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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by fires on December 16, 2005, at 18:34:32
Has anyone here, other than pregnant women, been advised to take folic acid supplements while taking Lamictal?
If so, what dose have you been advised to take?
(I now take 1200 mcg/day - same as prior to Lam.))
_______________________________________________
Please don't move this to Alternative. This is science based medicine.
Posted by linkadge on December 23, 2005, at 18:16:44
In reply to Lamictal and Folic Acid, posted by fires on December 16, 2005, at 18:34:32
Many anticonvulsants can affect the way folic acid is utilized. Does the prescribing information give any idea ?
I know that folic acid is generally advised for those taking depakote.
From www.rxlist.com under lamotragine, I found..
"Folate concentrations were also reduced in male rats given repeated oral doses of lamotrigine. Reduced concentrations were partially returned to normal when supplemented with folinic acid."
Linkadge
Posted by fires on December 23, 2005, at 19:26:02
In reply to Re: Lamictal and Folic Acid, posted by linkadge on December 23, 2005, at 18:16:44
> Many anticonvulsants can affect the way folic acid is utilized. Does the prescribing information give any idea ?
>
> I know that folic acid is generally advised for those taking depakote.
>
> From www.rxlist.com under lamotragine, I found..
>
> "Folate concentrations were also reduced in male rats given repeated oral doses of lamotrigine. Reduced concentrations were partially returned to normal when supplemented with folinic acid."
>
>
>
> Linkadge
>
>
That's the exact text that I found on some site -maybe rxlist. I remember it because of the use of the term "folinic acid".I take 1200 mcg of folic acid per day + weekly nascobal (B-12) and I still have homocysteine levels at the high end of normal. I'm glad I'm not a rat.
Thanks
Posted by gardenergirl on December 23, 2005, at 23:23:07
In reply to Re: Lamictal and Folic Acid » linkadge, posted by fires on December 23, 2005, at 19:26:02
Hmmm, I take folic acid as part of my prenatal vitamins (not pregnant). I also take Lamictal, although only 75 mg. I wonder if the Lamictal is affecting my folic acid levels? If I were to get pregnant, of course beyond the obvious need to get off my meds, I wouldn't want to risk spina bifida.
And fires, I'm glad you're not a rat, too. :)
gg
Posted by octopusprime on December 24, 2005, at 7:43:03
In reply to Re: Lamictal and Folic Acid » fires, posted by gardenergirl on December 23, 2005, at 23:23:07
gg, i would not worry about it. my pdoc specializes in women's health and reproductive issues. i specifically told her that i was taking prenatal vitamins and was planning on getting pregnant while taking lamictal and she didn't advise any additional folic acid supplements.
she also advised me that lamictal is relatively safe during pregnancy. (it is still category C, though). since i would like to keep my job (heh), i am going to continue to take lamictal through pregnancy. she specifically mentioned spina bifida risk with klonopin, so that drug was discontinued before conception.
Posted by gardenergirl on December 24, 2005, at 8:06:59
In reply to Re: Lamictal and Folic Acid » gardenergirl, posted by octopusprime on December 24, 2005, at 7:43:03
Thanks for the info. I don't know that I've discussed pregnancy since I started Lamictal, although the Nardil will have to go.
I've never taken klonopin, but good to know.
gg
Posted by fires on December 24, 2005, at 11:00:30
In reply to Re: Lamictal and Folic Acid » fires, posted by gardenergirl on December 23, 2005, at 23:23:07
> Hmmm, I take folic acid as part of my prenatal vitamins (not pregnant). I also take Lamictal, although only 75 mg. I wonder if the Lamictal is affecting my folic acid levels? If I were to get pregnant, of course beyond the obvious need to get off my meds, I wouldn't want to risk spina bifida.
>
> And fires, I'm glad you're not a rat, too. :)
>
> ggI'm not a 4 legged rat, but since I've been known to contact law enforcement agencies about some people, I"m proud to be a 2 legged "rat". ;)
Posted by gardenergirl on December 24, 2005, at 11:21:56
In reply to Re: Lamictal and Folic Acid » gardenergirl, posted by fires on December 24, 2005, at 11:00:30
Posted by linkadge on December 24, 2005, at 21:32:52
In reply to Re: Lamictal and Folic Acid » linkadge, posted by fires on December 23, 2005, at 19:26:02
You might be able to lower it further with the addition of b6 and TMG. The four work together to increase methylation.
Someone told me that SAMe could be dramatically increased with these supplements. I was taking celexa and folic acid/b12 when I added the TMG I got serotonin syndrome.
Linkadge
Posted by linkadge on December 24, 2005, at 21:37:49
In reply to Re: Lamictal and Folic Acid » gardenergirl, posted by octopusprime on December 24, 2005, at 7:43:03
I don't mean to sound rude, but I would seriously seek an additional opinion about folic acid supplementation during pregnancy under lamictal.
The clonazepam risk is related to its effects on folic acid isn't it ?
When I was in the hospital, the doctor would not prescribe topomax, tegretol or depakote without folic acid.
Do the vitamins you are currently taking contain folic acid ?
Linkadge
Posted by Larry Hoover on December 27, 2005, at 12:41:09
In reply to Re: Lamictal and Folic Acid » linkadge, posted by fires on December 23, 2005, at 19:26:02
> > Many anticonvulsants can affect the way folic acid is utilized. Does the prescribing information give any idea ?
> >
> > I know that folic acid is generally advised for those taking depakote.
> >
> > From www.rxlist.com under lamotragine, I found..
> >
> > "Folate concentrations were also reduced in male rats given repeated oral doses of lamotrigine. Reduced concentrations were partially returned to normal when supplemented with folinic acid."
> >
> >
> >
> > Linkadge
> >
> >
>
>
> That's the exact text that I found on some site -maybe rxlist. I remember it because of the use of the term "folinic acid".
>
> I take 1200 mcg of folic acid per day + weekly nascobal (B-12) and I still have homocysteine levels at the high end of normal. I'm glad I'm not a rat.
>
> ThanksYou don't mention pyridoxine (B6). Folate/B12/B6 work together. The commonly used pyridoxine hydrochloride may be ineffective in some people, due to poor phosphorylation, so some people find P-5-P (pyridoxal-5-phosphate) more useful. Also, high niacin intake can provoke hyperhomocysteinemia in some individuals. It becomes a matter of balancing hyperlipidemia against hyperhomocysteinemia, if you're also using niacin as a drug.
Lar
Posted by fires on December 27, 2005, at 14:03:55
In reply to Re: Lamictal and Folic Acid » fires, posted by Larry Hoover on December 27, 2005, at 12:41:09
> > > "Folate concentrations were also reduced in male rats given repeated oral doses of lamotrigine. Reduced concentrations were partially returned to normal when supplemented with folinic acid."
> > >
> > >
> > >
> > > Linkadge
> > >
> >
> >
> > That's the exact text that I found on some site -maybe rxlist. I remember it because of the use of the term "folinic acid".
> >
> > I take 1200 mcg of folic acid per day + weekly nascobal (B-12) and I still have homocysteine levels at the high end of normal. I'm glad I'm not a rat.
> >
> > Thanks
>
> You don't mention pyridoxine (B6). Folate/B12/B6 work together. The commonly used pyridoxine hydrochloride may be ineffective in some people, due to poor phosphorylation, so some people find P-5-P (pyridoxal-5-phosphate) more useful. Also, high niacin intake can provoke hyperhomocysteinemia in some individuals. It becomes a matter of balancing hyperlipidemia against hyperhomocysteinemia, if you're also using niacin as a drug.
>
> Lar
>I take some B6. Pretty sure its the hydrochloride type. I split a "super" multiple B tab into 4 pieces do the the outrageously high doses. I'm wondering what dose of B6 is used. I'm aware that too high of a dose can lead to neuro. problems.
I had problems with the Niacin flush at higher doses, so I take only what is in the piece of the multiple B.
Posted by Larry Hoover on December 29, 2005, at 5:55:03
In reply to Re: Lamictal and Folic Acid » Larry Hoover, posted by fires on December 27, 2005, at 14:03:55
> I take some B6. Pretty sure its the hydrochloride type. I split a "super" multiple B tab into 4 pieces do the the outrageously high doses.
It's possible, since you seem to have "done the experiment" with B6, and yet you've not seen the results you were looking for, that this indicates that the artifical B6 supplement is not fully utilized in your body. Or, that the dose was still too low to have a noticeable effect. There's still room for increases in dose. "Outrageously high doses" of B-vitamins are used in medicine for their drug-like effects. You've not given me numbers to work with, so I'm wondering what realm we are speaking of. Alternative to dose increase is a substitution to the pre-metabolized B6, called P-5-P.
> I'm wondering what dose of B6 is used. I'm aware that too high of a dose can lead to neuro. problems.
All right. Mythbusting time. I checked all the medical literature( many times), and especially the references used by the National Academies of Science NIH specialist recommendations on nutritional intakes (the basis for RDA estimates), and B6 neuropathy is so exceedingly rare that it is still largely based on case reports. One example of such a case report was a woman who took 7 to 9 *grams* of B6 every day for years. She eventually developed a peripheral neuropathy. It was entirely possible that the neuropathy only developed because she wasn't taking a balanced B intake. Her neuropathy reversed upon ceasing that ridiculous intake. B6 neuropathy is always reversible.
On such cases are medical myths built.
> I had problems with the Niacin flush at higher doses, so I take only what is in the piece of the multiple B.
Two things. Niacin flush goes away in time. So, if you persisted, it would have remitted. Two, niacin flush is associated with the niacin form called nicotinic acid. The aminated form, called niacinamide or nicotinamide, does not cause the flush (except in rare cases). Moreover, niacinamide directly stimultes the GABA-A receptor complex, and has a calming effect. Niacin, quite to the contrary, has a stimulating effect. The niacin flush is due to histamine release. Niacinamide suppresses histamine release. Therefore, niacinamide also assists in allergy and asthma control.
But, niacin increases homocysteine (if not balanced by adequate folate, B6 and B12). Note that "adequate" depends on actual relative intake. If your source of both nutrients (niacin and B6) comes from a balanced B complex, then you will not recognize a benefit from taking the nutrients this way. You need an imbalance to induce the drug-like effect.
I hope you follow what I'm saying. IN ADDITION TO the B-complex, you add MORE pure B6, B12, and folate, to induce the beneficial effect on homocysteine levels. If you take those Bs balanced by niacin, you cancel the "imbalancing" effect you seek.
And, I'm adding this further statement. The drug-like effect of these nutrients arises at doses many multiples of the RDA. If you wish, I can show you, in great detail, just how much safety factor is inherent in the RDA estimate. In fact, the RDA, by definition, is a dose at which 1 in 40 "normal" (whatever that is) adults exhibits *overt* symptoms of nutrient deficiency. That level is far far below the optimal intake level, which itself is far far below the treatment dose.
Lar
Posted by Nickengland on December 29, 2005, at 8:43:04
In reply to Re: Lamictal and Folic Acid » fires, posted by Larry Hoover on December 29, 2005, at 5:55:03
Hi Larry, (sorry to interrupt)
I've been wondering about the interactions with B6 and anticonvulsants - more so Neurontin, with regards to how much B6 do you think is safe to take along side Neurontin (and other mood stabilisers in general) With the literature, is it best to keep B6 capped at a certain dosage and not any higher to prevent the interaction happening?
Also, whats P-5-P like compared to pyridoxine hydrochloride - would it be possible you could take more of the P-5-P form and so get less of an interaction?
Many thanks if you can answer this. I find great benefits from alot of the B-vitamins and B6 in particular, but also find that at some dosages it can stop the benefits I get from anticonvuvlsants so i'm looking for ways to get the best of both worlds..
Best regards
Nick
Posted by fires on December 29, 2005, at 11:06:28
In reply to Re: Lamictal and Folic Acid » fires, posted by Larry Hoover on December 29, 2005, at 5:55:03
Thanks for all the info.. It will take me quite some time to digest it all.
Here's what's in my whole B-complex with vit. C tab:
(maybe not so high after all):
Vit. C 300mg 5x Daily value
Thiamin 15mg 10x
Riboflavin 10.2mg 6x
Niacin (niacinamide ascorbate) 50mg 2.5x
B-6 (hydrochloride) 5mg 2.5x
Pantothenic acid 10mg 1x
I'm skeptical by nature, so I'm in the middle re: vitamin therapy for any condition. I'm not insinuating that your ideas are on the fringe.
Posted by Larry Hoover on December 29, 2005, at 11:57:49
In reply to Re: Lamictal and Folic Acid » Larry Hoover, posted by fires on December 29, 2005, at 11:06:28
> Thanks for all the info.. It will take me quite some time to digest it all.
Oh, I must have been on drugs when I wrote this following post.....I'm sure not up to putting that together right now. Take a look at the graphs (first two links in it) and just try to assimilate the explanation of what they represent. When I grasped the concept, I was astounded at the implications for health.
http://www.dr-bob.org/babble/social/20050224/msgs/465446.html
Sorry if it's a lot to take in, in one gulp.
> Here's what's in my whole B-complex with vit. C tab:
>
> (maybe not so high after all):
>
> Vit. C 300mg 5x Daily value
>
> Thiamin 15mg 10x
>
> Riboflavin 10.2mg 6x
>
> Niacin (niacinamide ascorbate) 50mg 2.5x
>
> B-6 (hydrochloride) 5mg 2.5x
>
> Pantothenic acid 10mg 1xYou're not going to reduce homocysteine with a quarter of one of those.
> I'm skeptical by nature, so I'm in the middle re: vitamin therapy for any condition. I'm not insinuating that your ideas are on the fringe.Fair enough.
I'm around, if you wanna chat.
Lar
Posted by Larry Hoover on December 30, 2005, at 10:59:13
In reply to Re: Lamictal and Folic Acid - P-5-P and Neurontin » Larry Hoover, posted by Nickengland on December 29, 2005, at 8:43:04
> Hi Larry, (sorry to interrupt)
Sorry to read it and not twig on responding.
> I've been wondering about the interactions with B6 and anticonvulsants - more so Neurontin, with regards to how much B6 do you think is safe to take along side Neurontin (and other mood stabilisers in general) With the literature, is it best to keep B6 capped at a certain dosage and not any higher to prevent the interaction happening?We're all so different, it would be like me throwing statistics at you. Guideline intake is something like 2 mg/day. A normal healthy person needs at least that amount (really 7 times that amount a week, because they calculate RDA based on weekly intake), to avoid overt symptoms of deficiency. It's not clear what these mood stabilizers do, to affect B6. Is it enhanced excretion? Is it enhanced utilization? Is it bound up somehow? Blocked uptake?
So, if you're taking one of those B-complex formulations based on B-25 to B-50 range, you should be fine. The symptoms of B6 deficiency are vague, and poorly defined. They also would be mistaken for symptoms of a mood disorder, or side effects of a drug.
> Also, whats P-5-P like compared to pyridoxine hydrochloride - would it be possible you could take more of the P-5-P form and so get less of an interaction?
Believe it or not, in just checking some references for this reply, I found one source claiming that P-5-P cannot be taken up from the gut. This astounds my brain, so I'm going to have to defer answering this bit while I cogitate.
> Many thanks if you can answer this. I find great benefits from alot of the B-vitamins and B6 in particular, but also find that at some dosages it can stop the benefits I get from anticonvuvlsants so i'm looking for ways to get the best of both worlds..
>
> Best regards
>
>
> NickTell me about this "stopping the benefits" effect from B vitamins, and the dose you were taking.
Lar
Posted by Nickengland on December 30, 2005, at 17:20:19
In reply to Re: Lamictal and Folic Acid - P-5-P and Neurontin » Nickengland, posted by Larry Hoover on December 30, 2005, at 10:59:13
Hello Lar,
>Sorry to read it and not twig on responding.
No worries, my mind hasn't been working so well recently so my messages aren't too clear probably due to my thinking not being too clear lol
>We're all so different, it would be like me throwing statistics at you. Guideline intake is something like 2 mg/day. A normal healthy person needs at least that amount (really 7 times that amount a week, because they calculate RDA based on weekly intake), to avoid overt symptoms of deficiency. It's not clear what these mood stabilizers do, to affect B6. Is it enhanced excretion? Is it enhanced utilization? Is it bound up somehow? Blocked uptake?
I've been taking a muiltivitamin/mineral, just checking that it contains the standard 2mg of B6.
Yeah its really strange this interaction with B6, it seems to be doing several things depending on the dosage. Here I'll provide this link (its one of afew i've come across which all says the same thing) about B6 with the interaction with Gabapentin
"One controlled study revealed that taking anticonvulsant drugs dramatically reduces blood levels of vitamin B6.26 A nutritional deficiency of vitamin B6 can lead to an increase in homocysteine blood levels, which has been associated with atherosclerosis. Vitamin B6 deficiency is also associated with symptoms such as dizziness, fatigue, mental depression, and seizures. On the other hand, supplementation with large amounts of vitamin B6 (80–200 mg per day) has been reported to reduce blood levels of some anticonvulsant drugs, which could theoretically trigger seizures. People taking multiple anticonvulsant drugs should discuss with their doctor whether supplementing with vitamin B6 is advisable."
http://www.numarkpharmacists.com/hn/Drug/Gabapentin.htm
>So, if you're taking one of those B-complex formulations based on B-25 to B-50 range, you should be fine. The symptoms of B6 deficiency are vague, and poorly defined. They also would be mistaken for symptoms of a mood disorder, or side effects of a drug.
I like the sound of a B-25 formulation. Unfortunately the ranges I can buy in the shops over here seem pretty extream, I can either get one around the very, very low range, then theres one slightly higher (you take 2 tablets a day and get 10mg B6 in total) then it jumps straight to the B-50 then B-100. Perhaps I can get a B-25 online.
>Believe it or not, in just checking some references for this reply, I found one source claiming that P-5-P cannot be taken up from the gut. This astounds my brain, so I'm going to have to defer answering this bit while I cogitate.
I had a brief read of P-5-P yesterday and from what I read so far it seems like it may be a better form than the other type of B6 lol but then at the bottom of the page they were selling it, so i'm not sure if it was all salesman talk) Still, i'm thinking of trying it to see if I can get a more positive effect.
>Tell me about this "stopping the benefits" effect from B vitamins, and the dose you were taking.
Okay, basically I take 900mg Neurontin (sometimes 600mg) for anxiety with Bipolar, also I guess it does really act as a weak mood stabiliser too for me. I also was taking 25mg Topamax (as a mood stabiliser) but i've briefly had to stop that.
Along with the muiltivitamin/mineral (2mg B6) I was then taking B-50 and also a 50mg B6 tablet. Straight away I noticed excellent benefits from the B6. Then after about a week or too I felt that the Neueontin wasn't having such an effect. I couldn't quite work it out. Sure enough though, I stopped the B6 and B-50 and the Nuerontin effect came straight back. Ever since, i've been taking a B complex only on and off which contains 10mg B6.
What I really want is too get the mood benefits of B6 back, at the same time keep the effect of the Neurontin. Thinking about it, it was just like the vitamin was causing the drug to poop out.
I guess its going to take some tweaking with the vitamin to get the right results?...possibly timing involved too. Any ideas?
Kind regards (glad you responded :)
Nick
Posted by octopusprime on December 31, 2005, at 10:35:34
In reply to Re: Lamictal and Folic Acid » octopusprime, posted by linkadge on December 24, 2005, at 21:37:49
linkadge, yes i am currently taking vitamins that contain folic acid. i did not ask what caused the clonazepam risk.
the question was about additional folic acid supplementation beyond what would be supplied in a standard prenatal formula. is the standard formula not sufficient?
Posted by linkadge on December 31, 2005, at 17:07:26
In reply to Re: Lamictal and Folic Acid » linkadge, posted by octopusprime on December 31, 2005, at 10:35:34
I can't say for sure because I don't know. Some is better than nothing, I was just a little surprised that your doc came to the conclusion so quickly that additional folic acid was unecessary.
There doesn't seem to be a consencious as to weather lamictal affects folate levels or not.
Linkadge
Posted by octopusprime on January 2, 2006, at 9:14:08
In reply to Re: Lamictal and Folic Acid, posted by linkadge on December 31, 2005, at 17:07:26
it is apparently based on some compelling evidence (short of a scientific study) showing successful pregnancies while patients are taking lamictal. i got the "lamictal is a category c drug but we think it's safe in pregnancy" talk. i have not yet told my pdoc that i am pregnant so we'll see how her tune changes at my next visit.
Posted by linkadge on January 5, 2006, at 18:23:22
In reply to Re: Lamictal and Folic Acid » linkadge, posted by octopusprime on January 2, 2006, at 9:14:08
I see what you are saying. I wonder if it is possable to get a serum folate test to see if you're in a safe range while taking the Lamictal.
Linkadge
Posted by octopusprime on January 13, 2006, at 23:57:35
In reply to Re: Lamictal and Folic Acid, posted by linkadge on January 5, 2006, at 18:23:22
funny how i posted about not worrying about it, i miscarried jan 2.
putting this info up here for anybody else that may come across it.
the pdoc, after hearing of miscarriage, would hear nothing lamictal causing adverse outcomes in pregnancy and did not feel it was necessary to reconsider the regime. she lectures on the topic and feels that lamictal is safe. she did ask me if i had been taking the prenatal vitamins, i said yes, she said well if you take them consistently that ought to do it.
i have heard stats of 20-40% miscarriage risk for first pregnancy, so who knows really.
she gave two resources for follow up:
1. http://www.womensmentalhealth.org/topics/pregnancy.html - from the site: "The manufacturer of Lamictal maintains a pregnancy registry for lamotrigine and has presented preliminary data regarding outcomes of children exposed to lamotrigine in utero. (Physicians may obtain a copy of this report can be obtained from GlaxoSmithKline at 800-336-2176.) The registry identified 599 pregnancy outcomes exposed to lamotrigine. Of the 360 children exposed to lamotrigine alone, 2.8% had a major malformation, which is within the range of 2 to 4% observed in women with no known exposure to a teratogen. " - this is the evidence to support that lamictal alone does not cause neural tube defects and does not require additional supplementation.2. a phone number for the pregnancy registry - 888-233-2334. we can now wonder if the results were skewed - because i was not registered when i was pregnant, they did not count the miscarriage as one of their pregnancy outcomes. also, they don't disclose the drug risks over the phone unless you register in the registry. you can only register if you are currently pregnant.
so i am going to be trying this again, honestly i do not know if i am going to be doing anything different. i read the side of the breakfast cereal - all bran is enriched with folic acid, along with orange juice. that plus the prenatal supplements ought to cut it. i'll talk it over with the ob/gyn - but it's one or two more miscarriages (depending on the accounting) until i ride the high-risk pregnancy train with its associated blood draws.
Posted by pseudoname on January 18, 2006, at 9:33:48
In reply to Re: Lamictal and Folic Acid, posted by octopusprime on January 13, 2006, at 23:57:35
> i miscarried jan 2
I'm very sorry to hear it. My mother had 3 miscarriages before raising a brood; the cause of them was never known. But I know the thought of them still touched her late in her life.
You seem to be coping. Best wishes in the future.
Posted by gardenergirl on January 18, 2006, at 21:38:14
In reply to Re: Lamictal and Folic Acid, posted by octopusprime on January 13, 2006, at 23:57:35
There are no adequate words.
Thinking of you...
gg
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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