Lamictal dosing question

[witchywoman]

I am on 25mg Lamictal working my way up to 200mg.  Im on the starter pack, and I was noticing it says when you get to 50mg (2 25mg tablets), that you should take them at the same time, together.  My pdoc told me to take one in the morning and one at night.  Anyone else take theirs like that?  I plan on doing what he says, but Im just curious if anyone else has taken it like that, and if your pdoc gave you a reason.  I don't know what the reason is, I didn't think to ask.  Im just curious.  Thanks for any responses.

[ncc1701]

Heya witchywoman,

How does the Lamictal make you feel?  (OK, at 25mg, maybe nothing at all, but here's my take.)

I take all my Lamictal at the same time, 6:30 pm, because it makes me very sleepy from 7:30 til 10:30.  Really weird how this affects me, like clockwork.

If it made me feel awake instead, I'd take it all in the AM.

I think the half-life of Lamictal (how long it takes half the drug to get out of our systems) is soooo variable -- like, anywhere from 12-26 hours or something (I'm at home so I haven't got my Big Book of Drugs.) -- that it's hard to guess how often to take it.

I think the ideal might be to take it twice a day, and I've been thinking of asking my psychiatrist about adding a *small* AM dose (although even 25mg put me to sleep when I started) because I'm feeling crummy in the afternoon most days now.  It *would* have to be small, though, because I'm not sure I'm safe to drive on it.

Stands to reason that, if it's not too sedating or activating, taking it every 12 hours would keep a more consistent level in our blood and brain.

Many people with seizure disorders take it twice a day.

If your doc suggested it, it's worth a try.

--ncc--

[witchywoman]

At first, it made me tired.  I've been taking it in the morning, and I would be useless the rest of the day.  Since yesterday, it hasn't done that to me, so I guess my body is adjusting. 

It does seem to be helping (or the combo of Lamictal and Abilify).  Im feeling better these past couple days.  Possibly a bit manic, but nothing terrible, yet.  Of course, Im not officially diagnosed bipolar yet, so who knows.

[NARS]

I had to split my doses at first because the tegretol I was taking cleared the lamictal out of my system faster than usual, so I needed to spread them out to maintain the levels.  I now take my 300 in the am.  I may try switching to split doses again because I'm having sleep trouble.  Maybe.

[LunaRufina]

I am on 25mg Lamictal working my way up to 200mg.  Im on the starter pack, and I was noticing it says when you get to 50mg (2 25mg tablets), that you should take them at the same time, together.  My pdoc told me to take one in the morning and one at night.  Anyone else take theirs like that?  I plan on doing what he says, but Im just curious if anyone else has taken it like that, and if your pdoc gave you a reason.  I don't know what the reason is, I didn't think to ask.  Im just curious.  Thanks for any responses.

<{POST_SNAPBACK}>

For some people, Lamictal is activating and for some it can be a bit sedating and for others it doesn't really matter when they take it.

Pretty much as long as you take it at the same time every day, you're good.  The Lamictal is one of the things that I split the doses for.  I take it in the AM and in the afternoon and I have actually found it to work best for me. [in combination with all my other meds]

ncc is right, it is sort of hard to pinpoint. So... pretty much, there is no real reliable formula. One thing to note: when you take twice daily, the half-life tends to be shorter, which could alleviate any particularly activating or sedating effects.  I think once you settle into your final dose you can find what works best for you.

  I know your doctor said to take one in the morning and one at night, but if you asked, I bet your doctor would probably say it doesn't matter what time. I take it in the morning and afternoon now because it is simply most convenient.

~navy~ 

[revlow]

My doc says doesn't matter what time of day, just to take it at the same time every day. BUT...I have also learned over the years to be flexible when it comes to figuring out what time of day is best for me. Examples in the past: Prozac put me to sleep, so I took it at night. Now, you don't hear that very often -- but that's the way it effected me. Same thing with Effexor. Not common, but the way it worked for me.

I'm taking Lamictal at night. No particular reason, just started that way. And since my sleep has improved, and I am waking up refreshed (for the 1st time I can ever remember!) I figure why mess with it. But that's just me.

[LikeMinded]

Lamictal for me is activating as all hell.  In fact, even though I take it in the morning, the day of a dosage increase, I simply don't sleep.  At all.  Right now I'm at 100 mg, will be here for a couple more days, then 150 for 3 days, and then 200 for maintenance.  So I'm scheduling 2 nights where I won't be sleeping much. :-p

[revlow]

herrfous:

Have you thought about titrating more slowly, with not as much of an increase in mg. each time? Seems like that might be a good idea to minimize the sleep problem.

[Guest Guest_Robbie_*]

Again, my pdoc says over and over again that research has found that 50 mg is 90% as effective as any higher dose.  He claims the study is being published in January and that the 200 mg dose as the "accepted" rule of thumb is simply not reality.  He points out that it's all subjective and there is no way to really measure how effective any dose is except by anecdotal information.

I know this annoys lots of people who post here, but what if this new study is accurate?

[Batou]

Again, my pdoc says over and over again that research has found that 50 mg is 90% as effective as any higher dose.  He claims the study is being published in January and that the 200 mg dose as the "accepted" rule of thumb is simply not reality.  He points out that it's all subjective and there is no way to really measure how effective any dose is except by anecdotal information.

I know this annoys lots of people who post here, but what if this new study is accurate?

<{POST_SNAPBACK}>

I am not annoyed. If the study is accurate? Simply, YMMV.

[Fiona]

The morning and evening dose might be to minimize the impact the increase has on you all at once. It might also help you figure out when taking it is best for you. Or, it might just be the way your pdoc likes to introduce Lamictal.

I take 1/3 my dose in the morning and the other 2/3 before sleeping.

Fiona

[NARS]

Have you thought about titrating more slowly, with not as much of an increase in mg. each time? Seems like that might be a good idea to minimize the sleep problem.

I think I respectfully disagree.  I went directly from 100 to 200 (not unusual for lamictal titration, though many like to go by 50s).  And I had so much more stabilization on 200 than at 100; my sleep improved hugely (was mediocre at 100, sound and steady at 200).  If I'd stopped at 150, that could well have meant another few days with little sleep.

Robbie, we've already had the thread about the new study, but I just offer up my own experience: less depressed but unstable at 25 for 2 weeks, un-depressed but unstable at 50 for 2 weeks, un-depressed but more stable at 100 for a week, un-depressed and marvellously stable at 200.

Of course, the dose that does it for you is the dose you should be at.  But staying unstable at 50mg if a higher dose would work simply doesn't make sense to me.  That goes for any med.

[revlow]

NARS:

I understand what you are saying. However, if you read herrfous' original post, you'll see he (or she?) is saying the titration itself is causing the sleep problem, on the day of an increase:

Lamictal for me is activating as all hell.  In fact, even though I take it in the morning, the day of a dosage increase, I simply don't sleep.  At all.  Right now I'm at 100 mg, will be here for a couple more days, then 150 for 3 days, and then 200 for maintenance.  So I'm scheduling 2 nights where I won't be sleeping much. :-p

<{POST_SNAPBACK}>

In that case, it would seem to make more sense to go slowly.

revlow

[NARS]

NARS:

I understand what you are saying. However, if you read herrfous' original post, you'll see he (or she?) is saying the titration itself is causing the sleep problem, on the day of an increase:

Lamictal for me is activating as all hell.  In fact, even though I take it in the morning, the day of a dosage increase, I simply don't sleep.  At all.  Right now I'm at 100 mg, will be here for a couple more days, then 150 for 3 days, and then 200 for maintenance.  So I'm scheduling 2 nights where I won't be sleeping much. :-p

<{POST_SNAPBACK}>

In that case, it would seem to make more sense to go slowly.

revlow

<{POST_SNAPBACK}>

Sorry if I left this out, but I too had particularly high activation and poor sleep at the low end of the titration.  Of course, if it feels wrong, don't speed it up, or slow it down further.  I'm just suggesting that herrfous might want to actually go ahead and go higher if it's possible that better sleep is lurking right around the corner.

Sorry if I seem ornery; hot flashes, you know.

[revlow]

LOL. No problem, NARS. Believe me, I understand.

[LikeMinded]

NARS:

I understand what you are saying. However, if you read herrfous' original post, you'll see he (or she?) is saying the titration itself is causing the sleep problem, on the day of an increase:

Lamictal for me is activating as all hell.  In fact, even though I take it in the morning, the day of a dosage increase, I simply don't sleep.  At all.  Right now I'm at 100 mg, will be here for a couple more days, then 150 for 3 days, and then 200 for maintenance.  So I'm scheduling 2 nights where I won't be sleeping much. :-p

<{POST_SNAPBACK}>

In that case, it would seem to make more sense to go slowly.

revlow

<{POST_SNAPBACK}>

HE! HE! HE! it's HE! herr is German for Mr.!  Ok ok ok ok, done with the paranoia, I do happen to get mistaken for a woman in real life disturbingly often, so...

(sad thing is, I generally keep a generous coat of stubble to avoid either looking like a woman or a 14 year old boy.  My major demographic in terms of "phone numbers received from the opposite sex" is STILL the 13-15 age group.  That's why I have to avoid shopping malls like the plague.  Rrrrrr.)

HR secretary: "How may I help you, ma'am?"

me: *blank stare*

secretary: "Ma'am?"

me: *cold, blank stare*

secretary: "Excuse me, ma'am??"

me: *colder, blanker stare*

secretary: "Uhhh... sir????"

[revlow]

HE! HE! HE! it's HE! herr is German for Mr.!