurpsieNoOdle on April 12, 2008, at 10:01:29
Ooh!!! I think I might be allergic to the blue colourant in the lorazepam tablets... just took 0.5mg and my hives are itching like crazy. Come to think of it, I'd just taken a lorazepam tablet the morning they appeared. I've taken a Piriton, so I hope this settles down before I go to bed.
Q
Posted by Phillipa on April 12, 2008, at 19:49:39
In reply to Re: Starting Lamictal, posted by Quintal on April 12, 2008, at 17:50:13
Q hope mystery solved. Another brand perhaps? Phillipa
Posted by Quintal on April 12, 2008, at 20:09:32
In reply to Re: Starting Lamictal » Quintal, posted by Phillipa on April 12, 2008, at 19:49:39
Yeah, that would be a good idea, but I don't think I'll be getting any more any time soon. I'm up hoovering my floors in the middle of the night - neighbours clean their coal fire out between 5-6:00AM every morning and make a huge racket that wakes me up, so I don't care if noise of hoovering wakes them up. Serves them right :-) Had two cans of lager in addition to lorazepam and zopiclone and am feeling fine.
Q
Posted by Phillipa on April 12, 2008, at 20:46:32
In reply to Re: Starting Lamictal » Phillipa, posted by Quintal on April 12, 2008, at 20:09:32
Q you've been up all night? Or you're planning to be? Must still be very cold there. Well cold front hitting here tonight. No mania right? Love Phillipa
Posted by llurpsienoodle on April 12, 2008, at 20:57:15
In reply to Re: Starting Lamictal » Phillipa, posted by Quintal on April 12, 2008, at 20:09:32
Q, I have a lot of house to clean. again, I kindly extend the invitation... I'll cook for you. I dunno about lager, but you can have a cocktail while you whistle while you work?
how long you've been up for? since 5 am?
Posted by elanor roosevelt on April 12, 2008, at 21:59:18
In reply to Starting Lamictal, posted by Quintal on April 11, 2008, at 12:02:41
i'm on week 3 of 25mg
and successfully stabilized at a mood called angry
Posted by undopaminergic on April 13, 2008, at 2:14:25
In reply to Starting Lamictal, posted by Quintal on April 11, 2008, at 12:02:41
> I'm really not happy about that, but I'm afraid of being perceived as 'difficult' if I don't take the dose he has prescribed. This is what held me back from saying anything during the appointment.
>If you think it will matter, just tell him what he wants to hear. I agree with everyone else that 50 mg is too much to start with and that 100 mg on day 2 is way too much too soon.
Posted by Quintal on April 13, 2008, at 19:39:31
In reply to Re: Starting Lamictal » Quintal, posted by Phillipa on April 12, 2008, at 20:46:32
No, I was only up until 3, then slept like a baby until this afternoon. Took 11.25mg Zopiclone and 1mg lorazepam though. I don't know what I'm going to do tonight. Lamitcal is giving me a lot of background energy, it's like there's a light on in my head that won't go off.
Q
Posted by Quintal on April 13, 2008, at 19:49:27
In reply to Re: Starting Lamictal » Quintal, posted by llurpsienoodle on April 12, 2008, at 20:57:15
I was actually thinking of hiring one myself. I'd forgotten my mother used to have one, then I took over, or was trained to, and did it for free.
http://www.nakedcleaners.co.uk/
I'm thinking of going for either Dynamite or Skipper.
Q
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