Lamictal/Lamotrigine Blood Level

[First]

Hi-

There have been two times when I accidentily took more of my Lamictal / Lamotrigine than I should have:

1. 2012:
I am prescribed to take 600mg in the AM. I tolerate this fine. A couple of weeks ago I was not feeling well-a cold, violent sneezing the night before. Next morning: I took my 600mg dose at about 9:00am along with my coffee (in bed) and I was barely awake. I finally got up, still very tired with a cold or whatever it was, took my 600mg AM Lamictal dose at about 10:30am or so, and took a shower. I ran out of the door because I was running late to work, about 11:00am. So, I was driving on the interstate about 15 minutes later (+/-) and felt godawful. I exited the interstate and pulled over immediately on the shoulder of the offramp (safe place). I exited the car and went to an area about 50' from the car. I was feeling more and more awful-could not standup, slurred speech, very unsteady, and was quickly becoming more and more impaired. The police came and I took an ambulance to the hospital. My memory is "a little hazy" about some things, but I remember being slightly irritated, and this is reflected in my discharge paperwork from the hospital. At first I refused treatment adamantly.
Appears groogy, falling asleep during the interview. Speech is slurred.”…It was becoming more and more clear to me that I had taken the 2nd Lamicatal dose, and the doctors were in so many words accusing me of being under the influence of an intoxicating drug (which I was but they were obviously referring to a recreational drug). I told the doctor that I was pretty sure that I had taken an extra Lamictal dose, and my wife told the doctor both on the phone and in person that she believed I had taken an extra dose of the medicine. My wife and friend came to the hospital an hour or so later and I felt better having somebody “friendly” around. I agreed to a Lamictal / Lamotrigine blood test. The test came back at 22.3. Whatever anybody says, this level was hugely debilitating to me. By the time they drew the blood I was feeling much better, so I am sure that the level was much higher earlier when I was much more impaired. I was cognitively much better, but I was still very unsteady and my wife and friend had to hold me up as I walked out to the car-this was after 4 hours at the hospital and about 5 hours after the 2nd Lamictal dose. So, a level of 22.3 several hours after the peak of the effects caused me to be “a little” disoriented.

2. 2010. Prescribed 400mg AM 400mg PM (800mg/day). Took PM dose late (~2am), AM dose Early (~6am?), and then an accidental dose going out the door again. So, 1200mg in a 6 hour period (+/-). Made it to work but took a taxi to the hospital. About 12PM noon lamictal blood level was 16.5. At the time of this blood draw I was much more there than the time about 2 weeks ago. (Probably partially explained by my regular daily dose was 800mg/day at this time in 2010, but has been only 600mg/day recently).


Does anybody have any experience with this? Or advice? I was pretty screwed up. The next day I called the ER doctor who said he didn’t know if the 22.3 level was therapeutic or high or toxic or not. It was clear to me that he did not want to let go of the idea that I had been taking recreational drugs. It just really irritates me that this type of thing happens/happened/will happen to me and others. I’m thankful that I’m OK, but I’m still irritated at my treatment by the hospital staff.


So, sorry for the long post, but there doesn’t seem to be much documentation/studies about Lamictal/Lamotrigine levels and therapeutic/toxicity levels.

(I now have one pill container that I use so the double dose will not happen again hopefully).

:roflmao:

 

[Nakamova]

Hi First, welcome to CWE!

There isn't a specific therapeutic level for Lamictal, because the therapeutic dose is whatever works for a given individual. So if 600mg works for you, that's your therapeutic dose. If 150mg works for me (as is the case), that's my therapeutic dose. There is a suggested range, but plenty of folks fall outside either end of that range.

That said, 1200mg - 1600mg is pretty high amount to ingest, and I'm not surprised that you suffered adverse effects. The most common overdose symptoms are drowsiness/lethargy, nausea, dizziness, clumsiness. The ER doctors should have consulted a neurologist regarding your blood serum levels. Again, while there's no specific toxic level due to patient variability, the recommended range is 1.5 to 10, and the vast majority of folks are in that range. Some folks do okay with higher blood serum levels, but it would be very rare to be above 20. It might help to know what your standard blood serum level is for comparison, but it's safe to say that your 22.3 level was high, and could well be associated with the side effects you describe.

You may find the links below of interest:
http://www.neurology.org/content/63/6/1022.full
http://www.theannals.com/content/38/11/1811.full

I'm glad you're using a pill container now -- I was going to suggest something along those lines.

Best,
Nakamova

 

[qtowngirl]

Hi First,
It's never happened to me but as I just started doubling my lamotrigine dose I'm thankful for your post; if I ever make a mistake and am out of it I will have a better idea as to why.

My only advice, as with any AED, is if you take it every 12 hours, and you've taken one at the wrong time - do not either take that dose if it is more than six hours past your regular dosage time, or, take dosages any closer than six hours apart. I know this means the same thing essentially but keeping those two 'ideas' in mind can really help when a dosage has gone awry.
I can't imagine the 2am/6am/another in the morning day you had in 2010 - glad you made it out okay and are using a pill container.

 

[First]

1200mg in ~2 hours 2012--1200mg in ~6 hours in 2010

Hi-
Just wanted to clarify that:

2012: Taking 600mg one time, in the morning. No adverse effects that I can tell. Took two of these 600mg doses in a period of about 2 hours for a total of 1200mg/2 hours.

2010: Prescribed 400mg in the AM, 400mg in the PM. This time: 400mg at 2AM, 400mg at ~6AM, and accidental dose of 400mg about 9-10AM. 1200mg in about 5-6 hours.
I guess this may have added up to 1600mg for the day if I took the 400mg PM dose (I forgot over the last 2 years).

Concerning the incidents, Both times it was a dose of 1200mg, one in a period of about 2 hours (2012) and one in a period of ~6 hours.

I was pretty affected both times. Level= 16.5 in 2010 and Level = 22.3 in 2012.

Both the 2010 dose of 800mg/day (400mg AM, 400mg PM) and the current 600mg in the AM (one dose) are effective.

I also took a Lamictal test in 2007 when I believe I was taking 400mg/day (200mg AM, 200 PM) and my level was 3.3. I think I may have been experiencing "Breakthrough Seizures/Auras" occasionally, or I may have just been scared that the level was so close to the suggested range (normal range 3-14:side effects more likely over 14 according to the hospital-defined range). I may have moved up to the 800mg/day (400mg AM, 400mg PM) at this point. I guessing that I was probably in the "therapeutic range" at both the 2010 (800mg/day-Divided 400mg AM, 400mg PM) and 2012 (600mg/Day-AM). No side effects to my knowledge (of course the med affecting the brain might affect my ability to determine any side effects). But I seemed to be fine, my driving was fine, etc.

Both the 2012 (22.3 Blood Level) and 2010 (16.5 Blood Level) caused major side effects and at least the 2010 Neurologist said the 16.5 may well explain my sedation, slurring, etc symptoms. I will be visiting a new neurologist tomorrow from the same hospital (I changed health insurance)-I don't like the idea that it is at this same hospital with the same computer systems.

I am certain that I took the double doses both in the 2010 and 2012 episodes, and with the major, debilitating symptoms, I am sure that this double dose caused the symptoms.

2012: I did get off the road before the major symptoms developed (about 30 minutes after the accidental 2nd dose) and I was safe but lucky that there was a convenient shoulder to get on to.

My main issue with all of this is that I felt OK with my conversation with the State Police-seemed really friendly-called AAA for me, etc, but I'm not sure if they gave me a blood test which may have shown a low level of another medicine which I took the night before for sleep/anxiety (sleep helps me with my seizures). I absolutely believe that this dose so much earlier in the scheme of things would have absolutely nothing to do with any impaired driving, etc. I guarantee that it was completely the 2nd accidental dose. But I started to forget things as I was talking with the police and I am not sure if I was asked to provide a blood sample. I was scared of the possibility of both taking too much of the Lamotrigine and the possibility of "Traces" of the anxiety med showing up, and I would hopefully have declined to take the test. I was never observed driving, and I don't believe my driving was affected as I got off the road so soon after feeling the 2nd dose coming on (had not come close to the Tmax or even a majorly high blood level due to the second dose, I just knew I needed to get off the road. Nevertheless, I was afraid of having taken the accidental 2nd dose of the Lamotrigine as well as the minute traces of the anxiety med from the night before. My memory was fading, and I would have hoped that I would have refused the test as I was scared that either or both of the detectable results would have put me in the DUI range. (I guess that even for "Cold Medicine" you can get a DUI if it affects your driving in my home state). Like I said, I pulled off the road before the major effects came on, and nobody witnessed my driving, but I was in "physical control" of the car (had possession of the keys) but absolutely no intention to drive-way too affected to drive. If I had been given a field sobriety test, I would not have been able to pass by the time they arrived and I would have been required to take a blood test because this may have been considered reasonable cause. So, if I was "offered" a blood test, I would hopefully have refused this, as it would only suspend my license for 1 year whereas the penalty for a DUI or Physical Control conviction are much more severe (jail, criminal record, etc).

So, the truth comes out. This is about fear of ramifications of using my medicines-the only one even potentially affecting my driving being the 2nd dose of the Lamotrigine. All I told the police was that I thought I was going to have a seizure-wasn't absolutely sure about the 2nd dose yet and probably wouldn't want this known anyway-

"Guilty until proven innocent".

I would suspect that others may have had similar situations. General fears regarding things related to medications-hopefully this is appropriate for a forum such as this. I have been told to talk with an attorney, and two of them suggested that I was probably either given a blood test or refused one (but I don't have any paperwork suggesting this).

Anyway, the point is that my blood level was so high that it would have been this 2nd dose of lamotrigine - even though this may also be grounds for a DUI/Physical Control charge.

I can understand a problem in that it was indeed very dangerous for me to be driving at that point, even though it was an accident taking the 2nd dose. Probably mitigating, but the danger to the public does warrant some type of repercussion. I'm quite affraid of losing my license and the big-time affects this will likely have on my driving insurance.

Anyway, sorry for the ramble and I appreciate all of the answers you've provided so far. I can ramble on. Sorry-but I think all of it is relavant and certainly important to me.

I'll be much more careful in the future-I have to take the medicine by law and too prevent these seizures, but taking accidental dose can be a big deal for me since I take a relatively high daily dose to begin with.

Thanks.
:brain:onder: