Posted by Ritch on February 26, 2003, at 13:52:25
In reply to Re: Rich... » colin wallace, posted by Ritch on February 26, 2003, at 13:29:31
> > Hi there Ritch,
> >
> > Cheers for your previous response by the way- you're a good man to share ideas with.
> > You mentioned that someone had posted previously on some success with a low dose combo.of Lamictal/Valproate/thyroid.
> > I think at first I'm going to opt for the Trileptal to augment my Lamictal(if necessary).
> > That extra oxygen molecule makes Trileptal seem far superior to plain Tegretol in terms of tolerability and side-effects.
> > If that bottoms out(or I'm refused the med.,as seems more likey!)then my options may be limited to a cautious trial of Divalproex(seems to be better tolerated than Valproate)and an AD.
> > I wondered have you heard of any other reasons not to combine Lamictal/Valproate(apart from the obvious decreased clearance of Lam. and increased risk of rash).
> > I'm sure that these risks can be greatly reduced by dose adjustment and a very cautious introduction of Depakote anyhow(seeing as I'm already past the LAM. rash risk).
> >
> > Waddaya reckon??
>
> Colin,
>
> From what I understand the rash thing is associated much more frequently with coadministration with valproate period. I *suspect* it has to do with both meds having a tendency to double each other's levels. So, if you are already on Lamictal and you add some Depakote (i.e.), your Lamictal blood level should jump up considerably (similar to a too quick dose titration of the Lamictal), thereby bringing on the increased risk of the rash due to a sudden lurch in the Lamictal blood levels. That's just my hunch though. There may be some oddball interaction that has nothing to do with the relative change in either blood levels of valproate or lamotrigine that increases the risk of TEN or SJS. ??? I would give the Trileptal a shot because 1) You haven't tried it yet, and 2) There isn't a contraindication of taking it with the Lamictal. I always will save the scary sh*t for last! I just read that post about the VPA+LTG+thyroid working well and it seemed to make pretty good sense. The VPA works good for hostility/mania, the LTG for depression, and the thyroid is good for the cycling. Yet another thing that sounds good on paper, though.....
>
>OH, just wanted to add something if you aren't aware of this already, but maximum dosage of Lamictal isn't supposed to exceed 150mg/day (75mg bid) if you take VPA with it. This would approximate a 300mg dose of Lamictal without the VPA. Your doc doesn't want to exceed 150mg of Lamictal anyhow... so you could get yourself under med. *supervision* and ask them about adding some 100mg Epilim to that dose level and watch things closely. If you want to try that down the road. Just some thoughts.... That way let the NHS pay for all of your meds.
poster:Ritch
thread:203376
URL: http://www.dr-bob.org/babble/20030224/msgs/204039.html