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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Dinah on November 6, 2003, at 12:21:13
The neurologist who specializes in headaches tells me that she generally starts with lamictal for my type of headache. But that since I'm already on depakote for my cyclothymia she thought we might as well try going from 125 mg that I'm currently on to 500 mg that would be needed for migraine prophylaxis. I'm at 250 mg now, and I think it might be making me feel mildly depressed and a bit groggy. I guess it's hard to tell though, since my mood cycle includes that feeling. I also think I might be eating more, not good for my diabetes.
The more I think about it, the more I think that I might like to try Lamictal instead. Am I right in remembering that Lamictal also has anti-depressant effects as well as mood stabilization? I am rather constantly mildly depressed, so that appeals to me.
Does it affect norepinephrine or cause agitation?
Does it sound worth it to ask my neurologist if we can try that instead of upping the depakote?
Posted by SLS on November 6, 2003, at 19:37:58
In reply to Lamictal vs. Depakote, posted by Dinah on November 6, 2003, at 12:21:13
Hi Dinah.
I'm really not familiar with the usage of Lamictal for headache, however, I can attest the antidepressant properties of this drug. Unfortunately for me, it has provided only a mild improvement. I have observed that a great many people experience improvement of their depression early in treatment and at low dosages, only to find it necessary to increase the dosage, whereupon there is a plateauing of effect. I'm not sure how it might benefit someone with dysthymia, but I think it would be worth a try. Depakote can most definitely be depressogenic. That has been my own experience with it. There is a caveat regarding the combination of Depakote and Lamictal. Depakote causes blood levels of Lamictal to increase by a factor of at least two. The rule of thumb is to cut the daily dosage of Lamictal by half to compensate for this, and titrate more gradually to help prevent Stevens-Johnson's Syndrome and the development of serious rash. I have tried this combination and did not suffer any untoward reactions. It seems to me that you will increase your chances of receiving benefit to either condition by throwing both drugs at them.
I wish you luck. I hope this has helped.
- Scott
Posted by Dinah on November 6, 2003, at 20:41:39
In reply to Re: Lamictal vs. Depakote, posted by SLS on November 6, 2003, at 19:37:58
Yes indeed, Scott. Your answer was, as always, quite helpful. I'll talk to her about it at the next appointment. It sounds as if it's worth a try.
Posted by amy_oz on November 7, 2003, at 1:08:47
In reply to Re: Lamictal vs. Depakote » SLS, posted by Dinah on November 6, 2003, at 20:41:39
Hi,
Lamictal and Depakote are a safe combination if you know that Depakote increases the half life of lamictal by 2. This is not the same as doubling the dose.The half life is the time taken for half of the drug to be cleared by the body (or changed into something different).
So if you start with 200mg of Lamictal and the half life is 5 hours (for example I don't actually know the half life) then you have 100mg in the system after 5 hours.
After 10 hours you have 50 mg in your body. Everytime you go for another 5 hours you cut the previous dose by half. (this is an approximation only)
If you take Depakote and lamictal the half life is extended to 10 hours. So if you cut your dose of lamictal to 100 mg, after 10 hours you have still only 50 mg in your body.This is exactly the same amount as after 10 hours after taking 200mg at a 5 hour half life.
But at 20 hours at 200mg you have 12.5 mg left.
At 20 hours with depakote + lamictal you have 25 mg left.The difference is when you double the half life, the level of medication stays in your system for much longer.
You have to be more careful but you don't half to halve the dose.
Please check with your doctor before taking any action.AJ
Posted by Dinah on November 7, 2003, at 10:18:00
In reply to Re: Lamictal vs. Depakote, posted by amy_oz on November 7, 2003, at 1:08:47
Thanks. I'll definitely clear anything I do with my neurologist. I was thinking of using the Lamictal instead of Depakote. But I don't know. It may be worth a try, but it might also be better to wait till my slow season.
Posted by SLS on November 8, 2003, at 16:07:26
In reply to Re: Lamictal vs. Depakote » amy_oz, posted by Dinah on November 7, 2003, at 10:18:00
Here's an excerpt from the Lamictal monograph posted at rxlist:
http://www.rxlist.com/cgi/generic/lamotrigine_cp.htm
"Valproate decreases the apparent clearance of lamotrigine (i.e., more than doubles the elimination half-life of lamotrigine), whether given with or without EIAEDs. Accordingly, if lamotrigine is to be administered to a patient receiving valproate, lamotrigine must be given at a reduced dosage, no more than half the dose used in patients not receiving valproate (see DOSAGE AND ADMINISTRATION and PRECAUTIONS: Drug Interactions)."
Posted by Dinah on November 8, 2003, at 18:40:40
In reply to Re: Lamictal vs. Depakote, posted by SLS on November 8, 2003, at 16:07:26
This is the end of the thread.
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