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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by PeterMartin on January 27, 2015, at 11:08:30
Hey.
After 5yrs of taking Marplan & Lamictal for Bipolar I/TRD I had to taper off and stop taking Marplan due insurance no longer covering it.
I know Lamictal levels are affected by most other medications and that both Marplan & Lamictal are broken down by the liver.
Is it more likely that ceasing Marplan would lead to a raise in Lamictal blood levels or a lowering?
It's been 2weeks completely off Marplan and while it hasn't been as bad as I thought Ive been quite depressed the last 3 days. At the same time I've noticed I've felt very itchy which I used to experience with Lamictal increases.
I'm just wondering if some of my depression this week could be due to changes in my Lamictal levels and not only the return of MAO. I only take 100mg of Lamictal as in recent trials higher dosages made me extremely fatigued (mid day map required). I took a little extra Lamictal mid day yesterday (maybe 20mg as I broke the tip off a Teva generic) and I do seem to feel better today (still in bed though).
Sorry for rambling but would it be more likely for Lamictal to be more effective/potent after removing Marplan or the other way around?
I know Marplan is uncommon even amongst the MAOIs. Id guess itd be someone similar to taking Nardil&Lamictal to Lamictal alome.
Thanks for any thoughts on this.
Posted by ed_uk2010 on January 28, 2015, at 4:10:25
In reply to Blood levels: Marplan + Lamictal vs Lamictal alone, posted by PeterMartin on January 27, 2015, at 11:08:30
> Hey.
>
> After 5yrs of taking Marplan & Lamictal for Bipolar I/TRD I had to taper off and stop taking Marplan due insurance no longer covering it.Do they cover any other MAOIs? If so, do you plan to switch?
>I know Lamictal levels are affected by most other medications....
By several, but not by most... by any means.
>Is it more likely that ceasing Marplan would lead to a raise in Lamictal blood levels or a lowering?
I couldn't find any evidence that this has been studied. Regarding the related Nardil, I found some evidence to suggest that Nardil does *not* inhibit the metabolism of Lamictal.
>I'm just wondering if some of my depression this week could be due to changes in my Lamictal levels and not only the return of MAO.
It's possible, but to be honest, I think the return of uninhibited MAO is far more likely to be the reason for depressive symptoms appearing.
Take care.
Posted by PeterMartin on January 28, 2015, at 8:03:35
In reply to Re: Blood levels: Marplan + Lamictal vs Lamictal alone, posted by ed_uk2010 on January 28, 2015, at 4:10:25
> > Hey.
> >
> > After 5yrs of taking Marplan & Lamictal for Bipolar I/TRD I had to taper off and stop taking Marplan due insurance no longer covering it.
>
> Do they cover any other MAOIs? If so, do you plan to switch?
>
> >I know Lamictal levels are affected by most other medications....
>
> By several, but not by most... by any means.
>
> >Is it more likely that ceasing Marplan would lead to a raise in Lamictal blood levels or a lowering?
>
> I couldn't find any evidence that this has been studied. Regarding the related Nardil, I found some evidence to suggest that Nardil does *not* inhibit the metabolism of Lamictal.
>
> >I'm just wondering if some of my depression this week could be due to changes in my Lamictal levels and not only the return of MAO.
>
> It's possible, but to be honest, I think the return of uninhibited MAO is far more likely to be the reason for depressive symptoms appearing.
>
> Take care.Ed,
Thanks a lot for the reply. I think an old writeup about Lamictal clearance from Crazymeds (now found here: http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/LamictalPharmacokinetics ) is what I've been ruminating over. It mentions how the half life/levels can vary greatly/etc due to interactions. Had I only gotten down and not gotten so itchy I probably wouldn't be questioning it but the itching has been noticable.
My insurance (CVS caremark) dropped Marplan Jan 1st and they don't cover any others in the class. I couldn't tolerate Parnate (spiked BP each dose). Nardil would be expensive but potentially doable out of pocket. The other alt would be having my doctor write a letter of medical necessity and see if I get continued coverage.
It's been a fairly good ~5yrs run on Marplan but since my living situation has improved (living w a longtime GF vs. parents / etc) I'm optimistic about trying to see where I'm at without. I did take Lamictal prior to adding Marplan and it generally did a good job of keeping me from getting too low even when my life was pretty lonely.
I haven't added anything for depression per say but my doc did OK a trial of the 5ht2c agonist Lorcaserin (Belviq). It's recently trialed & approved for weight loss in the US but may also have some positive affects of mood. Reviews on some forums for the med seem to support this. Even if not losing some of the weight I've put on from meds will prob help me feel better about myself overall, stick to eating better, and find exercise more rewarding. Down ~10lbs in 3wks (229 to 219 - 6' male 37y) - some loss could be from stopping Marplan too although the my weight gain has been about 10lbs per year since I've taken it.
So yea again so if this reads jumbled (typing on my phone) but appreciate the reply. It may be a bumpy couple months but yesterday was much better than the few days before......probably just need to give my body a few weeks to adjust / get consistent levels to see if Lamictal is sufficient on it's own at this point.
Posted by ed_uk2010 on January 28, 2015, at 12:18:36
In reply to Re: Blood levels: Marplan + Lamictal vs Lamictal alone, posted by PeterMartin on January 28, 2015, at 8:03:35
>I think an old writeup about Lamictal clearance from Crazymeds is what I've been ruminating over. It mentions how the half life/levels can vary greatly/etc due to interactions.
It can, and Lamictal does have quite a few interactions, but not with everything.
As far as I can tell, the potential for interaction with isocarboxazid has not received any study. Among the MAOIs, only the possibility of interaction with phenelzine, the most closely related drug, has been examined (minimally).
GSK, who manufacture Lamictal, list the interactions which have been studied:
http://www.medicines.org.uk/emc/medicine/4228#INTERACTIONS
'.....experiments also suggested that metabolism of lamotrigine was unlikely to be inhibited by..... phenelzine (Nardil)....'
>Had I only gotten down and not gotten so itchy I probably wouldn't be questioning it but the itching has been noticeable.You said you felt other symptoms at high lamotrigine levels before though, I think? You also mentioned feeling better when you took a bit extra lamotrigine yesterday.
I don't think you have anything to worry about with respect to lamotrigine levels. If you need to adjust lamotrigine you can do so in a few weeks' time but you should probably wait to find out how you do just by stopping isocarboxazid first. Due to the gradual increase in levels of active MAO, the full effects of stopping isocarboxazid will not appear straight away.
The fact that you've been on Lamictal long-term, with and without isocarb, suggests that the itching is not representative of anything serious. In addition, you're only on a fairly low dose. It doesn't sound like you have a rash. Perhaps it would help to take any antihistamine for a couple of weeks. Cetirizine 10mg per day would be suitable.
>My insurance (CVS caremark) dropped Marplan Jan 1st and they don't cover any others in the class. I couldn't tolerate Parnate (spiked BP each dose). Nardil would be expensive but potentially doable out of pocket. The other alt would be having my doctor write a letter of medical necessity and see if I get continued coverage.
If you do need to restart Marplan at some point, would you be eligible for the manufacturer's assistance scheme?
http://marplan.com/patient-assistance-program/
Glad to hear about the weight loss. It can be quite motivating :)
Take care.
Posted by zonked on January 28, 2015, at 23:59:05
In reply to Blood levels: Marplan + Lamictal vs Lamictal alone, posted by PeterMartin on January 27, 2015, at 11:08:30
> Hey.
>
> After 5yrs of taking Marplan & Lamictal for Bipolar I/TRD I had to taper off and stop taking Marplan due insurance no longer covering it.
>
> I know Lamictal levels are affected by most other medications and that both Marplan & Lamictal are broken down by the liver.
>
> Is it more likely that ceasing Marplan would lead to a raise in Lamictal blood levels or a lowering?
>
> It's been 2weeks completely off Marplan and while it hasn't been as bad as I thought Ive been quite depressed the last 3 days. At the same time I've noticed I've felt very itchy which I used to experience with Lamictal increases.
>
> I'm just wondering if some of my depression this week could be due to changes in my Lamictal levels and not only the return of MAO. I only take 100mg of Lamictal as in recent trials higher dosages made me extremely fatigued (mid day map required). I took a little extra Lamictal mid day yesterday (maybe 20mg as I broke the tip off a Teva generic) and I do seem to feel better today (still in bed though).
>
> Sorry for rambling but would it be more likely for Lamictal to be more effective/potent after removing Marplan or the other way around?
>
> I know Marplan is uncommon even amongst the MAOIs. Id guess itd be someone similar to taking Nardil&Lamictal to Lamictal alome.
>
> Thanks for any thoughts on this.Have you tried phenelzine (Nardil, which finally, has had a generic for the last several years)? Does your insurance cover it? It's not perfect, but it's been an importent component of my treatment for years now.
Marplan didn't do * for me when I tried it a few years ago..
-z
Posted by ed_uk2010 on January 29, 2015, at 10:03:27
In reply to Re: Blood levels: Marplan + Lamictal vs Lamictal alone » PeterMartin, posted by zonked on January 28, 2015, at 23:59:05
>Marplan didn't do * for me when I tried it a few years ago...
I get the impression Nardil is quite a bit more potent than Marplan.
I hope Peter does well on Lamictal alone, but if not, generic phenelzine might be effective, even at a low(ish) dose like 45mg-60mg/day.
This is the end of the thread.
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