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Lamictal And Estradiol


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#1 tamagotchi

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Posted 17 February 2011 - 09:24 PM

My obgyn put me on Vivelle once a month for PMS migraines. It is a patch that releases 0.025mg estradiol per day for 3 1/2 days. My obgyn said 0.025mg is a tiny amount and should not make any difference to the effectiveness of my meds, but I know I am sensitive to small changes in my lamotrigine level. I have read that estradiol lowers lamotrigine levels, and found some abstracts for studies, but I could not figure out how much estradiol was used in the studies.

Maybe one of the fabulous crazymeds medical researchers would like to help me find this information?
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#2 Jerod Poore

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Posted 18 February 2011 - 04:27 PM

It is a patch that releases 0.025mg estradiol per day for 3 1/2 days. My obgyn said 0.025mg is a tiny amount and should not make any difference to the effectiveness of my meds, but I know I am sensitive to small changes in my lamotrigine level. I have read that estradiol lowers lamotrigine levels, and found some abstracts for studies, but I could not figure out how much estradiol was used in the studies.


The pharmacokinetic and pharmacodynamic consequences of the co-administration of lamotrigine and a combined oral contraceptive in healthy female subjects 0.030mg ethinylestradiol: amount of Lamictal effectively halved.
Oral Contraceptives Induce Lamotrigine Metabolism: Evidence from a Double-blind, Placebo-controlled Trial 0.035mg ethinylestradiol: measured after women stopped taking birth control, Lamictal levels shot up by 84%.

0.025mg is not "tiny" when it comes to estradiol. 3.5 days is another matter. You may not be taking it long enough at any one time to make a significant difference.
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
Past meds (likely incomplete): Abilify, clonazepam, desipramine, diazepam, Gabitril, lithium, Neurontin, Paxil, prochlorperazine, Provigil, Prozac, Risperdal, Seroquel, Serzone, Strattera, Trileptal, Zyprexa

#3 tamagotchi

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Posted 18 February 2011 - 06:57 PM

Thanks very much Jerod. I really appreciate the links and info about amounts. I also asked my pdoc and I'm surprised she did not mention this.
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#4 vulgarityfilteroff

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Posted 20 February 2011 - 09:52 PM

Awesome... I'm on Zovia 1/50E and it's got 1 mg of ethynodiol diacetate and 50 mcg of ethinyl estradiol. I have to wonder how much Lamictal I'm actually getting.
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#5 notfred

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Posted 20 February 2011 - 10:05 PM

Awesome... I'm on Zovia 1/50E and it's got 1 mg of ethynodiol diacetate and 50 mcg of ethinyl estradiol. I have to wonder how much Lamictal I'm actually getting.



Is the Lamictal working OK for you ?

nf
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I am in full remission (296.36) from Depression. Insomnia, ADHD-PI, Epilepsy, and the Pseudoparkinsonian tremor are well controlled.

 

Psyc Meds: Forfivo XL 450 mg (Wellbutrin XL), Abilify 15 mg, (Aripiprazole), Eszopiclone 6 mg (Lunesta), Vyvance 70 mg, (Dextroamphetamine) Levetiracetam 2,000 mg (Keppra), Propranolol ER 60 mg (Inderal)
PRN: Lorazepam 1-4 mg (Ativan), Alprazolam 1-2 mg (Xanax), Dextroamphetamine 10-40 mg (Dexedrine), Propranolol 20-40 mg (Inderal), Ondansetron 8 mg (Zofran)

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I also take allergy and diabetes + it's complications meds.

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#6 vulgarityfilteroff

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Posted 20 February 2011 - 10:11 PM


Awesome... I'm on Zovia 1/50E and it's got 1 mg of ethynodiol diacetate and 50 mcg of ethinyl estradiol. I have to wonder how much Lamictal I'm actually getting.



Is the Lamictal working OK for you ?

nf



Not in the slightest. I just moved up from 150mg/day to 200mg/day this past week after a month of trials on Adderall XR and now Ritalin. I thought for sure it was the stims causing my mood swings and anger, but my dr. didn't seem as concerned with them as he was with my Lamictal dosage. We knew when I started Zovia that it would potentially jack with Lamictal (or rather, how I would deal with it), but we did the wait-and-see thing. Turns out we waited and saw a little too late.
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#7 Jerod Poore

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Posted 23 February 2011 - 03:22 PM

Awesome... I'm on Zovia 1/50E and it's got 1 mg of ethynodiol diacetate and 50 mcg of ethinyl estradiol. I have to wonder how much Lamictal I'm actually getting.


Not in the slightest. I just moved up from 150mg/day to 200mg/day this past week


Based upon the studies I posted, a couple others, and your latest post, probably the equivalent of around 100mg of Lamictal a day.

You may as well be taking Tegretol. I don't know why GSK doesn't include estrogen-based birth control in its green starter kit. The evidence is there.
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
Past meds (likely incomplete): Abilify, clonazepam, desipramine, diazepam, Gabitril, lithium, Neurontin, Paxil, prochlorperazine, Provigil, Prozac, Risperdal, Seroquel, Serzone, Strattera, Trileptal, Zyprexa

#8 vulgarityfilteroff

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Posted 23 February 2011 - 06:59 PM

Awesome... I'm on Zovia 1/50E and it's got 1 mg of ethynodiol diacetate and 50 mcg of ethinyl estradiol. I have to wonder how much Lamictal I'm actually getting.


Not in the slightest. I just moved up from 150mg/day to 200mg/day this past week


Based upon the studies I posted, a couple others, and your latest post, probably the equivalent of around 100mg of Lamictal a day.

You may as well be taking Tegretol. I don't know why GSK doesn't include estrogen-based birth control in its green starter kit. The evidence is there.


Thanks, that's what I was afraid of. I found this post in which a woman had to go all the way up to 600mg to stabilize, went down to 300mg because 600 was scary, then became symptomatic again. Interesting stuff.
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#9 tamagotchi

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Posted 23 February 2011 - 07:46 PM

I did try the Vivelle patch and got hypomanic, but don't know if it was the effect of estrogen itself, or lowered lamotrigine levels. Either or both could be the case, as I know that I am sensitive to hormone levels as well as lamotrigine levels.

However the patch did seem to prevent the PMS migraine, I did not have one this time. I think I will experiment again next month with cutting the patch in half and see if the reduced amount helps without destablizing me.

Edited by tamagotchi, 23 February 2011 - 07:49 PM.

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#10 In_Remission_grumpygramma

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Posted 29 April 2011 - 03:58 AM

I'm just a newbie here but thot I would mention that I started Lamictal yesterday and the doctor said since I was on estradol/norethindrone patch(.25mg a day)my Lamictal dose should be started low. She seemed to think that Lamictal dose should always be lower while on the patch. I'll ask her more about this when I see her Wednesday.
Am I crazy (lol) or is the opposite of what you guys are saying?

#11 Blue Heron

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Posted 29 April 2011 - 07:39 AM

I'm just a newbie here but thot I would mention that I started Lamictal yesterday and the doctor said since I was on estradol/norethindrone patch(.25mg a day)my Lamictal dose should be started low. She seemed to think that Lamictal dose should always be lower while on the patch. I'll ask her more about this when I see her Wednesday.
Am I crazy (lol) or is the opposite of what you guys are saying?


Your doctor is misinformed. Women taking both estrogen and Lamictal are supposed to take twice as much Lamictal as they otherwise would.
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#12 horselover

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Posted 30 April 2011 - 12:26 PM

And here is the Prescribers Information from GSK website:


DRUG INTERACTIONS
Valproate increases lamotrigine concentrations more than 2-fold. (7, 12.3)
Carbamazepine, phenytoin, phenobarbital, and primidone decrease lamotrigine concentrations by approximately 40%. (7, 12.3)
Oral estrogen-containing contraceptives and rifampin also decrease lamotrigine concentrations by approximately 50%. (7, 12.3)


Meaning, yes, you need twice as much. But starting on the equivalent of 12.5mg is common and shouldn't be a problem. Just makes the titration a bit slower.
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HL

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Lexapro
Pristiq
Ativan

#13 Blue Heron

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Posted 30 April 2011 - 01:43 PM

You could safely begin taking 25 mgs at first instead of 12.5, but you wouldn't want to start out with 50 mgs. It'd raise your risk of side effects.
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#14 bookowl

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Posted 08 October 2011 - 06:47 PM

It is a patch that releases 0.025mg estradiol per day for 3 1/2 days. My obgyn said 0.025mg is a tiny amount and should not make any difference to the effectiveness of my meds, but I know I am sensitive to small changes in my lamotrigine level. I have read that estradiol lowers lamotrigine levels, and found some abstracts for studies, but I could not figure out how much estradiol was used in the studies.


The pharmacokinetic and pharmacodynamic consequences of the co-administration of lamotrigine and a combined oral contraceptive in healthy female subjects 0.030mg ethinylestradiol: amount of Lamictal effectively halved.
Oral Contraceptives Induce Lamotrigine Metabolism: Evidence from a Double-blind, Placebo-controlled Trial 0.035mg ethinylestradiol: measured after women stopped taking birth control, Lamictal levels shot up by 84%.

0.025mg is not "tiny" when it comes to estradiol. 3.5 days is another matter. You may not be taking it long enough at any one time to make a significant difference.


Thank you, thank you. Now I finally know what's been wrong with me for 6 months. I had been stable for several years at 200 mg. per day and, due to my age and other factors, my doctor and I decided it was probably time for me to go off the birth control pills. Jerod, after reading your post, I checked to find my pill had the same 0.030mg ethinylestradiol cited in your reference.

What a rough ride it's been! I have been blaming it all on the hormonal transition and not understanding why it has been this bad. I haven't taken the BCP forever, and I'd come off them in the past with no backlash whatsoever.

I can't believe I didn't think of this. I don't know whether to be angry with my doctor or with myself. I've been just trying to weather the storm and telling myself it would be better when my body adjusted to the hormone change. Meanwhile, I've been dealing with most of the side effects listed for titrating too fast. Only now I know the problem is that I'm at a much higher dose than I should ever have gone. And I even ASKED my doc if coming off the pills would cause a need to adjust any of my other meds! One by one, we named them off and she said no. UGH!!

So what do you think? Since I now know what's happened, how fast can I taper down to where I probably should have been in the first place--which is likely 100 rather than 200?
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#15 Blue Heron

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Posted 09 October 2011 - 01:56 PM

So what do you think? Since I now know what's happened, how fast can I taper down to where I probably should have been in the first place--which is likely 100 rather than 200?


Do you remember the titration schedule you used when going up on Lamictal? Ideally, you'd want to go down on that same schedule, in reverse.
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#16 In_Remission_tired doggie

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Posted 09 October 2011 - 04:46 PM

Does anyone know if this interaction would also apply to cream based bio-identical hormones that are absorbed through the skin?

#17 bookowl

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Posted 09 October 2011 - 08:09 PM


So what do you think? Since I now know what's happened, how fast can I taper down to where I probably should have been in the first place--which is likely 100 rather than 200?


Do you remember the titration schedule you used when going up on Lamictal? Ideally, you'd want to go down on that same schedule, in reverse.


Well, I remember part of it. I don't remember how long I stayed at each step before going to the next step. I know I went from 150 mg. to 200 mg. Doing the 3/4 of a tablet thing was a pain, so I think that's why I remember it. I was considering going down faster (200 to 100) since I now know I've been higher than I ever should have been. I'm frustrated also because I no longer have a pdoc. Each time I get one, he either leaves the practice or retires (which has a humerous side--glad I'm not paranoid), but each has suggested that I don't need one since my meds have been unchanged for years. I've always said... "But when the time comes to make changes, that's when I'm gonna need you...."

But I didn't need changes then, and so now I feel a bit on my own. This situation proved my point quite nicely, but it doesn't help me a whole lot now. It would take me months to dig up a new pdoc, and I'm titrating down now, not later.

After all the precautions I took in trying to keep a pdoc and then asking all the questions I asked of my GP... I'm feeling like this month's poster patient for self-advocacy. What I did wasn't enough. I needed to get on here and do my own damn research because that's simply what's necessary apparently. This isn't the first time I've had a mind med mishap with a GP.

Jerod and mods, thanks for this board. I wish I'd looked at it sooner.
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