Starting Lamictal...at 100mg/day!?

[shutterbug]

What??!!

Peda...have you heard of this? Last time i was put on Lamictal it had to be started out low, like 25mg, and slowly bumped up, but my new doc wrote the Rx for 100mg.

Both the pharmasist and myself are stumped!?

Thoughts?

[St_Kurt]

Lamictal (lamotrigine) is also used as an anti-seizure drug; I know how to dose it for that, but not as a mood stabilizer since it's not used that way in veterinary medicine. In fact, it's so expensive that it's not used in veterinary medicine at all other than experimentally. Therefore, dosing is extrapolated from human medicine. I should shut up now, but I'll tell you my theory and in doing so, am trusting you to check with your doctor to find out THEIR theory since it's WAY way way way WAY way WAY WAY way more important than mine.

Lamictal has one very bad side effect present in the human population: It can cause severe bleeding problems in a very low percentage of adults. The first sign of these is a rash. Patients new to Lamictal are given slow incremental dose increases to insure that they are tolerating the drug and not going to bleed to death on it. (The first time you took it, your doctor probably warned you about the rash, yes?)

My theory is that since you already had a successful Lamictal trial, your doctor is confident that you will not develop a rash.

The reason I stayed up and wrote all this is two fold a) If I just came out and said the last sentence it would sound like medical advice and I wanted to be clear it was my rambling 3am theory, nothing more and b) If you are at all concerned, the side effects are serious enough that it would be totally reasonable to call your doctor ASAP before starting the drug. It might be that that's just the way this doctor prescribes this drug, but if you're concerned - it's your right as a patient to have the answer.

Hopefully these suggestions are not out of line. Anyway, goodnight.

~SK~

[reader]

I started out at 100mg than to 150 and now at 200 with no side effects. It is a great med....

[pedagogue]

Originally Posted by shutterbug

What??!!

Peda...have you heard of this? Last time i was put on Lamictal it had to be started out low, like 25mg, and slowly bumped up, but my new doc wrote the Rx for 100mg.

Both the pharmasist and myself are stumped!?

Thoughts?

I can't provide an opinion on your particular situation as I'm not your doctor and I am not familiar with your particular case, etc. Your prescriber may have specific reasons for starting you at 100mg, which may include previous history of tolerance at that level or maybe a metabolic consideration*, so it may be worth piece of mind to drop them a line and ask.

According to the manufacturer, the typical starting dose is lower than 100mg, and generally is titrated up over a number of weeks....though there are many things that can change this, so it may be helpful to hear the rationale in your particular case.

*Some medications inhibit/induce certain things that can influence the effective dose of other medications. So 100mg of one thing (in the presence of another medication) may have a different effect than if it was the only thing taken.

It is always important to pay attention to side effects and any changes you may have when starting a medication. It may be helpful to keep a log of how you are feeling, so if/when you speak to your doc, you can give them specific feedback. As noted above, rashes and skin irritation is one thing that you should keep an eye out for, and should be reported right away, as this may be suggestive of a reaction you won't want to have continue.

[nandm]

In retrospect I think I was started out low then tapered up. But today I take 100 mg and it works quite well. Lamictal can have a dangerous side effect. If you notice any thing that looks like a rash. See you doctor immediately. There is a rash associated with Lamictal that can be quite serious even life threatening. Even when one has been on the medication for a while this can still occur. I have been on Lamictal for over a year and a half and my psyc doc asked me every time I go in about rashes. Hope is works as well for you as it does for me. By the way 100 mg is the highest recommended dosing for this medication.

[St_Kurt]

Originally Posted by nandm

By the way 100 mg is the highest recommended dosing for this medication.

That's not necessarily true.

Pharmacology is very different from cooking so drug dosages are not recipes, but based on individuals and their therapeutic needs.

Imagine if, in order to bake brownies, the ingredient list and amounts were tailored to the baker, their specific oven, their kitchen, the geographic location of their kitchen, etc. It would be really hard to trade recipes. What might be a tasty brownie recipe baked by you in your kitchen could be mud pies when baked by me in mine but there's no way to know unless you've studied the science of kitchen geography chemistry and even then it might still be off. That's pharmacology.

(I'm not coming down on you personally, just saying in general.)

~SK~

[pedagogue]

The highest dose varies by person and treatment dx. 100-200mg is the general therapeutic dosing for BPD, but some go higher...obviously carefully because of the greater likelihood of side effects. Seizure disorders actually go much higher, but that is because of other meds that make the effective dose less....(usually). Pharmacology likes to be a PITA though, because other anti-epileptic can actually double the effective dose, so the dosing goes the other way.

[nandm]

Originally Posted by St_Kurt

That's not necessarily true.

Pharmacology is very different from cooking so drug dosages are not recipes, but based on individuals and their therapeutic needs.

Imagine if, in order to bake brownies, the ingredient list and amounts were tailored to the baker, their specific oven, their kitchen, the geographic location of their kitchen, etc. It would be really hard to trade recipes. What might be a tasty brownie recipe baked by you in your kitchen could be mud pies when baked by me in mine but there's no way to know unless you've studied the science of kitchen geography chemistry and even then it might still be off. That's pharmacology.

(I'm not coming down on you personally, just saying in general.)

~SK~

So my wording was not correct. As I am a nurse and have been for 20 years and a paramedic for 12 years I do understand medications and dosing as well as therapuetic levels so I do not need someone to explain pharmacology to me, thank you anyway. I have had a couple of really stressful days and I went by memory on that one and should have put a disclaimer in that I went on memory rather than a drug guide.

Just for the record a drug guide does state that for Bipolar it can go as high as 400mg a day in divided doses.

I appologize if I come across rather short but I really do not have the patience or tolerance to be talked down to right now. So what if I made a mistake in my wording. I did not need you to talk down to me.

[St_Kurt]

Sorry.

I wasn't talking down to anyone or addressing anyone in particular - as I explained in my post. Perhaps I should have only quoted only the numbers themselves without anyone's name attached since I was addressing an idea, not a person. I try to make these things clear; I just never know where people's sensitivities lie.

I was really proud of my analogy to be honest. Remember, I'm just a student so I spend the majority of my days studying this stuff and trying to figure it out.

I hope your mood improves.

~SK

[Dr. Snow]

I started out low, at 25 mg. It's probably because I had never been on it before and my doc was concerned about the rash. So, I like St. Kurt's explanation for why you skipped the small stuff, Shutterbug. I'm currently on 400 mg, but it's the only thing I'm taking. I guess this is called monotherapy or something. Anyway, I've done a lot of reading and I haven't come across many people who are taking more than 400. That seems to be the upper limit. Of course, there are always exceptions.

[nandm]

Kurt, I am sorry for my rant. My emotions are all over the board right now. The PTSD has gotten out of control the past two days. Even with meds and self care it is still creating insanity in me and extreme anxiety. I went a little overboard with my response and it definately was not called for nor was it a normal response for me. I rarely take posts personally. I do appologize as it truly had nothing to do with you. Thank you for your kind response though I do appreciate it. I hope to be back to myself soon as this is quite intolerable. Take care and once again please accept my appology and assurance I will do everything within my power not to have that happen again as it is not the type of person I would like to be.

[ksos]

Why do some people on SR insist on dispensing medical advice, despite forum guidelines which specifically prohibit this practice?

(Please reference http://www.soberrecovery.com/forums/...ting-tips.html (Policies, Rules & Posting Tips))

By their own admission, one of these individuals is not even a qualified medical staff person! This member admits to being "just a student", yet equates the science of psychopharmocology to an "anology of baking brownies"! How can this be permitted on a forum where human lives are being discussed? What would happen if, per chance, a new member actually took any advice of "a student" and their loved one died?

And then this prohibited pharmaceutical advice is given to us free of charge by another member, whose "medical qualifications" are unknown to this writer:

"The highest dose varies by person and treatment dx. 100-200mg is the general therapeutic dosing for BPD, but some go higher...obviously carefully because of the greater likelihood of side effects. Seizure disorders actually go much higher, but that is because of other meds that make the effective dose less....(usually). Pharmacology likes to be a PITA though, because other anti-epileptic can actually double the effective dose, so the dosing goes the other way."

So, what are you? A psychology student? A pharmacy student? Or are you simply a bored person who has somehow convinced cetain members that you are authorized to give medical opinions to human beings who you have never examined in person?

Okay. Allow me to dispense my non-medical, yet common sense approach to this specific issue which seemingly is being continually allowed to be posted without removal by the powers that be.

My ADVICE is to read the front page of the forum section and re-acquaint yourselves with the statement posted under "Substance Abuse" which explicitely states:

(DO NOT give or ask for, Medical advice.)

Yet, I understand that some folks may not understand this instruction, so I will direct those savants to the following, which is clearly stated in "Guidelines for Posting", specifically that annoying little part where it says that:

Please do not give medical advice, medication advice, or psychiatric advice.

Those who persist in practicing medicine and/or psychopharmocology on this forum, are just as dangerous as the real doctors who over-prescribed the killer medications to your loved ones. Just remember that the next time you ask some unknown person on any message board, including this one, as to what "advice" they have in terms of a medical intervention.

You might as well ask your ouiji board.

[pedagogue]

ksos,

It sounds like you have a pretty strong reaction to people sharing their experiences on here, and everyone entitled to their opinions. I decided to respond as you quoted me in your reply. I understand your concern about providing medical advice to individual people on here, and how this should only be done by their personal providers. I am in agreement that people need to seek out their providers for their medical issues, and should not rely on any other avenues as their sole source of information for making a decision about their individual situation.

I don't think people should say, "Everyone should take XYZ medication because it works great and doesn't have side effects", though people are often looking to normalize their experience and find support in others who may be having a similar experience.

Obviously each person's experience is different, so the advice should not be taken as fact. It would seem obvious to anyone reading that they should not take anything on here as a direct response to their particular situation, and they should always consult their personal provider before making any changes to their situation. In the event that is not made clear, statements like:

Originally Posted by pedagogue

I can't provide an opinion on your particular situation as I'm not your doctor and I am not familiar with your particular case, etc.

...can make it clear that under no circumstance is the information meant to be a consultation for any individual, and that any information is YMMV.

The use of medication is a complex area and often is confusing, so people are sometimes looking for very general information....as providers often don't have time to sit down with each patient and walk them through each medication, side effects, and other information that may be helpful for them to know. Anything that I post on here is my experience with the topic at hand, and shouldn't be viewed as medical advice. I believe I make it very clear that it is solely my personal opinion and not a professional consultation. In the event this isn't explicitly clear, I make sure to remind anyone reading the post that they need to consult with their medical professional for the information, as no one can speak to an individual case without an in-person evaluation. Any specific medication dosing is only in reference to what is listed on the manufacturer's release notes, as this is what is provided to each individual when they receive their medication. Ultimately it is up to each person to consult with their provider on any concerns with their individual case, though some find it helpful to learn a bit more about some of the topics on here, so when they do go and speak to their personal provider, that they can know a bit more about what they should ask and be aware of.

[shutterbug]

Ksos...please read Peda's response. It was made clear that the first person was a student and that Peda was not my doc, nor a substitution for one.

I posted this thread and question because i wanted opinions. I hadn't myself thought of the fact that i HAD previously been on this medication and had done well on it and the reason it is so slowly administered is because of the rare possibilty of the rash.

REGARDLESS, I called my psychiatrist before taking a single pill. He told me to take half a dose until i see him again in 2 weeks.

The HUGE point i want to make is that psychiatrists are not gods....they are human and make mistakes just like the rest of us.

And just as I don't take advice here as if it were written in stone, for what i believe are obvious reasons, I also DO NOT take ANY doctors (general, psychiatric, or otherwise) as absolute truth and 100 % correct.

I question everything when it comes to my mental health....because this is my life and i want to be as informed as possible. I can't afford (nor could very many on the planet) to have a daily appointment with my psychiatrist and therapist for them to answer every question i have. So that means i have to ask others, read what others have written about their personal experiences, packet information that come with the meds, read clinical trial outcomes and other research.

I've been doing my best to see a psychiatrist once a month for the past 4 years....and my therapist once a week for the past 4 years. I have yet to find a psychiatrist who seems to know more about me and my illness than I do....nor have i yet found one who seems to truely care about anything other than getting me out of their office and onto their next patient.

This particular pdoc has been the best one so far in the 4 years of my searches....and yet on Thursday he:
1. doubled the dose of my Effexor to 300mg/day - without a word to me about it
2. nearly had me on twice the amount of Lamictal that he said he wanted me on when i later called to question
3. Said if money was an issue (if my insurance hadn't kicked in yet) that i was to first fill the Effexor (an anti-d with a narley side-affect if not weaned off of) ....then the Visteril (to help me get myself in bed a little earlier some nights)....and only THEN the mood stabailzer!!!!!! I said questioned that and he said he thought the sleep meds more important. I said, "My moods are all over the map because of not being on a regular mood stabalizer. Wouldn't a mood stabalizer be the most important thing for a bipolar to be taking???!!!" No answer from what i remember. My moods have not been this out of wack in all my life - that i'm aware of. And my changing moods is what affects my sleeping habits the most!!

Moral of the story is....NEVER put your life or future health and happiness in someone elses hands - regardless of if they have a Phd or call themselves a doctor (or even if they say they love you).

Jenna

[historyteach]

Ksos;
I think Ped and Shutterbug both made it clear that there was neither medical *advise* asked for nor given. And re-reading StKurt's reply, I don't think he did either. He noted he was a student, not a doctor, and a vet student at that.

We share our ESH here. Esperience. That's what's being shared. That's the norm here at SR and what I sincerely hope will be continued.

Remember, take what you need and leave the rest.

Shalom!

[shutterbug]

Peda....what's PITA stand for?

Teach....what's ESH stand for?

[historyteach]

ESH = Experience, Strength and Hope.

PITA = Pain in the A..... you can fill in the rest yourself.

Shalom!

[ksos]

To All on This Forum:

I am sorry if my posted response offended anyone on this forum, for I consider everyone a cherished and valued human being. Furthermore, if I hurt anyone's feelings, then I am extremely sorry, for I would never consciously want to harm a fellow addict or a person with a psychiatric challenge.

If the norm on this forum is to discuss what HistoryTeach deems "ESH = Experience, Strength and Hope," than I probably ought to have read the rules more clearly in terms of what is appropriate to post and and what is not.

However, my own perception of what I have read here, remains, in my own mind, "medical and psychopharmocologic discussion". Further, in my opinion, no one on any message board, should respond to another individual in the manner that I have witnwessed.

For that sole reason, I will no longer participate on any thread here that makes me feel uncomfortable.

To shutterbug: Your last post was touching and definitely reminded me of my own experiences with psychiatry. I agree 100% with being an advocate and not just waiting around for the next pill or shot. I wish you the best in dealings with your particular issue and I will pray for you.

As HistoryTeach said, and this is so true, one should just take what they need and leave the rest behind. If this is, in fact the norm here at SR, than I feel the need to move on to another form of support.

I thank all of you for everything you have given me.

[historyteach]

Well, ksos, I'm sorry if you feel that way.
However, it was indeed made clear that ped was *not* shutterbugs doctor, and does not have her background so could not comment on her case.
That is NOT giving her medical advise.

But, he *was* sharing his experience. ESH. It's what we do all over SR.
And I would never want it to stop.

Nor would I want you to do anything you are personally uncomfortable with. We care about you too. And you will always be welcome if you should change your mind.

Believe me, in the past, there were others who *did* try to dispense medical advise, as if they were doctors. We stopped it quickly. It's far, far too dangerous.

But, we recognize the difference between sharing experience and telling someone else what to take, not take or how to detox, for example. Those types of behaviors are dangerous to an individual, and can never be acceptable.

I hope you can see the difference. In either case, I wish you well.

Shalom!

[ksos]

HistoryTeach,

You didn't make me feel bad about anything. I am 100% responsible for my reactivity and I deeply apologize for my comments which obviously disrupted this thread. A person obviously has choices to listen and absorb others' experiences, and I would have been better off just keeping my typed mouth shut : )

I maintain my stance that while the "norm" on Sober Recovery and on this particular Mental Health thread always was and probably is to share "Experience, Strength and Hope", the particular posts that I did and do find somewhat disturbing on this thread, were, in my particular opinion, no way, shape or form related to "ESH", particularly as you defined it. However, my opinions are my own, and I will forever hold my peace.

I am extremely sorry that I even voiced my opinion on this, but I am not alone in my stance, which is, in part, one variable as to why I felt compelled to do what I did. The other variable considers that when I first arrived on SR 5 years ago, I probably exclusively participated in the mental health section of the forum, as I was struggling with my own Bi-Polar Disorder and Agoraphobia, as well as the effects of my medications which, like one member here expressed, never seemed to get her psychiatrist's "valued time".

With that said, I would hope that we all can agree to disagree with what seems to be of extreme value to the members here. The last thing needed on this thread is desension and fruitless arguments, and I will cease to start any of this ever again.

Finally, I harbor no ill will whatsover toward Pedagogue or St Kurt or anyone else here on SR. Everyone who is here is obviously here for a wonderful reason, and that is the only issue which really matters, isn't it? The myriad of experiences that have always been so integral to SR cannot ever be dismissed, even if one person has an emotional reaction to it. So, I hope that I may be forgiven for acting on my impulsivity, which I can tell you is a byproduct of both my own mental challenges as well as my own substance abuse.

Thank you in advance for not ostrasizing me and keeping the door open...

[historyteach]

Ksos;

No apologies needed.
And I'm glad we all can agree on the wonderful benefits of SR!

I look forward to hearing your story. It seems we both started about the same time. I spent most of my early days on the naranon forum back then, though.

Shalom!

[ksos]

Originally Posted by historyteach

Ksos;

No apologies needed.
And I'm glad we all can agree on the wonderful benefits of SR!

I look forward to hearing your story. It seems we both started about the same time. I spent most of my early days on the naranon forum back then, though.

Shalom!

Yes, we did start within a month of each other and I actually had 3 months or so of recovery! June 2nd of 2003.

My story is still on the "Newcomers" section, I believe. I would love to re--read it since I returned for a completely different reason, which was substance abuse.

We must have been two ships that kept passing through the SR night!

Bless You!!!