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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Angel Girl on June 10, 2004, at 7:36:40
Hi! I'm currently taking 75mg/AM and 75mg/PM of Lamictal (Lamotrigine). I'm also taking 500mg of Depakote daily. I know that there is a drug interaction between the two, which fools the brain into thinking that it is getting 2X the amount of Lamictal than what it is really getting. I'm currently weaning off of the Depakote and replacing it with the Lamictal.
Has anybody taken Lamictal and had any side effects?
I read something about that you can get some kind of mouth sores, tooth cavities and gingivitis from it.
I guess I have the gingivitis because every time I brush my teeth and floss, my gums bleed. BUT now, the entire inside of my mouth (incl the roof of mouth, etc) is REALLY painful and raw, like it would get if you ate something too hot, which I don't recall doing. It is extremely painful to say the least. I've been taking Tylenol with codeine all week for it.
I'm going to my pdoc tomorrow and don't want to prematurely assume that it is my Lamictal that is causing this problem so I want to find out if anybody else has experienced this first.
So, has anybody else had this or anything similiar while taking Lamictal? I need to find out before going to my pdoc tomorrow.
Thanks,
AG
Posted by Emme on June 10, 2004, at 10:13:29
In reply to Need IMMEDIATE help re: Lamictal/Lamotrigine, posted by Angel Girl on June 10, 2004, at 7:36:40
> Hi! I'm currently taking 75mg/AM and 75mg/PM of Lamictal (Lamotrigine). I'm also taking 500mg of Depakote daily. I know that there is a drug interaction between the two, which fools the brain into thinking that it is getting 2X the amount of Lamictal than what it is really getting.
It's not fooling your brain. The depakote reduces the clearance of Lamictal. You are actually increasing the amount of Lamictal in your bloodstream, the same as if you'd taken twice the dose.
> I'm currently weaning off of the Depakote and replacing it with the Lamictal.
> Has anybody taken Lamictal and had any side effects?I had these startup SEs: headache, stiff tight shoulders, feeling a bit fluish. All went away within a few weeks.
> I read something about that you can get some kind of mouth sores, tooth cavities and gingivitis from it.Hmmm...I haven't heard about gum problems or cavities. I'll check the prescribing info. Mouth sores are one of the things one should be on the lookout for as they are a possible sign of the beginning of Stevens-Johnson syndrome. Do you have swollen lymph nodes or fever?
> BUT now, the entire inside of my mouth (incl the roof of mouth, etc) is REALLY painful and raw, like it would get if you ate something too hot, which I don't recall doing. It is extremely painful to say the least. I've been taking Tylenol with codeine all week for it.
That is a bad sign. Tell your doctor about it NOW and have it checked out! Now. You may be having an adverse reaction to it that could become serious.
> So, has anybody else had this or anything similiar while taking Lamictal? I need to find out before going to my pdoc tomorrow.It doesn't matter if anyone else here has had this or not. You are experiencing what you are experiencing. Report it and let your doctor make the call. Actually, I'd call right this minute and see your internist about this. It'll be helpful to both you and your pdoc to have another doctor's opinion. And if it's not the Lamictal, it sounds miserable enough that you'll want to do something about it anyway. Good luck to you!
Posted by Angel Girl on June 10, 2004, at 11:32:09
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Angel Girl, posted by Emme on June 10, 2004, at 10:13:29
Emme
Thanks for your quick reply. I also forgot to add that I've already ruled out that I can't take Lithium and I'm weaning off of Depakote.
No swollen lymph nodes or fever. Just pain that I can't eat or drink.
What else is there for me to take as a mood stabilizer?
AG
> > Hi! I'm currently taking 75mg/AM and 75mg/PM of Lamictal (Lamotrigine). I'm also taking 500mg of Depakote daily. I know that there is a drug interaction between the two, which fools the brain into thinking that it is getting 2X the amount of Lamictal than what it is really getting.
>
> It's not fooling your brain. The depakote reduces the clearance of Lamictal. You are actually increasing the amount of Lamictal in your bloodstream, the same as if you'd taken twice the dose.
>
> > I'm currently weaning off of the Depakote and replacing it with the Lamictal.
> > Has anybody taken Lamictal and had any side effects?
>
> I had these startup SEs: headache, stiff tight shoulders, feeling a bit fluish. All went away within a few weeks.
>
> > I read something about that you can get some kind of mouth sores, tooth cavities and gingivitis from it.
>
> Hmmm...I haven't heard about gum problems or cavities. I'll check the prescribing info. Mouth sores are one of the things one should be on the lookout for as they are a possible sign of the beginning of Stevens-Johnson syndrome. Do you have swollen lymph nodes or fever?
>
> > BUT now, the entire inside of my mouth (incl the roof of mouth, etc) is REALLY painful and raw, like it would get if you ate something too hot, which I don't recall doing. It is extremely painful to say the least. I've been taking Tylenol with codeine all week for it.
>
> That is a bad sign. Tell your doctor about it NOW and have it checked out! Now. You may be having an adverse reaction to it that could become serious.
>
> > So, has anybody else had this or anything similiar while taking Lamictal? I need to find out before going to my pdoc tomorrow.
>
> It doesn't matter if anyone else here has had this or not. You are experiencing what you are experiencing. Report it and let your doctor make the call. Actually, I'd call right this minute and see your internist about this. It'll be helpful to both you and your pdoc to have another doctor's opinion. And if it's not the Lamictal, it sounds miserable enough that you'll want to do something about it anyway. Good luck to you!
>
Posted by Emme on June 10, 2004, at 12:17:24
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Emme, posted by Angel Girl on June 10, 2004, at 11:32:09
Hi.
> Thanks for your quick reply.
More interesting than doing what I need to do! ;)
> No swollen lymph nodes or fever. Just pain that I can't eat or drink.Ouch! You can't go on with that.
> What else is there for me to take as a mood stabilizer?
First things first. Get a professional opinion on your mouth a.s.a.p. If it's thought to be the Lamictal, you and your doctor will decide on whether you should stop Lamictal completely, reduce it and retitrate more slowly, etc. How quickly did you titrate up on it anyway?
Other mood stabilizers...? Do you need anti-manic protection, or are you mostly depressed? In the anticonvulsant department, have you tried topomax? Zonegran? Trileptal? Keppra? I have a friend who's BPI who is doing well on just Seroquel after trying tons of other things. She tends to go manic extremely easily. Good luck.
Emme
Posted by Emme on June 10, 2004, at 14:54:09
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Angel Girl, posted by Emme on June 10, 2004, at 12:17:24
> Hi.
>
> > Thanks for your quick reply.
>
> More interesting than doing what I need to do! ;)Oops. That didn't sound right. I didn't mean to imply that your difficulties are entertaining in any way. Just that I was avoiding doing productive things and came across your post.
Emme
Posted by Angel Girl on June 10, 2004, at 17:20:14
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Angel Girl, posted by Emme on June 10, 2004, at 12:17:24
> Hi.
>
> > Thanks for your quick reply.
>
> More interesting than doing what I need to do! ;)
>
> > No swollen lymph nodes or fever. Just pain that I can't eat or drink.
>
> Ouch! You can't go on with that.
>
> > What else is there for me to take as a mood stabilizer?
>
> First things first. Get a professional opinion on your mouth a.s.a.p. If it's thought to be the Lamictal, you and your doctor will decide on whether you should stop Lamictal completely, reduce it and retitrate more slowly, etc. How quickly did you titrate up on it anyway?
>
> Other mood stabilizers...? Do you need anti-manic protection, or are you mostly depressed? In the anticonvulsant department, have you tried topomax? Zonegran? Trileptal? Keppra? I have a friend who's BPI who is doing well on just Seroquel after trying tons of other things. She tends to go manic extremely easily. Good luck.
>
> Emme
>
>
>
>
EmmeDon't worry about the comment. My fried brain didn't even pick up on it anyway.
The Lamictal was increased VERY slowly because I'm also on Depakote. I am replacing the Depakote with the Lamictal so I'm decreasing the Depakote and increasing the Lamictal in such a way that hopefully things are evened out through out the entire process. My goal is to come completely off the Depakote due to it's side effects. The Lamictal was started at 1/2 pill per day and increased by 1/2 pill every 2 weeks. My last increase was 1 1/2 pills per day, which is the most it has ever been increased at any one time. Don't know why she all of a sudden decided to increased it at a faster rate. Maybe it was too much of an increase for me? I'm very drug sensitive, including dosage changes. The inflammation of my mouth has only occurred after the last increase.
I haven't tried any of the other meds you listed. I haven't had a hypomanic episode for more than a year. I need something for depression which doesn't seem to want to go away.
BTW, I've read that Zonegran and Topomax have 'possible' side effects of weight loss. I certainly could use that. What's your thoughts on that. I know that everybody reacts differently and some people may not even get the weight loss side effect but presuming that I might, which one do you think would be better in that regard?
BTW, I'm not sure if I ever mentioned that I am BPII. Memory sure isn't what it used to be. :(
Thanks,
AG
Posted by Emme on June 10, 2004, at 22:15:48
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Emme, posted by Angel Girl on June 10, 2004, at 17:20:14
> My goal is to come completely off the Depakote due to it's side effects. The Lamictal was started at 1/2 pill per day and increased by 1/2 pill every 2 weeks. My last increase was 1 1/2 pills per day, which is the most it has ever been increased at any one time.I assume you mean 25 mg tabs. That's a nice conservative titration.
> Don't know why she all of a sudden decided to increased it at a faster rate.
When you get to a higher dose, you can generally speed up the titration a bit.
> Maybe it was too much of an increase for me? I'm very drug sensitive, including dosage changes. The inflammation of my mouth has only occurred after the last increase.
So yeah, it's possible that was too much of a change.
> I haven't tried any of the other meds you listed. I haven't had a hypomanic episode for more than a year. I need something for depression which doesn't seem to want to go away.
I think the folks here will have lots of thoughts to offer. Have you been on any combos of mood stabilizer plus an AD? Any dopamine agonists?You will see people voice different opinions on using atypical antipsychotics for mood disorders. From my own experience, about 2.5 mg of abilify gave me a lot of relief from a sluggish nasty depression. In only about 3 days. I didn't end up using it long term, but it sure was hepful for a while.
> BTW, I've read that Zonegran and Topomax have 'possible' side effects of weight loss. I certainly could use that. What's your thoughts on that.
I didn't do well with Topomax or Zonegran, so I wasn't on long enough to see if they made me lose any weight. But from what I read, it seems to be pretty common. There's going to be loads on Topomax in the archives and I'm sure others here will tell you about it. I've seen posts from one or two happy Zonegran users.
Let us know how it goes with your mouth.Emme
Posted by Viridis on June 11, 2004, at 4:27:02
In reply to Need IMMEDIATE help re: Lamictal/Lamotrigine, posted by Angel Girl on June 10, 2004, at 7:36:40
Just to second Emme's posts, strange rashes, inflammation, etc. with Lamictal need to be checked immediately by a doctor. Apparently, those above the neck (especially in sensitive areas with mucous membranes) are of greatest concern. It could be something else altogether, but don't take a chance. And yes, depakote increases your level of Lamictal by reducing the rate at which it's processed.
I've had no problem with 150 mg/day of Lamictal (I titrated up very gradually), but everyone reacts differently, and there is some level of risk (although quite low) involved.
Posted by Angel Girl on June 11, 2004, at 5:28:28
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Angel Girl, posted by Viridis on June 11, 2004, at 4:27:02
> Just to second Emme's posts, strange rashes, inflammation, etc. with Lamictal need to be checked immediately by a doctor. Apparently, those above the neck (especially in sensitive areas with mucous membranes) are of greatest concern. It could be something else altogether, but don't take a chance. And yes, depakote increases your level of Lamictal by reducing the rate at which it's processed.
>
> I've had no problem with 150 mg/day of Lamictal (I titrated up very gradually), but everyone reacts differently, and there is some level of risk (although quite low) involved.Emme/Veridis
I'm currently taking 150mg/daily of Lamictal and
500mg/daily of the Depakote. I also take Effexor XR 187.5mg/daily as well as a few other meds.I'm not sure where to go from here. I have a 10:00 am pdoc appt today and I'm in a LOT of pain right now. I've taken all the old rx's of pain killers I had in my medicine cabinet and already taken them all and I'm still in PAIN. ugh!!! I hope she will prescribe something strong for me. Maybe I might need an antibiotic too??? Or maybe take an antihistimine???
I'm not very knowledegable on all this med stuff. All I know at this point is that I want to get rid of this PAIN!!! It just about has me in tears. :(
AG
Posted by Emme on June 11, 2004, at 7:58:17
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine, posted by Angel Girl on June 11, 2004, at 5:28:28
>
> I'm not sure where to go from here. I have a 10:00 am pdoc appt today and I'm in a LOT of pain right now. I've taken all the old rx's of pain killers I had in my medicine cabinet and already taken them all and I'm still in PAIN. ugh!!! I hope she will prescribe something strong for me. Maybe I might need an antibiotic too??? Or maybe take an antihistimine???Go to your pdoc appt. But before you head out for your 10 am. appt., I really think you have to also call your internist/GP. Tell them you absolutely MUST get in there sometime today! Don't take no for an answer. Go to the ER if you must.
Don't wait on this. Get to see a doctor TODAY. Even if your pdoc doesn't send you to one. Play it safe. If it's not the Lamictal, you still have to do something about it anyway!
When I got a rash on Lamictal, my pdoc had her office manager find me a dermatologist, make a phone call, and I went directly from my pdoc's office to the dermatologist. The dermatologist promptly called my pdoc before I even left his office. A good pdoc will cover all the bases.
Posted by Harlock on July 7, 2004, at 13:10:57
In reply to Need IMMEDIATE help re: Lamictal/Lamotrigine, posted by Angel Girl on June 10, 2004, at 7:36:40
I just starded Lam., so I'm not sure, but, I am having similar symptoms as you.
Just like you said, I have symptoms that you'de get from burning the roof of your mouth. I have area's of skin that become loose and come off, like a burn.
I asked my ear/nose/throat doc about it, and he was stumped. I haven't mentioned it to my pdoc yet.
I had it for a while, then it went away.. it's back again.I'm currently taking:
Wellbutrin
Adderall
SymbyaxI think it started with the Adderall, but I'm not sure.
Posted by Angel Girl on July 8, 2004, at 22:38:24
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Angel Girl, posted by Harlock on July 7, 2004, at 13:10:57
Harlock
I would strongly advise you to call your pdoc IMMEDIATELY!!! After dealing with the mouth problems as you are having, then my legs started breaking out in rashes all over. The itchiness was unbearable. Getting rashes on Lamictal is not something to play around with. If it ends up being SJS, it has the potential to becoming fatal in some people. Word of warning, I came off Lamictal cold-turkey when I was on 150 mg daily. It was HELL!!!! The headaches were EXCRUCIATING!!! BTW, my withdrawal took about 3 weeks. I still have some itching and take med as required for it. You really need to call you pdoc NOW!!!
Good luck!!!
AG
> I just starded Lam., so I'm not sure, but, I am having similar symptoms as you.
>
> Just like you said, I have symptoms that you'de get from burning the roof of your mouth. I have area's of skin that become loose and come off, like a burn.
>
> I asked my ear/nose/throat doc about it, and he was stumped. I haven't mentioned it to my pdoc yet.
> I had it for a while, then it went away.. it's back again.
>
> I'm currently taking:
> Wellbutrin
> Adderall
> Symbyax
>
> I think it started with the Adderall, but I'm not sure.
Posted by Harlock on July 9, 2004, at 10:12:32
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Harlock, posted by Angel Girl on July 8, 2004, at 22:38:24
Wow, that's scary stuff. Actually, the mouth skin thing didn't start with the Lamictal. I had it well before I was on Lam. I agree though, I should tell my pdoc about it. It bothers me that my ear/nose/throat (I call him Dr. Pain) didn't seem concerned about it.
I wish doctors would take the meds they prescribe so they know how bad some of the side effects are. ;) I don't think they understand how bad side effects can be.
Posted by Angel Girl on July 9, 2004, at 11:51:44
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine, posted by Harlock on July 9, 2004, at 10:12:32
> Wow, that's scary stuff. Actually, the mouth skin thing didn't start with the Lamictal. I had it well before I was on Lam. I agree though, I should tell my pdoc about it. It bothers me that my ear/nose/throat (I call him Dr. Pain) didn't seem concerned about it.
>
> I wish doctors would take the meds they prescribe so they know how bad some of the side effects are. ;) I don't think they understand how bad side effects can be.
HarlockSince you had the problems in your mouth before starting Lamictal maybe you won't have a problem taking it. Still, to be safe I would call your pdoc immediately. Maybe the Lamictal is aggravating it even more. Did you go to your ear/nose/throat dr specifically to look at what's happening in your mouth now? You would think with him being a specialist he would know about this med and the potential side effects; however, my pdoc was NOT aware that your mouth could be affected by Lamictal. She thought it just involved rashes. Seems sometimes you learn more on this site and on the net than what so-called specialists know. Now she hs newly prescribed Topamax for me, which comes in tablet and sprinkle capsule formats. I told her I wanted the capsules and she had no idea what sprinkle capsules were. It is really disheartening when the patient knows more than the pdoc does. I wasn't about to waste my time explaining it to her. Sometimes I think I need to look for a new pdoc. Afterall, if I have to explain things to her then I think it only fair that she give me part of her salary. :) It just doesn't give you much faith in pdocs when sometimes you know more than they do. Thank God for the internet or we'd be blindly doing as they say without knowing what we're getting ourselves into. Sad but true.
So, not only do they not know about the side effects, they don't even know about the drugs, in some cases. Sheesh!!!!
AG
Posted by Harlock on July 9, 2004, at 12:05:05
In reply to Re: Need IMMEDIATE help re: Lamictal/Lamotrigine » Harlock, posted by Angel Girl on July 9, 2004, at 11:51:44
I agree, it's really a let down when you know more than your doc does. I do learn much more from this site than from ANY doc I had. I find that many docs only know about the drugs that those drug salespeople come to them with. I used to know bunch of people who did that for a living... selling prescription drugs to doctors and hospitals, etc. I guess it's very lucrative. ;)
These people knew a ton about the meds they sold, more than any doctor I've ever seen.I went to the ear/nose/throat doc a while back, to try to breath through my nose, normally. All my life I've had 1 side of my nose congested, at ALL times. I could never really breath fully through my nose. Makes sleeping at night with yout mouth open a real pain.. especially when your mouth dries out to the consistency of sand paper.
Anyway, I had two nasal surgeries, with very painlful recoveries. All in all, not the result I was hoping for, but I can breath through just my nose now.. not totally clear, but much better.
I guess my inferior turbinates were abnomally large, and I had a deviated septum. Weeeee!I better get back to work. ;)
This is the end of the thread.
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