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Masterjen

Max. allowable dose of lamictal

In scanning several threads, I've noted that many people are on fairly high doses of lamictal (whether or not combined with other drugs). The highest dose I've read about so far in this forum is 450 mg. I am currently on 200 mg, and potentially will be increased to 250 - 300 mg. I've read that at doses of 300 mg. and higher that lamictal is being used as a med for bipolar (and perhaps depression, but I'm not sure). I definitely don't have either of those conditions, and probably none of you taking these higher doses does either. This leads me to the following questions:

1. What is the max allowable dose of lamictal?

2. Do higher levels of lamictal offer even greater seizure control? PLEASE correct me if I'm wrong, but I thought lamictal's effectiveness for controlling seizures "plateaued" once you reached 300 mg, and that's why at these higher doses it is considered a bipolar drug rather than an AED.

Thanks in advance for any help!

Comments

Re: Max. allowable dose of lamictal

I'm not sure but I am on 400 Lamictal XR for CP seizures (not for bi-polar or depression). I've read of persons on this forum taking 600 or even 800 mg.  

Max. allowable dose of Lamictal

My doctor would not give me more than 400 mg a day,and he told me that my last dose should be @ 4:00 PM because Lamictal he said is like coffee,and if we take it late,we can not sleep.

Re: Max. allowable dose of lamictal

I can only tell you what I've been told by my doc. At its lowest level, Lamictal is an anti-anxiety drug. At its next level, it's an anti-anxiety and anti-seizure med and theoretically, beyond that, it's for bipolar people.

I'm at 300MG, possibly changing to 400MG. Just because I've been having a lot of accidents (falling down the stairs, etc.) that have led to dire consequences.  (I have stictches in BOTH legs!)  But I think 400MG is supposed to be the limit of effectiveness.  At least as far as I know.

And I do have life-long clinical depression. I think Lamictal helps with that, but I'm not sure, because the Lamictal is supplemented with Klonopin, another anti-anxiety, anti-seizure med.

It's always good to hear from you.  Hope you're faring well.     Phylis Feiner Johnson   www.epilepsytalk.com

 

Re: Max. allowable dose of lamictal

Hi there:

I've been taking 450 mg of Lamictal for 7 years--and I'm definitely not bipolar!. Around that that time of month I add one more, 600mg in total. It seems to work well since my seizures are mostly catmenial.

Teresa

Re: Max. allowable dose of lamictal

My name is Shawn. I am a Nurse and EMT in East Texas. I have seizures as well and can help you out with your concerns. I can tell you that the recommended maximum dosage for lamictal is 500 mg. The large group of neurologists I work with have told me that the dosage that a patient is put on depends on several factors. The two main factors in determining the proper dosage are weight and metabolism. One example I can give (as the neurologists have told me) is that a 21 year old athlete will most likely have to have a larger dose than 45 year old office worker. The key to that is the athlete burns more calories much quicker, so the body will get rid of the medication much quicker and be out of the therapeutic range as well. If you are on your feet a bunch or are still young, that may be the main key to increasing the dose. The blood serum tests are really the only way to determine if you are staying within the therapeutic range on your dosage.

I can tell you I am a good example though of using medication over the recommended maximum dosage. I am on Carbatrol and Keppra. I take 5000 mg of Keppra daily whereas the maximum recommended dosage is 3000 mg/day. My blood tests were showing that the 3000 mg/daily was getting me nowhere near the therapeutic range. They had to raise it to 5000 mg/day and I have actually had better control of my seizures than I have in over 17 years. The main key to the dosage though is what the blood serum tests show to determine if you are within the therapeutic range and if you can tolerate the side effects (if there are any). I wish you the best of luck. If you have any questions, feel free to e-mail me.

Re: Max. allowable dose of lamictal

I'm not sure what max is by itself, but I was taking 800mgs daily. That was combined with 4000 mgs Keppra and 400 mgs carbatrol also at the time. I'm not sure if the doctors know when to say when though. I also took another anti-depressant too. I started vomiting...I could'nt hold it down. By doctors not knowing the limits, mine tried to add another 1000 mgs Keppra to my 4000mgs that I take.5000 mgs which is not humanly possible to hold down of that medicine on top of everything else. I was an emotional wreck in tears non-stop and sick to my stomach. I called hospital to complain ,left a message with a nurse and got a call back immediately. It was a colleague, another neurologist yelling at me for taking that much keppra. He said what do you think you are doing on this much Keppra and I said why don't you make a phone to your "buddy" that works down the hall from you and ask him. He wrote the script. and incisted that I needed. I don't know these doctors all push it and push it some more. Take a good look at the watches they wear and other jewelry,cars....it's all kick backs from the pharmacuetical companies for the meds they write scripts for. Your at the right place though you take all the responses and it gives you an idea what the max close to.

 Take care , Johnny      

Re: Max. allowable dose of lamictal

I'm taking 800mg of Lamictal and 3000mg of Keppra per day. I'm nauseated and dizzy all the time, even tough they told me I'd get used to it. I haven't had a seizure since surgery in June. They say I can get off at least one of the meds in 2 years. I can't wait.

Re: Max. allowable dose of lamictal

I used to take Keppra but only 500mg a day. I feel sorry for those guys taking 3000+ because I think Keppra worsened my depression and made me drowsy, though it did seem to somewhat control my seizures. It made them come monthly for one week, exactly like a girl's monthly cycle, and it was only deja vu, no full seizures.

I'm taking 800mg of Lamictal a day and I don't think it's controlling my seizures very well. I still get deja vu monthly and lately they've been growing into full seizures. Though I think it's got rid of my depression but that could have gone away on it's own; I had very good reasons to be depressed (within one year my girlfriend broke up with me, my mom died, my grandma died, and I fell out of tree puncturing a lung and a kidney) Though I still think it could be they Lamictal keeping me happy. I can't think of much reason to be happy yet I don't have any reason to be depressed, but, hence the user name, Lamictal may be making me so happy it makes me cry.

Since this past seizure I've been put on Vimpat and Potiga along with the Lamictal. Anybody else got some experience with those drugs they can tell me about?

Re: Max. allowable dose of lamictal

Would love to hear how you find the Vimpat.
Since my initial post: I was taken off lamictal about a year ago and put on a combo of tegretol and keppra, fairly low doses of each due to side effects if doses too high (double vision on tegretol and worsening of seizures on keppra). They aren't controlling the seizures, and dr, wants to try me on combo with vimpat. Not sure yet which one she is going to take me off of, tegretol or keppra. Anyway, it is always a bit unsettling to start an entirely new med. Let me know how you do!

Re: Max. allowable dose of lamictal

I have been taking th maxium amount of Keppra for many year. When they came out with the generic I wanted to try it and my neuros assistant was against it, However my neuro asked if I would mind trying it. I have used 4 different generic keppras and they have all worked well. I was having a higher seizure count than I liked and talked to him about it and I told him I thought it might have been the generic I was taking. He excuesed himself and went out and checked files. When he came back he said he didn't think it was the generic keppra which gave me the increase in seizures. I told him that the last 3 months I had had more seizures. He also said I had not been in drug studies for those 3 months and the 1 1/2 years I had been in studies I was taking a new medicine which is why the count was down. He added vimpat to the keppra I tak and now the seizure count is lower and the time in th seizure and focus time are also down. 750mr 3 morning and evening of keppra and 100 mg vimpat morning and night. I see him nexy month and will be taking my diary. I have been on this combination for 2 1/2 months plus the time to get to th dosagee he wants me on.

Vimpat has been good and it is made by the same company as keppra. The only side effects I have had were while getting up to the dosage and that was blurded vision which lasted a few seconds. twice

Re: Max. allowable dose of lamictal

I am on that same combination: Vimpat, Potiga and Lamictal.I take everything 3 times a day. I am on a boatload of Lamictal (800mg), pretty much at the max of Vimpat (600mg), and at adose of Potiga that still has a lot of wiggle room to increase if need be (450mg).

These have been good drugs for me.

Lamictal was the second drug I was started on after Tegretol wasn't working very well when I was first diagnosed in high school. It doesn't seem to help much unless it is at such a high dose, but it is tough to deal with the drugginess.

I had a beautiful honeymoon period on Vimpat (3 months- a record), then the seizures came back but a little less often.

Potiga has been great. In four months, I have had two seizures, and they were much less severe (I have secondarily generalized). Instead of being wasted all day the next day, I feel a little better, and can do some stuff.

Potiga looks promising.

But with this combination, for an hour or so an hour after I take each dose, three times a day, I get really "druggy." Blurry vision, a little bit clumsy, and absolutely lusting for sleep.

BUT- it's getting better.

Re: Max. allowable dose of lamictal

I'm currently on 800mg of the XR. It works well and I know that it is above the "recommended" dose. I'm curious who "recommends" such things. But I can attest that I'm not bipolar and that the XR has allowed me to live a life of monotherapy. Less pills has been good.

Re: Max. allowable dose of lamictal

I recommend looking at scientific studies conducted on a few thousand patients by the NIH (National Institute of Health) and the NIMH (National Institute of Mental Health), both government agencies that do not accept advertising dollars from drug manufacturers. Even though they are government agencies, they offer consistent advice like that found in most non-governmmental websites which do not take advertising dollars from drug manufacturers insofar as I can tell.
Like most AEDs, someone with Bipolar Disorder cannot handle the higher dosages that someone with E (but no BP) can handle. I ersonally know someone on 800mg Lamictal. I was on 400mg Lamictal (I have BP and E) and it was ineffective for E but at even 200mg was my best med ever for BP. When I was raised to 400mg, due to blurry vision, I thought two was three and for a time was taking 600mg Lamictal. My seizures went away but the side effects were aggregious. At least in my case I really could not tolerate more than 400mg Lamictal for E.
Research is better than word of mouth. And I think neurologists guess, and are leary about prescribing anything above recommended levels for fear of lawsuits in case something bad should happen.
Good luck!
Little Sparrow

Re: Max. allowable dose of lamictal

i CURRENTLY AM ON 600 DAILY OF LAMICTAL AND 2700 DAILY OF GABAPENTIN. tHE SEIZURE HAVE LIGHTENED IN SEVERITY BUT ARE STILL HAPPENING 3 TIMES A WEEK. THE GAB JUST GIVES ME A HIGH FEELING AND WOULD RATHER TAKE SOMETHING ELSE. DOES ANYONE HAVE ANY RECOMENDATIONS