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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by papillon2 on February 1, 2012, at 0:37:13
Hello,
I'm looking for some help managing Lamictal (200mg) with the contraceptive pill (in this instance Yaz - Drospirenone/Ethinyl Estradiol). Question 1 could be answered by anyone with Lamictal knowledge though, so gentlemen please don't run away!
Background info: Lamictal and oral contraceptives interact with each other. Lamictal levels are decreased by up to 50% then return to normal on pill free days.
1. Is there a way to get a reliable/interpretable Lamictal blood level? My psychiatrist says there isn't but people with epilepsy get their level taken so it must be possible. Has anyone had it done? What are the guidelines timing wise?
2. Does anyone have experience combining Lamictal with the contraceptive pill? How do you handle the pill free week? Do you run packets together? Or do you lower your Lamictal dose on the pill free days then go back to your usual (higher) dose? Yaz only has 4 pill free days, which should theoretically help.
Thank you.
Posted by ed_uk2010 on February 1, 2012, at 8:19:57
In reply to Lamictal Questions, posted by papillon2 on February 1, 2012, at 0:37:13
>I'm looking for some help managing Lamictal (200mg) with the contraceptive pill (in this instance Yaz).
Ethinylestradiol, the estrogen present in most combined oral contraceptives, is the drug which interacts with lamotrigine (Lamictal).
Have you considered using a contraceptive which doesn't interact? The Mirena intra-uterine device is highly effective and convenient.
Nexplanon/Implanon, a small implant in the upper arm, is also very effective. If side effects occur the implant can be removed.
A slightly less reliable but simple alternative would be norethindrone/norethisterone (Ortho Micronor tablets etc.). These progestogen only pills are not believed to interact with Lamictal. I was going to suggest Cerazette, one of the most popular contraceptives in the world (!), but it seems not to be sold in the US for some reason. I'm guessing you're in the US. Cerazette is the latest progestogen-only pill and is easier to take than the others because it's still effective even if you don't take it at the exact same time each day. Ortho Micronor is effective but it does need to be taken precisely and not at any random time of day. Implanon and Mirena are more reliable. Mirena might be preferable for you because progesterone implants and injections occasionally cause psychiatric adverse reactions. Mirena also reduces heavy menstruation, if this is a problem.
>My psychiatrist says there isn't but people with epilepsy get their level taken so it must be possible.
It is possible. Blood levels are sometimes used to adjust the dose during pregnancy, but the value of measuring blood levels isn't as clear with lamotrigine as with some of the other antiepiletics (especially phenytoin/Dilantin).
Posted by herpills on February 1, 2012, at 9:25:39
In reply to Lamictal Questions, posted by papillon2 on February 1, 2012, at 0:37:13
>
> 1. Is there a way to get a reliable/interpretable Lamictal blood level? My psychiatrist says there isn't but people with epilepsy get their level taken so it must be possible. Has anyone had it done? What are the guidelines timing wise?
>
When I switched to a new pdoc almost two years ago, I had blood work done and she ordered test for Lamictal levels. I have no idea as far as what you can interpret from the results, however pdoc lowered my dose from 300mg to 200mg after getting it checked. How that related to the blood test I don't know it didn't really come up. Also now I only take 150mg seems to be the best dose for me.
Posted by Phillipa on February 1, 2012, at 10:12:39
In reply to Re: Lamictal Questions, posted by herpills on February 1, 2012, at 9:25:39
I had no idea they did lamictal blood levels? What about using a cream or do they not make contraceptive creams. They do have the pellets implanted though? But that would be constant. Wow out of my league. Phillipa
Posted by ed_uk2010 on February 1, 2012, at 12:03:59
In reply to Re: Lamictal Questions, posted by Phillipa on February 1, 2012, at 10:12:39
>I had no idea they did lamictal blood levels?
The main problem with measuring Lamictal blood levels is that the therapeutic range is not well established. It is generally better to adjust the dose according to efficacy and adverse effects. Blood levels may have some role during pregnancy (which affects the blood level) because the dose can be adjusted to maintain approximately the same blood level as before the pregnancy.
Posted by sleepygirl2 on February 1, 2012, at 18:04:19
In reply to Lamictal Questions, posted by papillon2 on February 1, 2012, at 0:37:13
I can't speak to the contraception issue, but I can tell you that I got a lamictal level.
If I recall correctly?? I had my blood drawn about 12 hours from my last dose. I don't know what the reference values are, but pdoc said something about them being on the low side for the dose I was taking.
Posted by Phillipa on February 1, 2012, at 19:57:11
In reply to Re: Lamictal Questions » Phillipa, posted by ed_uk2010 on February 1, 2012, at 12:03:59
Ed definitely not pregnant!!!! PJx
Posted by papillon2 on February 3, 2012, at 6:43:46
In reply to Lamictal Questions, posted by papillon2 on February 1, 2012, at 0:37:13
Thanks everyone, you guys are the best!
It's good to know that you can get a Lamictal level and that the issue is more about the definition of the therapeutic range. My main concern is keeping my Lamictal level constant and at it's previous (higher) level, so I will propose that my blood is tested:
- in last few days of the active pills, which will presumably provide my lowest Lamictal level
- on the last day of the sugar pills which should give me my highest Lamictal level, though I suspect this won't be as high as it would be without any interference from the pill. I might have to stop/start it.Then we'll see how much it is changing, if at all, and adjust my Lamictal dose accordingly. It might take a few months to get right, but I'm happy to be vampired in the meantime.
Re: choice of oral contraceptive. This was prescribed for me by a specialist who said it was most likely to help without worsening my depression/anxiety or interacting with my anti-depressant. The older oral contraceptives, progesterone-only formulations and implants are apparently notorious for this.
As an alternate solution, I first tried supplementing for a few months with Premular (Chasteberry) and high-doses of B vitamins, particularly B6. Premular, paradoxically, seemed to worsen my anxiety. I've kept up the Vitamin B.
This is the end of the thread.
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