Split dose

[Guest ClaudiaP]

I've been stable on 150 mg Lamictal for over a year. In anticipation of the potentially destabilizing effects of major surgery, we decided to increase the dose. However, I had difficulty tolerating the increase, so 160 was as far as I got. Post surgery, there have been issues... for example, flexoril was prescribed as a muscle relaxant, but it turns out this is a tricyclic antidepressant, and it triggered some nasty mixed states. On top of that, exercise has been severely reduced (though I am still exercising regularly, just not as hard nor for as long), as has time outside in the sun (my house gets no sun in winter, so it's always been the case that I need to exercise hard outdoors). And for a while yet I'll be dealing with constant pain, though eventually this will go away. Plus, I think major surgery is always depressing. You can't help but feel violated and it takes ages to get the anesthesia out of your system.

We've added Ativan as needed to knock out the swings toward dysphoric hypomania, but I'm not thrilled with this. It depresses my mood and leaves me with incredibly intense sugar cravings. Anyway, rather than try another Lamictal increase or start cocktailing, I'm wondering if splitting the dose might help me achieve more stability throughout the day. I currently take the entire dose at night.

If it seems likely that split dosing might help, how do you get there? Gradually? Or just by taking half one night and the other half in the morning?

Any thoughts/experiences? I know I've been lucky and a bit spoiled by the near-immediate success I had with Lamictal monotherapy at a relatively low dose. Some of that, I'm sure, has been due to the years I spent trying to stabilize without meds and the longstanding relationships I've had with therapists and holistic doctors, and all the stuff I've been able to do with diet, exercise, yoga, acupuncture, etc. These modalities were not a solution, but they have helped me a lot. Now, with my ability to practice yoga or exercise severely restricted, and with some financial crunches that make therapy and alternative modalities like acupuncture harder to pay for, I'm a-hurting.

Thanks for your help.

[nalgas]

I am all in favor of splitting doses of things like Lamictal into more than one per day. The half-life is under 24 hours, so by taking it every 12 hours instead of every 24, you have a noticeably more consistent level of it in your system. Some people don't really notice much of a problem taking it (or other things with similar half-lives) once a day, but in my own experience, I feel significantly better if I don't space doses of a med out further apart than the half-life is, which has meant Lamictal and Topamax were twice a day, and Keppra is now four times a day (which is mildly annoying, but it's an enormous improvement in how I feel compared to when I was taking it twice a day when I started it). I don't know off the top of my head if there's a particular recommended way to change how often you're taking it like that, but when I've switched how often I take meds, I've just done it all at once. It seems to generally have been more benign for me switching from once to twice, twice to thrice, or three to four times a day than the usual dose increases/decreases have been. I've mostly adjusted to splitting things up more quickly and easily than I have to raising or lowering them.

[Guest ClaudiaP]

I am all in favor of splitting doses of things like Lamictal into more than one per day. The half-life is under 24 hours, so by taking it every 12 hours instead of every 24, you have a noticeably more consistent level of it in your system. Some people don't really notice much of a problem taking it (or other things with similar half-lives) once a day, but in my own experience, I feel significantly better if I don't space doses of a med out further apart than the half-life is, which has meant Lamictal and Topamax were twice a day, and Keppra is now four times a day (which is mildly annoying, but it's an enormous improvement in how I feel compared to when I was taking it twice a day when I started it). I don't know off the top of my head if there's a particular recommended way to change how often you're taking it like that, but when I've switched how often I take meds, I've just done it all at once. It seems to generally have been more benign for me switching from once to twice, twice to thrice, or three to four times a day than the usual dose increases/decreases have been. I've mostly adjusted to splitting things up more quickly and easily than I have to raising or lowering them.

thanks. trying this starting today.

[mel1]

I take 300 mg. of Lamictal and I split my dose . I take 100 in the morning and 200 at night. I've been thinking about switching and taking 200 in the am and 100 at night.

[Unregistered]

I used to split, now I take it all AM. I seem to sleep a little better, but that's all. I don't think it makes much difference unless you find it either very sedating or very stimulating.

- edit to correct dumb typo -

[CER]

I take 200mg a day about 12 hours apart:

100mg when I wake up

100mg around 5-6pm in evening

That seems to work really well for me.

If I take it any later I have trouble falling asleep.

[Guest Guest]

thanks all. i am splitting evenly, when i wake up (which varies) and betwee 7 & 9 PM. seem to be more even throughout the day. waking up more easily, too.

thanks again.