Lamotrigine question

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JaneC

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Just wondering if anyone knows if there is a minimum therapeutic dose for lamotrigine? My daughter is on 150mg daily (which I think is quite low?) but feels it may be affecting her schoolwork during what is, unfortunately, the year that will decide what is open to her university-wise. We're seeing the E nurse and GP on Monday, primarily to discuss her mental health.
 
My neurologist says 100mg is generally the minimum dose for seizure control, Ive been on lamotrigine for many years :) I was controlled on 150mg for a while before my E got worse, hope this helps!
 
I've been on it a few years. I think the effective dose is highly individual. My neuro started very low, increased the dosage very slowly (over months). I ended up on 250 and then 300. I think 250 could have mostly done the job. I'm backing off the lamictal now, fingers crossed for seizure free.

The World Health Organization (WHO) has a recommendation of 100-200mg/day. Here's a link to their paper on lamotragine. The dosage info is on page 14.

http://www.who.int/selection_medicines/committees/expert/17/application/lamotrigine_inclusion.pdf
 
Thankyou both sooooo much for your replies. We are definitely going to ask the nurse if she can scale back down to 100. She is only 16 and quite small, her lack of concentration only started as she began to reach the 150mg dose, and her seizures aren't always too frequent.

Seems like we have nothing to lose - if she starts having seizure activity when she drops down, we'll just have to up the dose again :tup:
 
JaneC said:
Just wondering if anyone knows if there is a minimum therapeutic dose for lamotrigine? My daughter is on 150mg daily (which I think is quite low?) but feels it may be affecting her schoolwork during what is, unfortunately, the year that will decide what is open to her university-wise. We're seeing the E nurse and GP on Monday, primarily to discuss her mental health.
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There isn't one that I know of. Your daughter should have regular blood draws (aka lab work) to monitor the medication levels. Endless is right about doses being individual. A high dose for one person will be too low for another. No one can tell if a person is stable on meds unless a blood draw is done. If your doctor isn't requiring your daughter to undergo regular blood draws, the you need to find an epilepsy specialist who will order lab work. Sometimes, an epilepsy doctor will work with a primary doctor to get the lab work done and analyzed.
 
Hi,
I'm rather new to epilepsy and not really in a position to offer insights, but my son (age 18 ) is also taking lamotrigine. His memory has been pretty bad lately, and it is affecting his schoolwork. The first time we mentioned this to the doctor, he added a new medication (valporic acid). The second time we mentioned it, he increased the amount of valporic acid. He is currently taking 400 mg of lamotrigine per day along with the valporic acid. My understanding is that the valporic acid is supposed to help with concentration issues, but we have yet to see any improvement.
 
ksrandall said:
There isn't one that I know of. Your daughter should have regular blood draws (aka lab work) to monitor the medication levels. Endless is right about doses being individual. A high dose for one person will be too low for another. No one can tell if a person is stable on meds unless a blood draw is done. If your doctor isn't requiring your daughter to undergo regular blood draws, the you need to find an epilepsy specialist who will order lab work. Sometimes, an epilepsy doctor will work with a primary doctor to get the lab work done and analyzed.
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Thanks for your reply but it isn't common practice in the UK to do regular blood tests, the thinking being that seizure control and side effects are better indicators of what's going on. My daughter has seen a neurologist whose specialisms include epilepsy, which is as good as you get where I live, I;m afraid.

I would be interested to hear what others think about blood tests though.
 
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um-adam said:
Hi,
I'm rather new to epilepsy and not really in a position to offer insights, but my son (age 18 ) is also taking lamotrigine. His memory has been pretty bad lately, and it is affecting his schoolwork. The first time we mentioned this to the doctor, he added a new medication (valporic acid). The second time we mentioned it, he increased the amount of valporic acid. He is currently taking 400 mg of lamotrigine per day along with the valporic acid. My understanding is that the valporic acid is supposed to help with concentration issues, but we have yet to see any improvement.
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Thanks for replying Adam, I'm only just finding out the ins and outs to. That's very interesting. My friend's daughter was on valproic acid for a while and they didn't have a very good experience. I'm definitely hoping to go down the less rather than more route but I will bear what you say in mind. It's so hard to know what to do for the best, isn't it?

I hope you find something that helps your son - these later years at school are so important, and tough enough without epilepsy and AEDs being involved.
 
Endless said:
I've been on it a few years. I think the effective dose is highly individual. My neuro started very low, increased the dosage very slowly (over months). I ended up on 250 and then 300. I think 250 could have mostly done the job. I'm backing off the lamictal now, fingers crossed for seizure free.

The World Health Organization (WHO) has a recommendation of 100-200mg/day. Here's a link to their paper on lamotragine. The dosage info is on page 14.

http://www.who.int/selection_medicines/committees/expert/17/application/lamotrigine_inclusion.pdf
Click to expand...

i thinking doing samething,it worried me when i read it i take 250mg twice a day..pm me tell me how it is and how you doing it
 
My seizures are controlled on 150mg/day. For others it can as much as 3 times that amount. There's no specific therapeutic dose for lamotrigine, since it varies quite a bit from person to person. The "target dose" is whatever works for any given individual.

If your daughter has seizure control on her current dose of lamotrigine but is bothered by side effects, it's possible that her neurologist would okay slightly reducing her dose to see if that helps.
 
I've been on the med for abt 2 years now, and I'm on 125mg/twice a day. the doctors should be looking at the dose by how many lbs are on her(thats how they do it here in the u.s. until your over 18 )

But I do have to ask by what mg are the doses going up?
 
Good news. The E nurse says Rosie can have a go at reducing from 75mg am and 75mg pm to 75 and 50. If we want, we can phone her in a few weeks if she feels like going to 50/50.

The GP will refer her to the mental health service and she is having blood taken on Thursday. Thanks to everyone for their support on this, it made me feel confident my dose reduction idea was legitimate.

Cher, they may have weighed her when she first went to see the neuro but I honestly can't remember.
 
That's great -- hope the transition goes well.
 
Thanks Nakamova. She's pretty sure she had seizure control on 100mg daily so fingers crossed. If we have problems, she'll just have to go back up again x
 
Jane - I'm so happy for your daughter.:woot: getting used to a new dose can be VERY hard at any age. I'll be praying that she doesn't need to go back up.
 
Well, Rosie passed out while having blood taken, banging her head and cutting her chin, which she now has three stitches in, covered up by an attractive (not) large white dressing.

Nurses at odds over whether she fainted or had a seizure. She was "shaking" while she was out but nothing post-ictal going on. Wee soul had to go to work for a few hours tonight as well. A :rose: for my Rose.
 
Glad your daughter can have a low dose, I hope she has good control and no concentration problems! My daughter seems to have concentration problems on Lamictal, her current dose is 300mg/day, down from 500mg/day earlier this year because of her trouble thinking. But she does not have her seizures controlled, even with Vimpat added, so she is going to have to make changes again.

JaneC said:
Well, Rosie passed out while having blood taken, banging her head and cutting her chin, which she now has three stitches in, covered up by an attractive (not) large white dressing.
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So sorry to hear that happened :( I learned years ago that I can only have blood drawn if I am lying down, if I'm sitting up I will likely pass out. I feel like such a wimp asking to lie down, but it really helps! Maybe Rosie can try that next time :)
 
Bandmom, I'm so sorry your daughter is struggling to find a med or meds that control her seizures. Rosie is so much more fortunate than many people who have epilepsy in that she was diagnosed quickly AND the first med she has tried seems to work pretty well. I hope they come up with a solution for your daughter soon.

Apparently the phlebotomist asked Rosie if she was "a fainter". She said no but I can't remember her ever having had blood taken before. Guess we'll know to watch out in the future...
 
So sorry that she fainted witht he blood draw. Sometimes that can be a sign of dehydration or low blood sugar -- and sometimes it's just plain old anxiety. I hope she's feeling all right.
 
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