How Long Until Lamictal Starts Working (Onset of Action)
If you’re using Lamictal as directed it should work immediately, as you would transition from a working to Lamictal and, in theory, never lose control over your symptoms. If you’re using it off-label as initial therapy or replacing something that doesn’t work …
Usually whenever you reach a dosage of 200–400mg a day.
If you’re in the depressed phase of bipolar disorder,it can sometimes work within two-four days of your first 25 mg tablet. The average dosage that works for depression is 100 mg, and it typically takes 2–4 weeks to reach that dosage.
For mania/true mood stabilization it depends the average therapeutic dosage is around 150–200mg a day. But, like everything else, it depends. This one is a lot harder to nail down, but a month is the closest thing to an average that we have.
Likelihood of Working
The odds are decent that it will work for epilepsy, especially if you follow the PI sheet and add it to, or convert from another AED.
Generally considered to be the best drug on the market for bipolar 2. While there are always conflicting data, your mileage may vary, yadda yadda yadda, with its track record for efficacy and other factors, Lamictal should be the first med considered, but not necessarily the first med used, by many, if not most people diagnosed with bipolar 2.
If you take it like the FDA tells you to - after being stable on another med - the chances are pretty good you’ll stay stable. If you start it while manic1 or only mild-to-moderately depressed and aren’t taking, let alone stable, on another med, expect to be bouncing off the ceiling and have your cycling sped up.
Lamictal has the most complicated dosing instructions and schedules2 to increase the dosage (titration) of any crazy med. They take up 9 pages of the PI sheet. You need to look at the expanded dosing and titration page, as there’s no way to easily explain it without oversimplifying it. So here it is, which works for both epilepsy and bipolar disorder:
Find a med that works.
Once your symptoms are under control, decide if the side effects suck so much you want to be on a different med.
If they do, switch to Lamictal by taking the two meds at the same time, lowering the dosage of the med you don’t like while increasing the dosage of Lamictal per the instructions in the appropriate Lamictal starter pack.
That’s essentially it. If you really want Lamictal to work, do it the way it’s approved to and follow GSK’s instructions. This is one of the few times I recommend a target dosage. The average target dosage for adults with bipolar disorder is 200 mg a day, taken as 100mgtwice daily.
If you had your symptoms under control at a fairly low dosage of another med, then you can probably get away with a similarly low dosage of Lamictal. Work it out with your doctor.
How to Stop Taking Lamictal (Discontinue, Withdrawal)
Glaxo-Smith Kline (GSK) has a “discontinuation strategy” of sorts:
If a decision is made to discontinue therapy, a step-wise reduction of dose over at least 2 weeks (approximately 50% per week) is recommended unless safety concerns require a more rapid withdrawal. --the PI sheet
Our rule of thumb: decrease the dosage at the same rate you increased it. Otherwise as slowly as you can. 25–50mg a day every week until you’re down to 100mg a day, then 25mg a day per week. If you have to stop due to a really serious side effect, such as SJS (Stevens-Johnson Syndrome, a.k.a. The Rash), then you and your doctor (or whoever is in the emergency room) will have to figure out a faster schedule. Although if you’re in the ER with with SJS it’ll probably be extremely simple: you stop taking it immediately and take Benadryl (diphenhydramine) - or something similar - for the rash and one or more of clonazepam, some other benzodiazepine, and more of any other antiepileptic drug(s) you’re already taking.
The best medication on the market to deal with bipolar depression without the risks of mania or lowering the seizure threshold associated with antidepressants. Weight neutral. One of the safest meds to use during pregnancy. The side effects suck less than the other meds with FDA approval for maintenance treatment of bipolar disorder.
That “without the risk of mania” is only after you’re taking enough. You might get a little too happy the first couple of weeks. Easily affected by drug-drug interactions, in spite of being metabolized in such a way that only a few meds should affect it. Can mess with your skin in all sorts of ways that could cause you to panic and stop taking it when you don’t have to.
Interesting Stuff your Doctor Probably didn’t Tell You about Lamictal
Lamictal’s Potential Side Effects (Adverse Reactions)
Typical Side Effects
Rash, insomnia, itchy skin, lethargy, photosensitivity, memory and cognitive problems, rashes, and headaches that are sometimes really bad. Did I mention rashes and assorted other skin problems? The rash thing is overblown, as serious rashes aren’t all that common. Other skin problems, and mildly annoying, short-term rashes happen all the time. The headache is usually temporary, and if you do get it, the odds are it will be when you change the dosage. The lethargy and stupids usually diminish and may even go away, especially if you take folic acid. Folic acid may even help with some of the skin problems. The insomnia is one of those side effects you’ll know is temporary as soon as is stops and doesn’t come back for a few months.
Uncommon Side Effects
A specific type of insomnia where you’re really sleepy but just can’t fall asleep. Muscle aches, everything from just a twinge in your neck or back to full-body aches that make you wonder if you were possessed by some spirit that made you participate in a triathalon the day before and have no memory of it. Similar to what you get with Topamax. Dry mouth. OCD-like symptoms. Don’t be surprised if you get anxious or have other hypomanic effects if taking it for bipolar disorder.
As with the regular type of insomnia mentioned above, the muscle aches are one of those side effects you’ll know is temporary when it stops and doesn’t return. The dead-tired-but-still-can’t-sleep insomnia is like the headache - it might go away and only return when you change dosage, or it might go away for good (more or less) after some indeterminate amount of time, or it might just come and go on its own schedule3 for as long as you’re taking it.
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff4. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what5, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on lamotrigine’s pharmacokinetics page.
How lamotrigine Works
the current best guess at any rate
Originally designed as a folate antagonist (like antimalarial drugs), it was thought to have one of the simplest mechanism of action of any AED, doing nothing else except inhibiting voltage-sensitive sodium channels and maybe having a little affect on sigma opioid receptors (which are now being studied for all sorts of things). Now it looks like it also inhibits gated sodium and calcium channels, maybe even potassium. It’s still one of the least GABAergic AEDs around.
Antiepileptic drugs / anticonvulsants (AEDs / ACs) are generally a pain in the ass to take, and Lamictal is the biggest diva of them all. But it works, and works well, for two difficult-to-treat conditions: bipolar 2 featuring severe, near-constant depression that is usually misdiagnosed as a variant of unipolar depression, and Lennox-Gastaut syndrome.
Crazy meds are an exercise in patience. You need to wait for side effects to go away. You need to wait for the meds to start working. In The Prescriber’s Guide (Essential Psychopharmacology Series) Stahl has “Wait. Wait. Wait.” as the first three things to try in order to deal with side effects that he must of had a keyboard macro for it. Lamictal, being Lamictal, has to be the most extreme when it comes to that by requiring you to have your symptoms under control by another medication before starting. At least if you want to have the best chance for Lamictal to work. The idea is for Lamictal to replace whatever you’re taking.
You may have to drastically alter your lifestyle and that of your entire family (e.g. no more perfume or scented cleaning products) to keep taking it without being covered in a scary-looking, but otherwise benign rash, but that sucks so much less than treatment-resistant bipolar 2 or watching your kid with Lennox-Gastaut hit the floor for the twentieth time today. See the extended comments and detailed side effects pages for more information on Lamictal’s interaction with fragrances.
In spite of the climate of fear that permeates everything having to do with it because of The Rash, and loud complaints about killer headaches and full-body muscle aches, Lamictal actually has one of the lowest side effect profiles around. It’s not as low as Keppra’s but it is almost as low as Neurontin’s, with the added advantage of actually doing something for bipolar disorder and forms of epilepsy that are usually way too severe for Neurontin to handle. It may be the pickiest of all AEDs, but has been an absolute lifesaver for thousands of people.
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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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1 How many of us voluntarily see a doctor for the first time - or the first time after several years - during a euphoric mania? The only reason I did was because that was when I could deal with the agoraphobia and new people. I must be one of very few of the bipolar who consistently see new doctors while manic to some degree.
2 That's right, schedules, as in more than one. While many crazy meds have different titration schedules based on what condition you have, and can be influenced by any other medications you may be taking, it is such a freaking diva about drug-drug interactions that GSK has three different starter packs. But that still doesn't cover things like if you're planning to switch from your existing meds to Lamictal alone, or will you be staying on them.
3 There are probably all sorts of factors involved, such as life stressors or a random-seeming interaction with caffeine like Topamax has. Then again, it's Lamictal, and if there is any drug on the planet that is more random I'm glad I'm not taking it.
4 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.
5 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
6 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
7 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.
If you have any questions not answered here, please see the Crazymeds Lamictal discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)
Last modified on Monday, 29 December, 2014 at 12:24:50 by JerodPoore
Lamictal, and all other drug names on this page and used throughout the site, are a trademark of someone else. Lamictal’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot. Know your sources! Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
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‘Everything is true, nothing is permitted.’ - Jerod Poore
1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internetis a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.