![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 69. Go back in thread:
Posted by Quintal on April 13, 2008, at 20:05:38
In reply to Re: Starting Lamictal, posted by elanor roosevelt on April 12, 2008, at 21:59:18
Good luck with it too! I'm feeling less irritable and angry already. I was putting some blinds up today and the screw wouldn't go in. Normally I would have wanted to smash the ***** thing through the window, but Lamictal pacified me to a certain extent.
Q
Posted by Quintal on April 13, 2008, at 20:07:24
In reply to Re: Starting Lamictal, posted by undopaminergic on April 13, 2008, at 2:14:25
Yeah, I may just say I've been taking the dose he prescribed. It's working well at 25mg anyway, so it's not as if I'm delaying the therapeutic effect by taking a lower dose.
Q
Posted by kaleidoscope on April 14, 2008, at 15:25:32
In reply to Re: Starting Lamictal » llurpsienoodle, posted by Quintal on April 13, 2008, at 19:49:27
Dynamite or Skipper lol
I looked at the pics!
Posted by Phillipa on April 14, 2008, at 17:36:19
In reply to Re: Starting Lamictal » Quintal, posted by kaleidoscope on April 14, 2008, at 15:25:32
Humm I didn't look maybe I should look at the pic Love PJXXX
Posted by henryo on April 15, 2008, at 6:35:53
In reply to Starting Lamictal, posted by Quintal on April 11, 2008, at 12:02:41
have a look at my thread on a post above yours on my Lamictal experiences
Posted by Quintal on April 18, 2008, at 13:16:01
In reply to Re: Starting Lamictal, posted by henryo on April 15, 2008, at 6:35:53
I started on 50mg today. So far I feel a little woozy, like being on a small dose of a benzo or something. No rashes. One of the most prominent effects has been that my neuropathic pain has almost vanished. I'm more stable and brighter, even though I quit tianeptine on Sunday (supply ran out). I was trying to describe what it feels like earlier - it's almost as though I'm watching my mood from afar, but without feeling detached or numb in any way. I remembered reading something about lamotrigine binding to the NMDA receptor, perhaps making it similar to ketamine (a dissociative aneaesthetic) in that regard - which I guess would explain the analgesic and dissociative effects. I wonder if that is why you can watch yourself sleeping at 400mg+ henryo?
Q
Posted by Phillipa on April 18, 2008, at 18:58:42
In reply to Increased to 50mg, posted by Quintal on April 18, 2008, at 13:16:01
Q you sound well. Phillipa
Posted by Sigismund on April 18, 2008, at 18:59:50
In reply to Re: Starting Lamictal » Quintal, posted by kaleidoscope on April 14, 2008, at 15:25:32
Sunjai
Posted by Sigismund on April 18, 2008, at 19:02:04
In reply to Increased to 50mg, posted by Quintal on April 18, 2008, at 13:16:01
>my neuropathic pain has almost vanished
You want to speak a little more about your neuropathic pain?
I don't really know what questions to ask.
Posted by Quintal on April 19, 2008, at 7:22:12
In reply to Re: Increased to 50mg » Quintal, posted by Sigismund on April 18, 2008, at 19:02:04
Well I don't know whether it is neuropathic pain for sure because I've never been diagnosed with anything, but then the doctors haven't taken it seriously. It's general nerve pain, as if the nerve endings are sore and inflamed (or perhaps hyper excitable?). Tactile allodynia seems to be a good match - extreme sensitivity to light touch, as if my skin is raw and burnt. I also get a lot of joint pain, perhaps from early onset arthritis like both my parents. Anywyay, it's much improved since starting lamotrigine. Within an hour of taking the first dose my skin started tingling and the raw feeling went away. I can still feel a certain amount of joint pain, but it manifests as more of a cold metallic feeling than actual pain.
Q
Posted by bulldog2 on April 20, 2008, at 16:29:18
In reply to Re: Increased to 50mg » Sigismund, posted by Quintal on April 19, 2008, at 7:22:12
> Well I don't know whether it is neuropathic pain for sure because I've never been diagnosed with anything, but then the doctors haven't taken it seriously. It's general nerve pain, as if the nerve endings are sore and inflamed (or perhaps hyper excitable?). Tactile allodynia seems to be a good match - extreme sensitivity to light touch, as if my skin is raw and burnt. I also get a lot of joint pain, perhaps from early onset arthritis like both my parents. Anywyay, it's much improved since starting lamotrigine. Within an hour of taking the first dose my skin started tingling and the raw feeling went away. I can still feel a certain amount of joint pain, but it manifests as more of a cold metallic feeling than actual pain.
>
> QInteresting I got that same sensation from neurontin..
Posted by bulldog2 on April 20, 2008, at 16:30:17
In reply to Starting Lamictal, 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....
>
> QDid tianeptine hlep with your neuropathic pain?
Posted by Quintal on April 20, 2008, at 16:35:47
In reply to Re: Starting Lamictal, posted by bulldog2 on April 20, 2008, at 16:30:17
Yes, tianeptine eased the pain. Not quite as well as lamotrigine though.
Q
Posted by yxibow on April 23, 2008, at 2:35:33
In reply to Re: Starting Lamictal, posted by undopaminergic on April 13, 2008, at 2:14:25
Anybody can get Seborrheic Dermatitis at any time from reactions to soap or brushing or getting scratched by plants or even anxiety syndromes.
Taking Lamictal at the same time may bring on the thought that it is connected but correlation does not always imply causation.
However if one has had a substantial rash (not a small seb derm) on one's arm on a previous trial, then caution will robinson as for trying it again. A lot of doctors would say no.
But as a lot of posters have said, the titration is way too large -- it is always done slowly to offset Stevens-Johnsons Syndrome. 25 for two weeks and then 50 for two weeks and then maybe faster at 100 and 150 and 200, etc.
-- tidings
Posted by Quintal on April 23, 2008, at 11:01:57
In reply to Rash and restarting Lamictal and dosage, posted by yxibow on April 23, 2008, at 2:35:33
I saw him yesterday and told him I was only taking 50mg as the dose his understudy prescribed was far too much. He seemed okay about it and advised me to either go up to 75mg at the enxt increase, or up to 100mg, whichever I thought best. He's aiming for 150mg as the therapuetic dose.
The downside is that he didn't want to prescribe an antidepressant because we wouldn't know which drug was doing what. Right now I wouldn't be bothered, so long as the combo worked :-(
Q
Posted by yxibow on April 23, 2008, at 15:55:06
In reply to Re: Rash and restarting Lamictal and dosage, posted by Quintal on April 23, 2008, at 11:01:57
> I saw him yesterday and told him I was only taking 50mg as the dose his understudy prescribed was far too much. He seemed okay about it and advised me to either go up to 75mg at the enxt increase, or up to 100mg, whichever I thought best. He's aiming for 150mg as the therapuetic dose.
>
> The downside is that he didn't want to prescribe an antidepressant because we wouldn't know which drug was doing what. Right now I wouldn't be bothered, so long as the combo worked :-(
>
> Q
This is correct -- you don't add two things at once because you'll never know what actually worked. My doctor does the same thing.It's your body and doctor so I can't interfere, but seriously, it is the protocol from what I have heard from another person who is taking far more Lamictal that you ease up by 25s to begin with.
Not to be a scaremonger but you don't want to cook your insides. SJS is one of those intensive-care-at-best scenarios. Yes, I still think about it, but we've now established at 100 for some weeks that I dont react so we've gone up more quickly.
Anyhow, good luck--tidings
Posted by henryo on April 23, 2008, at 16:38:33
In reply to Re: Starting Lamictal » dbc, posted by Quintal on April 11, 2008, at 14:44:09
1 in ten? I don't think so.
Posted by Quintal on April 23, 2008, at 18:25:24
In reply to Re: Starting Lamictal, posted by henryo on April 23, 2008, at 16:38:33
What do you think then?
Q
Posted by Phillipa on April 23, 2008, at 22:02:33
In reply to Re: Starting Lamictal, posted by Quintal on April 23, 2008, at 18:25:24
Q I agree with xiybow. Knows his stuff. Love Phillipa
Posted by henryo on April 24, 2008, at 4:28:43
In reply to Re: Starting Lamictal » Quintal, posted by Phillipa on April 23, 2008, at 22:02:33
List some sources / links, It is nowhere near one in ten.
Posted by undopaminergic on April 24, 2008, at 5:57:00
In reply to Re: Rash and restarting Lamictal and dosage » Quintal, posted by yxibow on April 23, 2008, at 15:55:06
> >
> > The downside is that he didn't want to prescribe an antidepressant because we wouldn't know which drug was doing what. Right now I wouldn't be bothered, so long as the combo worked :-(
> >
> > Q
>
> This is correct -- you don't add two things at once because you'll never know what actually worked. My doctor does the same thing.
>It may be a good idea to use a faster acting drug along with a slow one (eg. SSRI + stimulant). You can always find out which ones are important by removing them one at a time later. This may not be a bad idea anyway as people too often end up taking cocktails where no-one knows what's essential or superfluous. On the other hand, some may not care about such details and prefer to leave a working combination alone.
Posted by Quintal on April 24, 2008, at 8:48:24
In reply to Re: Starting Lamictal, posted by henryo on April 24, 2008, at 4:28:43
I think I got the 1 in 10 figure from here:
____________________________________________________
Dermatological Events (see BOX WARNING, WARNINGS)
Serious rashes associated with hospitalization and discontinuation of LAMICTAL have been reported. Rare deaths have been reported, but their numbers are too few to permit a precise estimate of the rate. There are suggestions, yet to be proven, that the risk of rash may also be increased by (1) coadministration of LAMICTAL with valproate, (2) exceeding the recommended initial dose of LAMICTAL, or (3) exceeding the recommended dose escalation for LAMICTAL. However, cases have been reported in the absence of these factors.
In epilepsy clinical trials, approximately 10% of all patients exposed to LAMICTAL developed a rash. In the Bipolar Disorder clinical trials, 14% of patients exposed to LAMICTAL developed a rash. Rashes associated with LAMICTAL do not appear to have unique identifying features. Typically, rash occurs in the first 2 to 8 weeks following treatment initiation. However, isolated cases have been reported after prolonged treatment (e.g., 6 months). Accordingly, duration of therapy cannot be relied upon as a means to predict the potential risk heralded by the first appearance of a rash.
Although most rashes resolved even with continuation of treatment with LAMICTAL, it is not possible to predict reliably which rashes will prove to be serious or life threatening.
http://www.rxlist.com/cgi/generic/lamotrigine_wcp.htm
__________________________________________________So according to this source, in bipolar trials 14% of patients developed a rash - slightly more than 1 in 10.
Q
Posted by Quintal on April 24, 2008, at 9:00:05
In reply to Re: Rash and restarting Lamictal and dosage, posted by undopaminergic on April 24, 2008, at 5:57:00
I'm not really bothered right now about knowing precisely what drug is doing what. If I were in a clinical trial that would be the priority, but sometimes a patient's suffering should take precedence over the meticulous gathering of scientific evidence. I don't want to watch months of my life disappearing down the plughole just so my pdoc knows for sure what is doing what, although I do agree this is the scientifically correct method of gathering information. I'm taking so much stuff he doesn't know about that whatever evidence he thinks he's gathering is invalid anyway.
I really needed an antidepressant this week because I ran out of tianeptine, but now I'll have to wait at least six weeks to get a second chance, and even then... It was a blow to say the least.
Q
Posted by henryo on April 24, 2008, at 18:36:28
In reply to Re: Starting Lamictal » henryo, posted by Quintal on April 24, 2008, at 8:48:24
Read your own link- it says .03 percent, 11 people out 3,480
NOT 1 in 10
Posted by Quintal on April 24, 2008, at 19:14:36
In reply to Re: Starting Lamictal, posted by henryo on April 24, 2008, at 18:36:28
I don't know why you're continuing with this, but yes, I did read my own link and it does say that 10% of patients in the epilepsy trials developed a rash. 10% is 1 in 10. It also says that 14% of bipolar patients developed a rash, making that slightly higher than 1 in 10.
The figure you quoted at the beginning of the article however, only relates to the incidence of *serious rash* associated with hospitalization and discontinuation from Lamictal. This is *not* the overall incidence of benign rash among Lamictal patients - only the most serious ones. The overall incidence of rash is much higher, and these stats are posted further down under 'Dermatological Events'. I'll post them again:
__________________________________________________In epilepsy clinical trials, approximately 10% of all patients exposed to LAMICTAL developed a rash. In the Bipolar Disorder clinical trials, 14% of patients exposed to LAMICTAL developed a rash.
__________________________________________________
Q
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.