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Re: Valproate + Lamictal for BP2-doses

Posted by SLS on July 28, 2006, at 11:20:41

In reply to Re: Valproate + Lamictal for BP2-doses, posted by C5 on July 28, 2006, at 9:59:53

> >
> > Generally speaking, you go with the dosage of Valproate that you think is best according to your doctor's experience and cut the dosage of Lamictal in half. If the target dosages of each drug separately would be Depakote 1500mg and Lamictal 200mg, the combination would result in dosages of:
> >
> > Depakote 1500mg + Lamictal 100mg
> >
> > If you are taking Depakote at the same time, you would need to start the Lamictal at a low dosage and raise it gradually to avoid provoking a dangerous rash reaction:
> >
> > 12.5mg x 2 weeks
> > 25mg x 2 weeks
> > 50mg x 1 week
> > 100mg
> >
> > * For the first 2 weeks, the current package insert says to take 25mg every other day. The original package insert said to take 12.5 each day. I don't know why the change was made.
> >
> >
> > - Scott
>
> thanks Scott for your prompt reaction ;
> I have well understood your point as far as the Lamictal doses are concerned,but a little bit surprised about the dose exemple you have provided for the Valproate,as I am on just 600mg Orfiril(Long) known to be a "typical" dose for a soft bipolarity(Cyclothimia)?! what is your opinion? does it seem to you being too low?


I really haven't looked into it enough to form an opinion. I see that there is some thought that low dosages are sufficient to stabilize mood in cyclothymia.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8331092&dopt=Abstract

I think it depends on how much of a problem mania is. Acute manic episodes usually require dosages of 1000mg and higher. I believe blood levels are usually kept in the range of 50-100 mcg/mL for prophylaxis. That probably translates into a dosage range of 750-1500mg.

I am guessing from your questions that valproate 600mg monotherapy is not sufficient to treat your condition. Are you a rapid cycler? Can you describe your cycle and symptoms?


- Scott

 

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