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Sewingmom

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Ronnie had a brain hemorrhage 3.5 years ago. After 99 days in hospital and rehab, he was able to return home with impaired ability to communicate (aphasia). He was progressing nicely ,but, the Neuro , after he came home, told us to take him off Amantadine. The doc didn't say to wean him off. I noticed some irritability and began to research the amantadine. Duh!!! The literature said to carefully wean him off. Well we made it through that with no seizures, until he fell in the bathroom and hit his head. The ER gave him a dose of kepra and a prescription for the same. The kepra had such side effects right away that we did not fill the prescription. Then a new neurologist and a psychiatrist said he needed to be on seizure meds and they both prescribed generic trileptal. After 10 days and rising blood glucose levels, I asked more questions and the druggist stated that generic trileptal could cause the blood glucose levels to rise. My husband is a well controlled type1 diabetic. I talked to the druggist and the neuro nurse practitioner. Neither one said to wean him off. After all, It was just 10 days. Five days later he had a grand mal seizure and his shoulder was shattered .
He was started on Lamictal XR 200. Two weeks later he had a shoulder replacement he was given lomotigran by the surgeon instead of Lamictal, Ronnie had 2 grand mal seizures the evening after surgery. They finally consulted Ronnie's Neuro and who added Vimpat 200 to Lamictal.
It was discovered 2 days later that he had and enlarged prostate and could not empty his bladder after surgery. He was sent home to follow up with our Neuro and a urologist. Two months later he had prostate surgery.
From Nov. 2013-Sept 2014, Ronnie had a total of 13 seizures. Three were grand mal. He was definitely more impaired in his ability to communicate than he was before the first seizure. Now, I research all medicines before filling a prescription. I do not hesitate to question the doctor.
In September he will be 2 years without a seizure. With the Neuro's permission, we have been weaning him off the Vimpat. In 1year, he is down from 200 mg of Vimpat to 50 of Vimpat. His cognitive ability is returning. I am here to research the way to wean him off the Lamictal xr 200. I want to know other peoples experiences with lamictal and coming off it. We see the Neuro in September. I want to discuss the subject intelligently.
We also keep him on a diet high in fat, 70 grams carb\day, moderate protein which works for his diabetes and seizure control.
One thing I have noticed in the last year is a tremor in Ronnie's right leg and in his right arm. It is only there when he is still and concentrating and standing up. He says it is a nervous habit.
I apologize for being so long winded
Sewingmom
 
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Hi Sewingmom,
Welcome to CWE.

Sorry Ronnie has been through so much, I hope things continue to improve.
 
Hope things go smoothly from now on.

I'd never seen info about blood glucose & oxcarbazepine connections, interesting. My child was on that drug for a few years and I read a lot about the drugs she takes or might take so there are countless gotchas. Doesn't sound like the effect is limited to generic, happens with brand medication as well.

Lamotrigine is just generic name for Lamictal. Our hospital substitutes generics for brand or vice versa - pharmacy/hospital policies, doc probably can't affect that without proof a person needs to stay on specific formulation. Would be an issue if they mess up extended release and immediate release formulas. Given surgery stress, possibility of seizure might be higher with same meds. Stress, illness, lack of sleep are all common triggers that can be hard to avoid in the hospital. I know with lamotrigine our child stays on the same manufacturer because I have asked* but most people do equivalently well on either brand or generic according to recent studies. With lamotrigine, weaning should be very slow. The last time we were set to wean off it from a moderate/low dose, it would have taken 3 months. Never did get off it, it turns out to be doing enough for generalized seizures that stuck with it after brief reduction for many day EEG.

Has your husband had a recent EEG? The neurologist might suggest one before trying the weaning or some point after depending on his history. Worth mentioning the tremor to the neurologist.

* Works for filling prescriptions, in hospital one gets what formulation the pharmacy had on hand.
 
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Too Many Variables To Know For Sure!

Sewingmom,
WELCOME TO CWE!!!!!!!
The many cases of E that exist and are diagnosed have so many variables that treating E can take what seems like forever! When something happens in a person's life it can have an effect on how someone's body reacts or heals! Your husbands had many things happening in his life so each of them may affect his recovery in a different way!
You have to stay strong for him and work through this! You may just find that you are a stronger person than you thought you were! :twocents:

ACsHuman
 
The problem of insurance coverage on medicare has brought to my attention that we may not be able to get decent coverage because of his use of Lamictal. Our previous retirees plan switched him to an advantage plan that will not provide very good care in the event of another hemorrhage or diabetic complications. I need all the links with verifiable info, that I can get to print and take to his next neuro visit next month. He has improved cognitively with the decrease in Vimpat but his common sense is still the pits. When we put him on lamictal his cognitive decline was very apparent.
Can anyone point me to reliable published information on the long term effects of Lamictal use and how to titrate the dose down. His doctor is reasonable and wants to help us.
Is there a step down drug that would enable him to step down quicker without complications that would then be easier to wean him off of?
Is that something that is done???
 
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Hi and welcome Sewingmom,

Sorry you and Your husband have been thru this. I applaud you for questioning the doctors. Never, never question YOUR judgment but keep on questioning what the doctors are putting your husband thru.... the side effects of drugs, the surgeries, etc.... and if the docs won't tell, question the pharmacists, too. I was once put on a medication for depression that eventually caused TYPE 1 DIABETES for me!! I now have to take insulin shots AND seizure meds! Some AEDs can lower the glucose levels, causing hypoglycemia, so speak with the docs about it, make sure everyone is on the same page. So, ALWAYS question the docs!! And my lobectomy caused more seizures for me than they cured..... my cognitive abilities have been impaired and I suffer from aphasia also. I've tried 12 different seizure meds and now have the VNS which helps but isn't a "cure" for seizures.

Here is info on Lamictal from the PDR (Physicians Desk Reference):

http://www.pdr.net/drug-information/lamictal-xr?druglabelid=207

Good Luck and Hang in there!
 
Depending on your sense of humor... check out crazymeds.us - the take on what the published drug info means in non medical speak can give a person a different perspective. It isn't the only source of info but everyone needs a variety of info sources. That site explains some of the complexity with lamotrigine in less technobabble.
 
Can anyone point me to reliable published information on the long term effects of Lamictal use and how to titrate the dose down. His doctor is reasonable and wants to help us.
Is there a step down drug that would enable him to step down quicker without complications that would then be easier to wean him off of?

Some information about Lamictal and long-term side effects:
http://www.ncbi.nlm.nih.gov/pubmed/9579888
Patient feedback on lamictal, including those who have been on it 18 years:
http://www.askapatient.com/viewrati...e=LAMICTAL&PerPage=60&sort=timelength&order=0

Tapering off Lamictal:

In general, when weaning off an AED, it's best to go "low and slow" — tiny increments (12 or 25mg) over a long period of time. That's the best way to reduce the potential for withdrawal side effects or rebound seizures. Unless there's a medical reason for a fast withdrawal, you want to taper off no faster than you ramped up, and slower is better, so that the brain can adjust to each incremental change before proceeding to the next one. Two weeks at each reduced increment (at minimum) is recommended.

Lamictal is available in 25mg increments, and even those can be razored in half to 12mg. If it isn't already, your husband might benefit from receiving his rx in the smaller pill size in order to facilitate the taper.

With Lamictal, adding a "step-down" drug would not ordinarily be required; given your husband's health issues it would make sense to avoid adding another med to the mix.

Anecdotal tapering information:
https://beyondmeds.com/2008/01/21/completely-painless-lamictal-taper/
http://www.crazyboards.org/forums/index.php?/topic/22578-lamictal-withdrawal/

It's important to remember that everyone reacts differently to meds and to changes in med dosages. Since brain meds are especially powerful, it's best to "err" on the side of safety. And keep your husband's doctors in the loop.
 
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