Lamictal Maximum?

[jt07]

Hi everyone,

I'm trying to get a feel for what the maximum dose of Lamictal is. I don't mean the maximum dose as per the PI, but the real-world maximum dose where pdocs may be going off label. Currently I'm taking 400 mg (200 am and 200 pm) which my pdoc says is the maximum dose. Does anyone here take more than 400 mg? I'm really about fed up with this med since I feel like it's not doing anything and that I'm spending money on it for nothing. My pdoc suggested going up to 600 mg/day.

[AirMarshall]

The PI sheet suggests 400mg but then says 500mg my be used. We've even had a few members on 600mg.

fortunately Lamictal has a very high toxicity range.

[SashaSue]

600 isn't unheard of, but it is a lot. I think 400-450 is the usual cap. If you aren't seeing any benefit from it at 400, going up to 600 probably won't help much. But there's no reason not to give it a shot, unless you're having troublesome side effects.

[jt07]

Thanks, guys, I think that I will probably give the 600 a shot. My pdoc and I basically agreed to max it out and see if it works, and if it doesn't, then we will start to discontinue it. Right now, at 400 mg, it is like taking sugar pills. No adverse effects, but very little benefit also. I'm wondering if anyone here is taking more than 400 mg and if it is helpful to them and what kind of side effects I need to be on the lookout for.

I'm just a little dissappointed in Lamictal. I had such high hopes for it since I responded so nicely to carbamazepine (other AC) and since I read so many glowing reports on it here and elsewhere.

[nalgas]

400 mg/day is only the normal maximum for mood disorders. 500 mg/day is frequently used for seizures and I believe is the normal upper limit for that use, although people can and do go higher from time to time. Also, it's somewhat unusual, but you can have your Lamictal blood level checked to see if it's unusually low.

I had such high hopes for it since I responded so nicely to carbamazepine (other AC)

They may both be ACs, but other than being in the same very, very broad category, they're incredibly different meds and don't have a whole lot in common with each other. I got along pretty well with Trileptal (oxcarbazepine, carbamazepine's close cousin), but Lamictal was no good for me at all.

[Obscuremachine]

I'm currently taking 400mg of Lamictal (200 in the morning and 200 at night). My racing thoughts have slowed down tremendously with each increase and I almost feel normal. Almost. I still have some periods where my thoughts go nuts, so I wouldn't mind if my pdoc raised it more, which he said is possible.

[dancesintherain]

Thanks, guys, I think that I will probably give the 600 a shot. My pdoc and I basically agreed to max it out and see if it works, and if it doesn't, then we will start to discontinue it. Right now, at 400 mg, it is like taking sugar pills. No adverse effects, but very little benefit also. I'm wondering if anyone here is taking more than 400 mg and if it is helpful to them and what kind of side effects I need to be on the lookout for.

I'm just a little dissappointed in Lamictal. I had such high hopes for it since I responded so nicely to carbamazepine (other AC) and since I read so many glowing reports on it here and elsewhere.

Do you feel like you're getting some benefit but not enough? Or that you're not getting anything from it?

If the first, it might be a tweak the other meds situation...but if nothing, than it's a lamictal d/c situation. Or at least those are some initial reactions, obviously not a pdoc.

[AirMarshall]

One other consideration: If there is a question of bio-availability, there is a blood test which your doctor can order. This would be helpful if there is a question of med interactions which might decrease Lamictal blood levels. Lamictal is similar to lithium in that there is not a direct correlation between dosage and blood levels. The difference is that Lamictal is much less toxic so most people never require blood checks.

a.m.

[AnneMarie]

If I did not know that I was getting something out of each increase, I'd bail and go to something else instead of increasing what is not working to an unusually high dose.

[AmyBipolarFrontalLobeTBI]

How do I delete this post as I only meant to post the next post (post 2 of 2)?  I want to keep my other post and get rid of this one as I deleted the text, obviously.  Thanks, Amy

[edited to remove email address]

Edited May 6, 2013 by Wooster

[AmyBipolarFrontalLobeTBI]

http://www.crazyboards.org/forums/index.php/topic/47336-lamictal-maximum/

 

 

 

Re: 600 milligrams of Lamictal daily at http://www.crazyboards.org/forums/index.php/topic/47336-lamictal-maximum/ - I just joined crazyboards.org right before writing this long essay to you about Lamictal and me.  I too need much advice about switching from 400 mg to 600 mg to stop or weaken my mania like 400 mg did for 2 years.  I also have a great deal (sorry if repetitive!) advice too.  I really hope this topic continues to be discussed by all who are taking or have taken Lamictal.  Good luck to you too!

 

MY THREE EXTREMELY IMPORTANT PIECES OF INFORMATION FROM ME TO YOU ABOUT LAMICTAL (BASED ON THE WORDS OF MY EXTREMELY EXPERIENCED PSYCHIATRIST AND BASED ON MY (OFF AND ON) HYPO-MANIC AND MANIC EXPERIENCES FROM 2003 until NOW.  (However VERY unfortunately my current mania also makes me think that I should go from 400 mg/day to 600 mg/day, but my psychiatrist does not recommend going over the allowed doses, so I am extremely frustrated and do not know what to do... hide that I am too manic and I am ordering 200 more mg/day from Canada without her approval? Thoughts anyone?):

 

1) ALL GENERIC FORMS OF LAMICTAL ONLY WORKED FOR ABOUT 40% OF ALL OF HER PATIENTS AND CAN  HAVE TERRIBLE OR VERY SCARY SIDE EFFECTS (THAT I EXPERIENCED THAT SCARED ME SO MUCH!!!). I on the other hand have never had even one negative side effect (that I am aware) of from taking name brand Lamictal and it has been the only medicine that has often affected my mania (after trying about 10 other bi-polar meds with major side effects).

 

2)  THEREFORE APPROXIMATELY 60% OF MY (VERY KNOWLEDGEABLE!)  PSYCHIATRIST SAID THAT ABOUT 60% OF HER PATIENTS (including me) ONLY CAN EVER TAKE NAME BRAND LAMICTAL FOR ANY ACTUAL RELIEF OF BIPOLAR SYMPTOMS AND SHE WRITES THAT ON EVERY SINGLE ONE OF MY LAMICTAL PRESCRIPTIONS = "DO NOT EVER SUBSTITUTE; NAME BRAND LAMICTAL IS MEDICALLY NECESSARY".

 

3) EFFEXOR taken by itself in the winter and entire spring of 2004 after taking almost no other psych meds ever in my life (I was too embarrassed about admitting to having any mental illness sadly) and then tried to commit suicide in late 2003.  Effexor was thus given to me post suicide attempt, when I only showed signs of unipolar depression, When he increased my somewhat helpful low dose of Effexor to an EXTREMELY HIGH DOSE OVER THE RECOMMENDED LIMIT OF EFFEXOR, that high dosage of Effexor 100% caused my very first and ABSOLUTE WORST AND MOST EMBARRASSING EPISODE. OF EXTREMELY SEVER MANIA!  My psychiatrist, after my depression improved slightly when I started on very low dose of Effexor, thought I had only unipolar depression.  My next psychiatrist when Mania ended in June 2004 when I was taken off of Effexor, took me off of Effexor obviously.  Effexor (I cannot emphasize enough ruined part of my life and I cannot remember about 40% of what I did or who I contacted while so manic.  In summary, Effexor put me into the most extreme and very first manic state for months and I just instantly moved away from my rightly at that time (and now forever) worried and controlling  parents immediately when so high on life with mania to live with a friend in a far away city 10 hours away by car (that I drove at about 90 miles per hour! I lost many friends and did again recently in the past year back with my parents, and very manic once again on 400 mg/day on Lamictal (plus Xanax,Cymbalta, and tiny amount of Adderal).  I lost many scared friends and even my brother due to the fact that I was the craziest, rudest, meanest but happiest, most selfish, and psychotic person that I have EVER been in my entire life.

 

Next, now I am also writing to you as I think I need to try 600 mg of Lamictal as I have just finally realized now that I just had at least one or more years of severe mania on 400 mg of Lamictal and medsabove, but always told my many new and different psychiatrists (I had to move to a couple different cities recently and not because of manic reasons) that my meds seemed to be working very well (I was happier and greatly in so much manic denial plus somehow I successfully hid my hypo-manic and then severe mania episodes in short appointments) and thus kept taking my 400 mg/dayLamictal as until someone seriously confronted me, telling me in great deal about almost every recent manic episode on Friday, I finally became 100% aware that I am/WAS manic, The reason I feel I WAS manic is because after taking 600mg/day instead of 400mg/day of Lamictal just this Friday, Saturday, and Sunday (every manic sign has completely disappeared and extreme depression exists in me once again).  All weekend my parents have commented that for the first time in so many months I am so nice, never yelling or blaming them, I have no sexual or spending issues AT ALL which is my number one sign of mania, and I seem so "normal" again.  This have literally been so happy about how relaxed and very kind I have been to them all weekend.  They keep thanking me my new thoughtfulness and kindness all weekend, but I never have told them as they would completely panic (my mom mostly) that for 3 days in a row I have not experienced even one warning sign of mania after taking 600 mg instead of 400 mg of Lamictal today.  We have fought and screamed and cursed at each other DAILY, EVERYDAY - most often because of my EXTREME MANIC mood swings for at least a year.  They blame me as they do not understand that I really am often controlled by mental illnesses, like my extreme bipolar 1.

 

I am either in denial, but probably more unaware of my mania and I am just simply so happy to have so much less severe and almost no suicidal depression... although I very often had both severe mania, severe anxiety, a horrible memory, worsening ADD, and severe depression throughout this past extremely bipolar year. Regularly, I also experienced major denial when manic, because I would walk, go outside, date, have sex, go shopping, feel so much joy, and was socia (yet evil to my controlling yet VERY loving parents) as I usually only took out my major mood swings on 2 of only a few final people who will forever and ever conditionally love me, but try to control my mood swings, blaming medicines, and never mental illness, which infuriated me daily!  Whenever I was manic recently my depression decreased by about 75% so instead of NEVER leaving my bed and often wanting to die of natural causes - when I reached the South Pole, as I call my states of severe bipolar depression.  The North Pole (life with mania) is happy happy happy but I ACT SO CRAZY AND VERY MEAN AND SO WEIRD THAT OTHERS OFTEN THOUGHT OR GOSSIPED THAT I AM ON COCAINE OR SPEED DUE TO MY mania, but I have never in my life had anything other than pot, alcohol, and prescribed medications. I really wished I just lived somewhere in the Northern Hemisphere not too close to my manic North POLE of Bi-POLar - in a happy and healthy place that is not too close to the North Pole so I have no bipolar symptoms which has not happened for over ten years - ever.  I always had depression, but after a major car accident that changed my physical and mental health forever in 2000, causing major brain damage in both frontal lobes - especially the right frontal lobe - and caused an extremely severe concussion and about 7 years of not working due to chronic pain, that is so much worse ever since my 2009 and 2010 spinal surgeries that have left me unemployed and living at my extremely generous, loving parents' home, depending on them 100% and they treat me like I am 16 instead of 36.  They are SO extremely controlling and think I am lazy despite pain and sometimes such severe depression. My mother counts my pills and does not want me to take any medicines at all, believing all possible listed side effects from pharmacy's and damn Dr. Oz!  She is so Catholic and makes me feel so guilty (as does my Athiest father) for always needing to borrow money, while screaming at them due to mood swings that are completely out of control.  My amother often stays awake worrying about me and if I actually ever spend the night at someone that I am dating's house she thinks I am a slut, as I not married.

 

Moving on.... I am so sorry to hear that you have had no luck with Lamictal.  It has greatly helped me reduce my major manic symptoms and no other bipolar recommended drug has ever helped me and/or they had such horrible side effects and the side effects were so much worse than the advantages of every type of other possible types of bipolar meds..  It took my psychiatrist a very long time to agree to put me on Lamictal due to the very high risk of the deadly rash  However I did not get the rash THANK YOU GOD!  

 

Lamictal took away about 70% of my manic symptoms or much more the first or two year I upped my dosage from 200 mg to 400 - now can I be approved to use 600mg?  Is that safe?  Good?  Bad side effects as I am psychologically very sensitive to many other psych/bipolar medications?

 

I have Bipolar 1 or 2, but most likely Bipolar 1, but it is unclear due to my severe tramatic brain damage in both frontal lobes, and this form often shows very similar symptoms.

I just wanted to add a few things about Lamictal which ended my mania for a couple of years on 200 mg in 2007.  Then I tried 400 mg of Lamictal when my mania got much worse a couple of years later. All of this weekend, I do not feel even 1% horny after feeling like I needed sex everyday for months until this past Thursday; my Catholic mom would die that I used the word horny, even once in my lifetime, but as this is my first post ever, I am 99% sure that this is 100% anonymous.  In summary, after 200 mg of Lamictal I again got much worse a couple of years later and then 400mg  worked VERY well for a couple of years, but NOW i SEEM TO ABSOLUTELY NEED 600 mg.  Taking 600 mg without talking to a doctor for three days in a row has started (for the past 3 days only) to greatly reduce every manic warning sign.  Unlike for the past year, I do not even feel or exhibit one warning sign of even possible mania (honestly!) after only 3 days of 600 mg of Lamictal.  Needing to know and greatly fearing all risks of taking 600mg (probably secretly sadly), I Google'd 600 mg of Lamictal and found this website (and this chat) for the first time ever.

 

CAN ALL PEOPLE WHO HAVE HAD THE SAME OR EXTREMELY SIMILAR EXPERIENCES AS ME WITH NEED 200MG THEN 400MG AND THEN 600MG daily of Lamictal, please give me every piece of advice that you have as side effects of 600 mg scare me as I am extremely sensitive to psych meds!  Please give all tips about your experiences on 600 mg of Lamictal daily.  Did your psychiatrist prescribe you 600 mg per day?  Does anyone have a prescriber of 600mg doctor in Sacramento areas or in the Bay Areas who I can talk to about the pros, cons, and possible side effects of 600 mg/day of Lamictal? I also fear that just like 200, then 400, greatly reducing mania ONLY for a couple years with each that even the high dose of 600mg will never be permanent in keeping mania away.  Is this reduction of my very recent manic symptoms only going away temporarily once again???  All thoughts and advice would be so greatly appreciated either on this chat OR via email - [edited out email address so you don't get spammed].  Thank you for your anticipated guidance!

 

I apologize as I have to go NOW without finishing this 100%, but is probably far too long anyway!  i ALWAYS talk and write too much, even when I am NOT manic at all unfortunately and embarrassingly due to my completely smashed right frontal lobe.  I must sign off right now as my patient yet very annoyed dog needs to walk NOW and go to the bathroom NOW as he is barking at me and only does that when he URGENTLY needs too go!  I always usually proofread everything, but not this time.  I did not edit or even read any of this, but I am sure you got my main points and messages still, even .  Despite my immediate change from sever mania (I am NOT cured by 600mg (yet?), but with my new severe depression this weekend, I at the very least I must now walk my dog around the block as nature calls!

 

May peace and improved health be with you all!

 

Bless you,

 

Amy [edited out email address so you don't get spammed] :  )  :

Edited May 6, 2013 by Wooster

[AmyBipolarFrontalLobeTBI]

Jumping the CB Shark

• 
• Member
• 
• 6691 posts

Posted 18 July 2011 - 09:59 PM 

MY QUESTIONS FOR YOU (are there really no stupid questions?):

 

1) What is "The PI sheet"?

 

2) Members of what group?  "We've even had a few members on 600mg."

3) How do you know that "fortunately Lamictal has a very high toxicity range."?  I can clearly guess what it means to have a high toxicity range, but can you please explain that to me in great deal as I am about to move from 400 milligrams of Lamictal to 600 milligrams of Lamictal and want to be sure that is very safe?  You provide helpful information and I am wondering where or how I can learn more.  Do you know this as a medical employee or from what type of research?

 

Thank you SO much for your anticipated, hopefully extremely detailed answers as although Lamictal has been great for me for years, I have done very little research as I start worrying about the negative experiences that happened to other happening to me too - in my head but I have too much anxiety and worry about moving to 600mg of Lamictal!  If you have the time please read my post directly above this one.  

 

Thanks again,

 

Amy   [edited out email address so you don't get spammed]

**My work is done.  Swimming for the nearest shore.**

Edited May 6, 2013 by Wooster

[Luna-]

My pdoc says she will go to 600mg.

 

ETA: I'd also second the bit about getting the blood test to determine the level. I just had a test done recently.

Edited May 6, 2013 by Luna-

[meganhalley]

1) What is "The PI sheet"?

 

2) Members of what group?  "We've even had a few members on 600mg."

 

 

1.  The PI sheet is the prescription information sheet that comes with your medication.  They can also usually be found online.

 

2.  The members of the group--members meaning people that are a part of the CrazyBoards community.

[Luna-]

Hi Amy

I had a look at the PI sheet for generic lamotrigine here in South Africa and I found the following:

 

"Some patients have required 500 mg/day of ASPEN LAMOTRIGINE to achieve the desired response."

 

Here is the source: http://home.intekom.com/pharm/aspen-p/a-lamot.html

 

... why don't you try and go see your pdoc and tell her/him what has happened - that you took 600mg and it has helped? (I believe in the straightforward and honest approach.) Tell her someone sat down with you and explained how manic you've been and how you manage to hide it during appointments. (I used to do that.) Sooner or later you are going to need a script for the 600mg, aren't you?

 

What do you think?

 

[notfred]

The standard dose for seizures is 600 mgs/day with a max of 1,200 mgs/day so lots of people are on 600 mgs/day, it is not an especially high dose.

[Wooster]

Hi Amy... Just a heads up that I have edited out your email address from your posts for a couple of reasons...

 

First, posting your email address in a publicly searchable forum makes it incredibly likely that your email address will get picked up by spambots. Second, we encourage people to post on the boards instead of just private message so that everyone can benefit from the community knowledge.

 

Welcome to CB. I hope you find what you're looking for.

[melissaw72]

I've been on 600 mg and pdoc would not go over that amount.

[bookgirl]

I'm on 450, which is my usual stabilizing dose. I've been experiencing mild breakthrough depression lately, and my pdoc added a new med instead of titrating the Lamictal up because she doesn't think an increase will help. 

[Night in Juniper]

I'm on 400mg/day divided like you- 200 am 200 pm. 

 

I must say that I haven't noticed any improvement in upping my dose since reaching 200-300mg. I'm holding at 400mg though because I just don't want to mess around with my primary mood medication. 

 

I've read that dosages above 200mg/day aren't anymore effective. But I could be wrong on that. I might be, if 600mg is helping some of our members!

[Alien Navel Cord]

That is weird. All the pdocs I've ever gone to have told me that 200mg is the max Lamictal they will prescribe. i've never gone higher than 200.

[Squirlygrl]

The carbamazapine that you are taking can reduce serum levels of Lamictal. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885026/ (2005).  So your functional dose may be lower than your actual dose.

 

I am only on 225mg, but I took a lower dose for some time with no results.  It wasn't until I had serum levels within the range for epilepsy that I saw any benefit.

[crtclms]

I'm on 400mg. I am wobbly on this dose. I am better on than off, but still pretty unstable. I would feel comfortable discussing 600mg with my pdoc if it were worse than this, because my husband is on 600mg for epilepsy. But I personally think beyond 400 won't make a difference for me. It definitely works for some people.

[Beancounter13]

I've been on 450/day of Lamictal for several years now and I take it as a single dose at night. I'm currently also taking 40mg Lexapro and 20mg of Saphris, both of those in a single dose at night as well. I'm about to need some tweaking and am considering asking about a higher dose of Lamictal.

[forgetmenot220]

I was on 300 and it worked but I had some cognitive issues. I took a break from it to try Li, that didn't work, now I'm back on 200 mg and its working nicely!!

[Wonderful.Cheese]

I'm on 400mg and it works well for me.

[ANYC]

Actually, someone posted about a drug-drug interaction; this is very valid.  I am on 600, but it is because I take a medicine that reduces Lamictal by 80%.  

 

Another factor influencing this is simply your genetics:  what is the make-up of your liver digestive enzymes.  It may just be that your liver chops up Lamictal fast and thus blood concentration and effect is low.  

 

In any event, there is a "Lamictal Level" blood test.  That'll tell you how much ends up in your blood.  It should be a minimum of 4.0 mcg/mL3 up to 20.0...so thing between 4 and 20.  

 

Best of luck!

[melissaw72]

I recently went from 600 mg to 400 mg because I started taking the ODT lamictal, which is not generic.  For some reason I either wasn't absorbing the pill form very well, or because it was a generic.  I guess it could be from other medications, but pdoc has never mentioned it, and at this point he would have had it been a problem.

[jt07]

My oh my, I don't even remember starting this topic so long ago. I went up to 600 mg and when that didn't help, I went back down. I'm now on 200 mg. I'm still not sure what Lamictal is doing for me. I keep it in my cocktail because I'm afraid to rock the boat.

[Chimako]

My oh my, I don't even remember starting this topic so long ago. I went up to 600 mg and when that didn't help, I went back down. I'm now on 200 mg. I'm still not sure what Lamictal is doing for me. I keep it in my cocktail because I'm afraid to rock the boat.

 

That's why it's in my cocktail.  The pdoc asks me "what's lamictal doing for you?", the tdoc asks me "what's the lamictal doing for you?".   How the hell should I know, I'm not a dr.  :/

[jt07]

 

My oh my, I don't even remember starting this topic so long ago. I went up to 600 mg and when that didn't help, I went back down. I'm now on 200 mg. I'm still not sure what Lamictal is doing for me. I keep it in my cocktail because I'm afraid to rock the boat.

 

That's why it's in my cocktail.  The pdoc asks me "what's lamictal doing for you?", the tdoc asks me "what's the lamictal doing for you?".   How the hell should I know, I'm not a dr.  :/

 

I actually can tell you what every med in my cocktail is doing for me ... except the Lamictal (and possibly the Remeron).

[Chimako]

I can say what the lithium and clonezepam is doing but the lamictal is either doing nothing or so subtle that I can't figure it out.  If I wasn't scared to, I'd just skip it a few days and see what exactly happened.  But, I won't.  

[jt07]

I can say what the lithium and clonezepam is doing but the lamictal is either doing nothing or so subtle that I can't figure it out.  If I wasn't scared to, I'd just skip it a few days and see what exactly happened.  But, I won't.  

Yep. It's the same with me.