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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 34 to 58 of 69. Go back in thread:
Posted by Sigismund on April 18, 2008, at 19:02:04
In reply to Increased to 50mg, posted by Quintal on April 18, 2008, at 13:16:01
>my neuropathic pain has almost vanished
You want to speak a little more about your neuropathic pain?
I don't really know what questions to ask.
Posted by Quintal on April 19, 2008, at 7:22:12
In reply to Re: Increased to 50mg » Quintal, posted by Sigismund on April 18, 2008, at 19:02:04
Well I don't know whether it is neuropathic pain for sure because I've never been diagnosed with anything, but then the doctors haven't taken it seriously. It's general nerve pain, as if the nerve endings are sore and inflamed (or perhaps hyper excitable?). Tactile allodynia seems to be a good match - extreme sensitivity to light touch, as if my skin is raw and burnt. I also get a lot of joint pain, perhaps from early onset arthritis like both my parents. Anywyay, it's much improved since starting lamotrigine. Within an hour of taking the first dose my skin started tingling and the raw feeling went away. I can still feel a certain amount of joint pain, but it manifests as more of a cold metallic feeling than actual pain.
Q
Posted by bulldog2 on April 20, 2008, at 16:29:18
In reply to Re: Increased to 50mg » Sigismund, posted by Quintal on April 19, 2008, at 7:22:12
> Well I don't know whether it is neuropathic pain for sure because I've never been diagnosed with anything, but then the doctors haven't taken it seriously. It's general nerve pain, as if the nerve endings are sore and inflamed (or perhaps hyper excitable?). Tactile allodynia seems to be a good match - extreme sensitivity to light touch, as if my skin is raw and burnt. I also get a lot of joint pain, perhaps from early onset arthritis like both my parents. Anywyay, it's much improved since starting lamotrigine. Within an hour of taking the first dose my skin started tingling and the raw feeling went away. I can still feel a certain amount of joint pain, but it manifests as more of a cold metallic feeling than actual pain.
>
> QInteresting I got that same sensation from neurontin..
Posted by bulldog2 on April 20, 2008, at 16:30:17
In reply to Starting Lamictal, posted by Quintal on April 11, 2008, at 12:02:41
> I just got back from my pdoc appointment. I saw his understudy today and he agreed that Lamictal was a good choice since it worked well in the past. He refused Parnate for now because he wants to discuss it with pdoc in chief, since it's such a powerful drug and all. He made an appointment for me to see Big pdoc in two weeks, which is very fast for the NHS. In the meantime I'm supposed to be titrating up to 100mg of Lamictal, but I think the titration rate he's given me is much too fast. Now I'm wishing I'd said something at the time, because the patient information leaflet says to alert the doctor if you've ever had a rash during previous lamotrigine treatment, and I got a rash on each occasion I tried Lamictal.
>
> I can't remember for sure, but I think I started on something like 12.5mg the first time, and I got a rash even on that low dose. This pdoc advised me to start on 50mg tonight, then move up to 100mg tomorrow. I'm really not happy about that, but I'm afraid of being perceived as 'difficult' if I don't take the dose he has prescribed. This is what held me back from saying anything during the appointment. In any case, it's Friday evening now and they'll be closed, so I can't even ring the mental health team for advice. I'll either have to wait till Monday, risk taking the full 50mg (don't think I'll dare raise it to 100mg until I'm sure I'm having no reaction to 50mg), or split a 50mg tablet into halves, or even quarters. Decisions, decisions....
>
> QDid tianeptine hlep with your neuropathic pain?
Posted by Quintal on April 20, 2008, at 16:35:47
In reply to Re: Starting Lamictal, posted by bulldog2 on April 20, 2008, at 16:30:17
Yes, tianeptine eased the pain. Not quite as well as lamotrigine though.
Q
Posted by yxibow on April 23, 2008, at 2:35:33
In reply to Re: Starting Lamictal, posted by undopaminergic on April 13, 2008, at 2:14:25
Anybody can get Seborrheic Dermatitis at any time from reactions to soap or brushing or getting scratched by plants or even anxiety syndromes.
Taking Lamictal at the same time may bring on the thought that it is connected but correlation does not always imply causation.
However if one has had a substantial rash (not a small seb derm) on one's arm on a previous trial, then caution will robinson as for trying it again. A lot of doctors would say no.
But as a lot of posters have said, the titration is way too large -- it is always done slowly to offset Stevens-Johnsons Syndrome. 25 for two weeks and then 50 for two weeks and then maybe faster at 100 and 150 and 200, etc.
-- tidings
Posted by Quintal on April 23, 2008, at 11:01:57
In reply to Rash and restarting Lamictal and dosage, posted by yxibow on April 23, 2008, at 2:35:33
I saw him yesterday and told him I was only taking 50mg as the dose his understudy prescribed was far too much. He seemed okay about it and advised me to either go up to 75mg at the enxt increase, or up to 100mg, whichever I thought best. He's aiming for 150mg as the therapuetic dose.
The downside is that he didn't want to prescribe an antidepressant because we wouldn't know which drug was doing what. Right now I wouldn't be bothered, so long as the combo worked :-(
Q
Posted by yxibow on April 23, 2008, at 15:55:06
In reply to Re: Rash and restarting Lamictal and dosage, posted by Quintal on April 23, 2008, at 11:01:57
> I saw him yesterday and told him I was only taking 50mg as the dose his understudy prescribed was far too much. He seemed okay about it and advised me to either go up to 75mg at the enxt increase, or up to 100mg, whichever I thought best. He's aiming for 150mg as the therapuetic dose.
>
> The downside is that he didn't want to prescribe an antidepressant because we wouldn't know which drug was doing what. Right now I wouldn't be bothered, so long as the combo worked :-(
>
> Q
This is correct -- you don't add two things at once because you'll never know what actually worked. My doctor does the same thing.It's your body and doctor so I can't interfere, but seriously, it is the protocol from what I have heard from another person who is taking far more Lamictal that you ease up by 25s to begin with.
Not to be a scaremonger but you don't want to cook your insides. SJS is one of those intensive-care-at-best scenarios. Yes, I still think about it, but we've now established at 100 for some weeks that I dont react so we've gone up more quickly.
Anyhow, good luck--tidings
Posted by henryo on April 23, 2008, at 16:38:33
In reply to Re: Starting Lamictal » dbc, posted by Quintal on April 11, 2008, at 14:44:09
1 in ten? I don't think so.
Posted by Quintal on April 23, 2008, at 18:25:24
In reply to Re: Starting Lamictal, posted by henryo on April 23, 2008, at 16:38:33
What do you think then?
Q
Posted by Phillipa on April 23, 2008, at 22:02:33
In reply to Re: Starting Lamictal, posted by Quintal on April 23, 2008, at 18:25:24
Q I agree with xiybow. Knows his stuff. Love Phillipa
Posted by henryo on April 24, 2008, at 4:28:43
In reply to Re: Starting Lamictal » Quintal, posted by Phillipa on April 23, 2008, at 22:02:33
List some sources / links, It is nowhere near one in ten.
Posted by undopaminergic on April 24, 2008, at 5:57:00
In reply to Re: Rash and restarting Lamictal and dosage » Quintal, posted by yxibow on April 23, 2008, at 15:55:06
> >
> > The downside is that he didn't want to prescribe an antidepressant because we wouldn't know which drug was doing what. Right now I wouldn't be bothered, so long as the combo worked :-(
> >
> > Q
>
> This is correct -- you don't add two things at once because you'll never know what actually worked. My doctor does the same thing.
>It may be a good idea to use a faster acting drug along with a slow one (eg. SSRI + stimulant). You can always find out which ones are important by removing them one at a time later. This may not be a bad idea anyway as people too often end up taking cocktails where no-one knows what's essential or superfluous. On the other hand, some may not care about such details and prefer to leave a working combination alone.
Posted by Quintal on April 24, 2008, at 8:48:24
In reply to Re: Starting Lamictal, posted by henryo on April 24, 2008, at 4:28:43
I think I got the 1 in 10 figure from here:
____________________________________________________
Dermatological Events (see BOX WARNING, WARNINGS)
Serious rashes associated with hospitalization and discontinuation of LAMICTAL have been reported. Rare deaths have been reported, but their numbers are too few to permit a precise estimate of the rate. There are suggestions, yet to be proven, that the risk of rash may also be increased by (1) coadministration of LAMICTAL with valproate, (2) exceeding the recommended initial dose of LAMICTAL, or (3) exceeding the recommended dose escalation for LAMICTAL. However, cases have been reported in the absence of these factors.
In epilepsy clinical trials, approximately 10% of all patients exposed to LAMICTAL developed a rash. In the Bipolar Disorder clinical trials, 14% of patients exposed to LAMICTAL developed a rash. Rashes associated with LAMICTAL do not appear to have unique identifying features. Typically, rash occurs in the first 2 to 8 weeks following treatment initiation. However, isolated cases have been reported after prolonged treatment (e.g., 6 months). Accordingly, duration of therapy cannot be relied upon as a means to predict the potential risk heralded by the first appearance of a rash.
Although most rashes resolved even with continuation of treatment with LAMICTAL, it is not possible to predict reliably which rashes will prove to be serious or life threatening.
http://www.rxlist.com/cgi/generic/lamotrigine_wcp.htm
__________________________________________________So according to this source, in bipolar trials 14% of patients developed a rash - slightly more than 1 in 10.
Q
Posted by Quintal on April 24, 2008, at 9:00:05
In reply to Re: Rash and restarting Lamictal and dosage, posted by undopaminergic on April 24, 2008, at 5:57:00
I'm not really bothered right now about knowing precisely what drug is doing what. If I were in a clinical trial that would be the priority, but sometimes a patient's suffering should take precedence over the meticulous gathering of scientific evidence. I don't want to watch months of my life disappearing down the plughole just so my pdoc knows for sure what is doing what, although I do agree this is the scientifically correct method of gathering information. I'm taking so much stuff he doesn't know about that whatever evidence he thinks he's gathering is invalid anyway.
I really needed an antidepressant this week because I ran out of tianeptine, but now I'll have to wait at least six weeks to get a second chance, and even then... It was a blow to say the least.
Q
Posted by henryo on April 24, 2008, at 18:36:28
In reply to Re: Starting Lamictal » henryo, posted by Quintal on April 24, 2008, at 8:48:24
Read your own link- it says .03 percent, 11 people out 3,480
NOT 1 in 10
Posted by Quintal on April 24, 2008, at 19:14:36
In reply to Re: Starting Lamictal, posted by henryo on April 24, 2008, at 18:36:28
I don't know why you're continuing with this, but yes, I did read my own link and it does say that 10% of patients in the epilepsy trials developed a rash. 10% is 1 in 10. It also says that 14% of bipolar patients developed a rash, making that slightly higher than 1 in 10.
The figure you quoted at the beginning of the article however, only relates to the incidence of *serious rash* associated with hospitalization and discontinuation from Lamictal. This is *not* the overall incidence of benign rash among Lamictal patients - only the most serious ones. The overall incidence of rash is much higher, and these stats are posted further down under 'Dermatological Events'. I'll post them again:
__________________________________________________In epilepsy clinical trials, approximately 10% of all patients exposed to LAMICTAL developed a rash. In the Bipolar Disorder clinical trials, 14% of patients exposed to LAMICTAL developed a rash.
__________________________________________________
Q
Posted by Quintal on April 25, 2008, at 12:44:00
In reply to Increased to 50mg, posted by Quintal on April 18, 2008, at 13:16:01
I decided to go for the 75mg dose instead of leaping up to 100mg. It seems to be making me feel tired. I had to go and have a lie down earlier, also a few cognitive side effects, but hopefully they'll go away in a few days.
Q
Posted by henryo on April 25, 2008, at 19:34:06
In reply to Re: Increased to 75mg, posted by Quintal on April 25, 2008, at 12:44:00
Where I am going is offering factual information about the incidence of rashes at .03 percent, NOT 8 percent or your previous claim of 10 percent. Lamictal is a great med. Some people insist on scaring others away from using it.
Use the google button on your internet machine, enter-
"lamictal rash percentages"
you will get a few hundred if not a thousand hits
http://www.psycheducation.org/depression/meds/LamRash.htm
http://www.pslgroup.com/dg/eb8ea.htm
The incidence of these rashes, which have included Stevens-Johnson Syndrome, is approximately one percent in pediatric patients (age less than 16 years old) and 0.3 percent in adults. In world-wide post-marketing experience rare cases of toxic epidermal necrolysis and/or rash-related death have been reported, but their numbers are too few to permit a precise estimate of the rate.
Posted by Quintal on April 25, 2008, at 20:41:34
In reply to reality, posted by henryo on April 25, 2008, at 19:34:06
I don't understand why you're holding me personally to account for the statistics printed on a webpage. These are not my own person claims on the incidence of Lamictal rash, not some wild figure I just picked out of hat. Something doesn't seem to be registering here. As I explained, according to the website the one in ten figure is the overall incidence of benign non-serious rash, which seems to be fairly common. The smaller figures are serious SJS-like reactions, which are very rare. It's as simple as that.
Again, I find even on the weblinks you provided, the 0.3% rate you quoted is only for serious rash. Further down he has a chart showing the overall incidence of rash, which is as high as 13% in one dosage range. As the author says below, using slow titration methods they managed to lower the incidence of *benign* rash (author's emphasis) to 3%, as opposed to the typical rate of 10% (1 in 10) usually found in other research studies. There were no *serious* rashes in this group studied.
__________________________________________________
Thus my main strategy on "handling the rash" is to try to avoid it in the first place. [Update 5/2005: Stanford's Bipolar Clinic, led by Dr. Terry Ketter, published their results from a strategy in which they warned patients not to add any new allergens: no new soaps, detergents, cosmetics, shaving creams, deodorants, etc; no new foods; and avoiding sunburn or poison oak. They also waited to start if the patient had recently had a rash, symptoms of a viral infection, or a rash. Using this strategy, they lowered the benign rash rate -- there were no serious rashes in this group of 100 patients -- to 3%, versus the common 10% rate for rash in other lamotrigine research studies.Ketter][Update 2008: when they repeated that strategy with the pharmacist giving the skin instructions, the difference in rash rates was not significant.Ketter (b) Ketter says he still gives the same instructions, despite those data.]
http://www.psycheducation.org/depression/meds/LamRash.htm
__________________________________________________Also, the paragraph above the one you cut & pasted from this webpage (http://www.pslgroup.com/dg/eb8ea.htm) quotes these statistics:
__________________________________________________Nine clinical trial participants discontinued due to rash, seven out of 129 in the lamotrigine group and two out of 66 in the placebo group, although none of the rashes were considered serious nor did patients require hospitalisation.
__________________________________________________So, if we take 7, divide it by 129, multiply the result by 100, that gives us 5.42% for the incidence of benign rash in the lamotrigine group of this study. You seem to have omitted the part that distinguishes between benign and serious rash - indeed you left out the statistics for benign rash altogether.
I'm getting sick of this subject. I had no intention of sparking such a debate when I quoted the figures in my original post, nor was I trying to scare people away from taking lamotrigine. It was just an innocent comment. I never expected it to receive this much scrutiny.
Q
Posted by elanor roosevelt on April 25, 2008, at 22:15:30
In reply to Re: Increased to 75mg, posted by Quintal on April 25, 2008, at 12:44:00
I also chose to up to 75mg rather than the 100mg
i'm thinking perhaps a week to ease into the 100
Posted by yxibow on April 26, 2008, at 0:41:22
In reply to Re: Increased to 75mg, posted by Quintal on April 25, 2008, at 12:44:00
Notice it says "in the first 2 to 8 weeks". This is why Lamictal is titrated slowly. 25mg for 2 weeks, 50mg for 2 weeks, 75mg for 2 weeks, 100mg for 2 weeks. At 100mg if any substantial rash was going to happen it would be extremely low.
This is how psychiatrists and other dispensers of Lamictal dispense Lamictal. Because anything leading towards SJS is not viable.
Posted by undopaminergic on April 26, 2008, at 6:53:15
In reply to Lamictal Rashes » henryo, posted by Quintal on April 25, 2008, at 20:41:34
Are there any data on whether giving lamotrigine with non-sedating antihistamines (e.g. cetirizine, loratadine, fexofenadine) affects the incidence of rash (whether benign or otherwise)?
Posted by Quintal on April 26, 2008, at 10:54:27
In reply to Re: Rashes and Lamictal, posted by yxibow on April 26, 2008, at 0:41:22
I know, but both my pdocs have told me it will be okay to go up to 150mg as fast as I want because I've taken it before. I don't trust this advice because I got a rash on each occasion I tried Lamictal, but for some reason this doesn't seem to register with them - that yes, I have taken Lamictal in the past, but it wasn't okay. They're starting to imply I'm being deliberately difficult for going at a slower rate than they'd prescribed, just like I thought they would. I'm caught in yet another double-bind scenario. That type that can drive people mad.
Same thing with the Lamictal insomnia, I told them I got this side effect last time I took it, and I'm having it again this time. As I was leaving he said "Lamictal will help you sleep better". He just isn't listening to me, but then he never did. It's as if they think I'll be gulled into believing whatever they say just because they're qualified.
Q
Posted by elanor roosevelt on April 26, 2008, at 12:22:25
In reply to Re: Rashes and Lamictal » yxibow, posted by Quintal on April 26, 2008, at 10:54:27
Lamictal titration is normally a doubling of dosage
25mg, 50mg,100mg
according to what i have read
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