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    Reader Question: Lamictal dosage (lamotrigine)

    I just received the following question from Janine:

    Julie,

    I was just prescribed Lamictal and doing a little research it seems most people are starting on 25 mg and slowly increasing. I have just started today…100mg a day for a week, and then I bump up to 200mg next week. Is this too much too soon?

    **

    Hi Janine,

    My coauthor Dr. John Preston as well as many of my doctor friends say that medication dosing is a fine science. For many, it’s a shot in the dark when you start.  There are definitely guidelines as to what drugs to use and at what dose, but so much depends on you and your background. Are you on any other drugs? Have you had trouble with drugs? Do you have more mania than depression?  How well does your doctor know your symptoms? etc….

    Starting at 25mg and then going up is called microdosing. Lamictal tends to have a lot of side effects which is why some prescribers suggest starting slowly. That’s what I did. I still had a lot of side effects, but I was able to tolerate a medication for the first time since being diagnosed. It is common to microdose with Lamictal.

    200 mg is the average dose, but it can be very different for everyone. I’m on 500mg, my mother is on 75mg.

    If you’re having too many side effects, then the dosage may be a problem. If you’re not, then the dosing may be fine.

    Another big question is your mood when you started the Lamictal. If you’re in a serious depression, your health care professional may want to reduce your depression quickly which is why you started on a higher dose.

    As you can see, there are many variables when it comes to meds.  Lamictal has been a miracle for me, but it’s not without it’s problems. My side effects come and go. If I miss doses, I have bad withdrawal. It took a few years for it to work as well as it does now. I have no regrets. I love this medication like a best friend!

    If you have concerns, it’s always fine to ask you medications professional for more of an explanation. It’s essential that you work with your doctor as a team- if you think about it, they work for you! Asking questions is fine.

    Julie

    PS: My coauthor Dr. Preston wrote a book called The Consumer’s Guide to Psychiatric Drugs. I can answer most of your psych med questions.

    Related posts:   Reader Question on Lamictal (Lamotrigine) |  Lamictal Side Effects: Reader Question |  Reader Question: Lamictal doses |





    2 comments to Reader Question: Lamictal dosage (lamotrigine)

    • Michael
      October 7, 2008 at 9:49 pm · Reply to this comment

      Janine,

      Familiarize yourself with the “package insert” for Lamictal… there is a very serious — though remote — potential for a side effect that requires mandatory discontinuation: the “Lamictal Rash.” This is believed to be avoidable by slow dose escalation.

      The formula provided in the package insert provides for a 5 week OR MORE escalation to your target dose:

      Weeks 1 and 2, 0.3 milligrams per kilogram of body weight, rounded down to the next smallest tablet.

      Weeks 3 and 4, 0.6 milligrams per kilogram of body weight, rounded down to the next smallest tablet.

      Weeks 5 and up, increase, every 1-2 weeks, by an additional 0.3 mg/kg and round down to the next smallest tablet, until the therapeutic dose is reached, or a maximum of 300mg, divided over two daily doses.

      Not medical advice, just quoting the manufacturer’s documents.

      http://us.gsk.com/products/assets/us_lamictal.pdf

      Looking back at my charts, this is what my doc did for the first month. 0.3 mg/kg in me is right at 25mg. I started there, went to 50 for 2 weeks… then actually went straight to 100, and on. I didn’t experience any notable side effects from Lamictal.

    • Marie Wallace
      November 13, 2008 at 4:26 am · Reply to this comment

      Thanks for posting all the Lamactill information. I took a 25mg tab and had horrid dreams that appeared in cartoon like pastel colors! Is that normall for a 25 mg dose? It frightened the heck out of me and I stopped taking the drug.

      I do not get manic, so I am beginning
      to wonder if I am bipolar ..!

      I read some info stating that Lamactil binds to the melanin in the iris and that the long term affects of this are unknown. Does anyone know anything about this?

      Thanks.

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