Doc prescribed too much Lamictal?

My bipolar has been out of control lately. I generally have the absolute mildest form with no problems at all. I recently had many, many triggers and I experienced the worst time of of my life.

I called my psyc and she told me me double my lamictal. Since I was on 300 mg/day, that bumped me up to 600 mg.

I couldn't walk without staggering, sometimes the room moved up and down so much I couldn't get out of bed, or even crawl to the bathroom. The floor kept moving like it was undulating.

I called the psych today and she told me to stop taking the double dose but she's mystified why I had that reaction. Have any of you had problems with too much lamictal or any of the reactions I had?

Thanks.

Jan

i just started on it.....so i'm not in a position to help you........i'm sorry that you had such a pronounced reaction to the dosage. keep me posted. pat

I'm not a doc, but that sounds like a large increase at once, my max was 300mg, then we gradually dosed down to 150mg. When I was still at 300mg and family matters were becoming small triggers, we tried getting up to 325mg., well just that 25mg increase seemed to make me feel agitated, so sticking at 300mg back then was best for me, but everyone is different. I hope you are alright since I read and replied this.

Sincerely,
DE

Pat,

Thank you so very much for replying. Don't be afraid to take your lamictal because of my experience. It had helped me so much until this gigantic increase.

Jan

Hi DE,

I drank four pepsi's yesterday and finally began to feel like a human being. I stayed up as late as I could make it and took all my meds including 150 mg of lamictal.

I seem to be ok this morning, although just a bit "buzzy". I don't know how else to explain it.

Many of the triggers are still there and there isn't anything I can do about it at the moment. I am so hoping it will settle down soon.

I have to call my psych back on Thurs. Maybe she'll have another suggestion.

Thank you so very much for answering my post.

Jan

Hi Jan

First of all I'm on lamictal and I know that I was increased very slowly and it's my understanding that was an important process so it seems to me that was a significant jump. Second my doctor just increased mine and I was concerned about it and I had asked her how high can you go? She had said to me that 400 is the maximum, but for the "typical" you would only see real results at 200. Very rarely do you see any improvement after that. Thats not to say for some individual cases that after 200 patients are not being helped for some cases there are, but that is to be determined by the close supervision of the doctor.

Anyways, I noticed at the difference in how much your dosage is. So I went to the lamictal web site.

http://us.gsk.com/products/assets/us_lamictal.pdf

This is the official info about the drug. I was reading it and I came across this part, which specifically explains dosage when it comes to Bipolar Disorder.

It's on page 12

Bipolar Disorder: There were 2 studies done. In both studies patients were titrated to a target dose of 200mg of lamictal, as add-on therapy or as monotherapy, with gradual withdrawal of any pyschotropic medications during an 8- to 16- week open-label period. Overall 81% of 1,305 patients participating in the open-label period were receiving 1 or more other psychotropic medications. (didn't list them). Patients with a CGI-severity score of 3 or less maintained for at least 4 continues weeks, including at least the final week on monotherapy with lamictal, were randomized to a placebo-controlled, double-blind treatment period for up to 18months.

The primary endpoint was TIME. The modd episode could be depression, mania, hypomania, or a mixed episode.

It goes on more to explain between the two dosages that being 200mg and 400mg. And explaining that there isn't any real signifcant benefit for the higher dose. The reason that I'm pointing this out is because well my doctor had pointed this out prior to me reading it. As I read further I can find anywhere anyone on the amounts you are on. So I'm concerned. Also, it does talk about lamictal being combined with other drugs and some problems and side effects you could have. I don't know what you are on or what you are feeling. Maybe you could read this and it could be of some help to you. Hopefully.

Sorry if this was long winded.

I have had some pretty bad experiences with being aggressively treated with drugs and I can't tell you what damaging effects that had on me.

Hope you are well (((January)))

Take care
Eva

Btw if that url doesn't work go here and at the very bottom click complete prescribing information for lamictal
http://www.lamictal.com/

The post above is correct. The established dose of Lamictal for the treatment of Bipolar is 200mg a day. If you happen to be taking Depakote too then the dose is much lower at 100mg. The other use of Lamictal is for seizures and in that case the max dose is around 400mg to 500mg a day. All the symptoms you mentioned are clearly documented as side effects.

In all cases Lamictal must be increased *very slowly* because of the small risk of developing a potentially lethal rash. Typically it takes 2-3 months when first starting Lamictal to get to the effective dose of 200mg. An immediate increase of 300mg per day not only is unlikely to be of benefit but could put you at increased risk of Stevens-Johnson syndrome which is a very serious drug reaction. If you get a rash you should stop the medicine and report it to your doctor (or in your case a suitably informed health care practitioner).

Your psychiatrist seems, *ahem*, uninformed of these dangers. This medicine is manufactured by GlaxoSmithKline and any of their drug reps are more than willing to be of "assistance" to her with the correct use of Lamictal. In fact usually doctors have to fend them off from breaking down their door. These reps make certain that prescribing docs know all about the rash. I also know that all the sample packs of Lamictal in my office have this gradual titration schedule plastered all over the package. Every article written about its use has warnings practically every other sentence on sticking to gradual increases. I don't want to scare you about Lamictal since it is an excellent drug and probably the first true "mood stabilizer" in that it treats mania AND depression and is generally well tolerated. I just think that it needs to be prescribed appropriately.

Sounds like you got some good advise there Jan. Some very good advise. Keep us posted on what your doc says.

Ry

Eva,

Thank you so very much for responding to my post. I read the part you suggested and much, much more. I am most certainly going to talk about all this with my psychiatrist.

Again, thank you so very much.

Jan

T,

Thank you so much for responding and for sharing all the information. I am beginning to think I'm the sane one and my psych is crazy.

She has me on 4 mg of Xanax for Panic Disorder. When I told my counselor she was absolutely horrified.

I don't know what to do. There are not many psychs here and she's supposed to be the best. I'm going to call my counselor, who is absolutely awesome and talk to her.

Thank you so much.

Jan

yvw January...I'd really like to know how you do with this issue. If you can pm me anytime and let me know when you can

Ty Good luck

I called my psychiatrist today. She won't return my call until tonight or tomorrow. I am so very tired and my head hurts all the time now. My regular dosage of meds now make me so sleepy that I can barely sit up. I don't know if it's a left over from the gigantic lamictal increase or what...

I'll keep you posted. Thank you so very, very much for caring. It makes me feel so comforted.

Jan

Dear Jan,

I am suppose to be on a much larger dose than i am of lamictal, but I get very sick in my stomach when I do.

Take care,
Leslie