Lamictal, Lithium, shakes and nausea

[6un6silent6]

You've probably read several of my posts complaining about Lithium side effects. They were tame when I started titrating Lamictal. Now I'm at 62.5 (2x25mg + 1/2 25mg) at night and as soon as I started that in the last week I shake uncontrollably, am nauseous most of the day, and feel like I'm forgetting stuff. My co-workers are noticing and it's embarrassing.

My last Lithium level @ 900mg was barely .5 and I'm still drinking ample water and ingesting salt. My shaking is not pronounced but I get head twitches, hand tremors, and if I stick my leg out straight it'll tremor slightly. I don't want to quit the Lamictal since it seems to be helping along with the Lithium but I also can't stand feeling sick every day.

I'm going to try to get in for a blood pull on my Lithium but the doctor says it's highly unlikely I'm hitting toxicity at 900mg since my last pull 1.5 weeks ago was .5.

Advice?

I'm increasing my ativan to try to control the shakes and eating bland food settle my stomach.

I'm sure it didn't help that I tried to quit smoking last weekend and it turned me into a mess too, but I'm smoking again unfortunately and the doctor said not to stop until I'm at a full load on my meds.

[AnneMarie]

Lithium can cause nausea in some people, more so when starting. Be patient. It should pass. I've not heard of this with Lamictal, but anything is possible.

Lithium can cause essential tremor for some people. If it persists, ask your pdoc about trying Inderall or something like it to see if that helps.

Lamictal has a low side effect profile, but could be contributing to your problems. Like most meds, s/e's often go away with time.

Unless you are only a casual smoker, your pdoc is right about quiting. Wait to quit smoking until you and your med regimen are stable. You have enough new chemistry for your body to adjust already.

The first few weeks of titrating meds can be the roughest. Try not to get too discourage. Things should improve for your soon.

[6un6silent6]

Thanks, I've been titrating up to 62.5 over about 45 days since I'm sensitive to meds. Each time I up the Lamictal by 12.5 I feel sick... But it's gotten worse in the last week. Maybe the attempt to quit smoking and getting back on the nicotine has threw my CNS for a loop?

[AnneMarie]

Could be. Maybe ask you pdoc about staying at 62.5 until the nausea subsides for a week.

[6un6silent6]

Thanks, I've been titrating up to 62.5 over about 45 days since I'm sensitive to meds. Each time I up the Lamictal by 12.5 I feel sick... But it's gotten worse in the last week. Maybe the attempt to quit smoking and getting back on the nicotine has threw my CNS for a loop?

He wants me to try some propanolol for the shakes 10mg/day and see if that helps. He said the nausea is probably a combination of the dose increase and Lithium (which causes me transient nausea all the time). I have an appointment with him next week so I'll blood draw then to be sure as I'm not feeling "deathly" just off and it come/goes.

[6un6silent6]

Update:

I'm at 125mg Lamictal and 900mg Lithium and I feel like arse!

Still shaky even with Propanolol, cognitive dulling, dizziness, transient nausea, headaches, feeling like I'm going to fall over, lack of focus. I'm going today to get my Lithium pulled but last time I did it was .5 @ 900mg QD. So if I'm getting toxic I'll be surprised but I'm not ruling it out. I've backed my Lamictal dose down to 112mg but the side effects are still funky. Plus since I hit 100-125 I started to rapid cycle which I haven't since I got on Lithium.

I've read until I hit my target dose I may see problems like this, but damn this is hell!