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Lamictal - Need input


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Hi,

Since it is Sunday and can't get a hold of my pdoc, I could really use some input on the Lamictal dosage. I am currently on 200mg, taking it before bed. I've been on it for about 3 months and I've plateaued so my pdoc wants me to go up to 400mg a day, but said to go up to 300mg for 2 weeks then 400mg. I have always titrated up by 25mg to reduce the risk of THE rash. Only side affects I have are headaches, and decreased sleep with night sweats when increasing dosage. I have a ton of 25 mg tablets left over and asked if I could use those. She said yes, but she didn't see a need for me to take baby steps anymore when going up in dosage.

I'm now having second thoughts on this and have not starting going up yet in fear of being increased too much, too quickly.

Any input would be greatly appreciated. 

 

Thanks

Edited by Liquid_Chaos87
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I don't remember going up that fast at any point in reaching the level I am on (600 mg) now.  When I started taking it I got a "starter" pack from the pharmacy (prescribed) and used that for awhile.  Then could go to the next level.  I didn't pay attention to the doses though; just took the med.  Now I am currently on 200 mg 3x/day (600 mg).

Maybe others have had different ways of titrating up, this was just my experience.

I'd call your pdoc tomorrow to ask about this.  (Sundays suck, don't they?)

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When I got to 200 mg, my pdoc said 50 mg increases were OK then. I don't know if that's the general rule, or just how my particular pdoc did things. I know I would hesitate before I went up faster than that, it made me nervous to start it at all. (although it's been a good med for me). See what your pdoc says tomorrow, and maybe ask the pharmacist for what their databases say. I'm a cautious type, so I question this sort of thing, and my pdoc is willing to discuss my concerns, so I hope yours will listen, too. 

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I'm not sure if I am missing something ... But I see (IMO) a problem with asking your pharmacist when they don't know what your pdoc's long-term plan for raising the dose is, and the pdoc is the one who is prescribing.  If I took it differently than prescribed because of what the pharmacist said (unless maybe if it was a lower dose until you could get in touch with your pdoc), it would be a sort of a med non-compliance.  I mean it might be ok to do, but sometimes pdoc likes to know before doing it.

 

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I don't think I'd go to the pharmacist for the same reason Melissa said. If it were me, I'd call my pdoc tomorrow just to make sure it would be safe. I'd be nervous about that big a jump. But maybe at the higher doses it's okay. 

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I should clarify what I meant by ask a pharmacist. I meant, ask what the databases or makers advise on rate increases, to have some input on that to discuss with pdoc. I wouldn't use that info to tell me what to do, but I would use it to see if that info matches what my pdoc says. Then I'd either feel reassured, or have something other than my opinion to bring to the discussion with pdoc. Or I might otherwise research the point. But no, I would not have the pharmacist tell me what to do, just ask for info. I guess I  should not assume people know what I mean, sorry, that was probably confusing. 

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Well, I called my pdoc and the lady that answered said the doc was out until the 19th...yay. I may ask a pharmacist, but I got the okay from the office staff that if I want to do a slower increase that I can and they will inform the doctor when she comes back. Sounds like I'm tweaking the dosage without the doctors approval.

 

But thanks for all your replies :)

Edited by Liquid_Chaos87
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56 minutes ago, Liquid_Chaos87 said:

but I got the okay from the office staff that if I want to do a slower increase that I can and they will inform the doctor when she comes back. Sounds like I'm tweaking the dosage without the doctors approval.

 

I don't see it as doing something without the DRs approval.  You called the office, their staff (I am assuming they are RNs or other pdoc/s are covering or something similar?) said it was ok to do.  When your pdoc returns and doesnt like the slower increase, you can (at least I would) say that the person covering approved it.  And you figured it was the people covering for her that gave you the ok to do it, so it would be ok, at least temporarily until your pdoc gets back on the 19th.

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I agree with Melissa so long as it was a covering pdoc/RN/etc.. In other words, if from the medical staff, you're modifying the plan to go more slowly with their approval.

i can't imagine a situation where it would solely come from administrative people, but in the tiny chance that it did, I would call back and ask for the covering pdoc or any other medical person.

FWIW, my pdoc just bumped me from 200mg to 300mg this afternoon.  I specifically asked if I need a 50mg in the middle and he said no.  That said, I've both been at 300mg before, done the titration at a faster pace generally, and am currently in an emotional mess (not saying you aren't), so that may have influenced things.

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