Concerned about beginning dosage of Lamictal
Posted by neilsark6 on August 25, 2010 at 4:08pm
I received a call this morning from my son's doctor that the results of the psych testing indicated that meds would really help him. He wants us to consider starting my 11 yr. son on 75mg. of Lamictal (generic) 2X day. Doing a little research it seems as if most kids are started at MUCH lower doses in the beginning. Is there a typical starting dose for children this age? We are meeting with the doctor on Friday to make a decision on what action we will take. I am so nervous. I would so appreciate any insights from those who have "been there, done that".
Thanks,
Nervous Mom
Hi Mom,
Lamictal is a great first line mood stabilizer and there are a lot of kiddos who are stabilized with it. I have NEVER heard of someone starting off Lamictal at 75 mg. twice a day and personally I think it is totally irresponsible of a doctor to start off on that high of a dose! Is there a chance that you misunderstood your doctor? I wonder if he didn't mean that he felt your son's target dose would be 75 mg. twice a day. Normally, Lamictal is started with their "starter pac". Lamictal is normally started at 12.5 or 25 mg. and it is titrated very slowly. The reason of the slow titration is that it reduces the risk of developing Steven's Johnson Syndrome - a very serious skin rash - which can happen with any medication, but more so with Lamictal. Our pdoc did a study on Lamictal and found that most patients were stabilizing at a dose of 300 mg. with 400 mg. being on the high end. Most people don't see the real benefit of Lamictal until they are at the 200 mg. dose. Lamictal is dosed according to symptom relief, not age/weight. Lamictal came out with a generic last year manufactured by numerous companies. There were a lot of reports of kiddos not doing well after the switch to generic with a return of mood instability. There were the same reports from parents who's kiddos take it for seizure control. My own son was one of those kiddos. We ended up having to trial 3 different manufactures before insurance would go back to paying for name brand. The key to Lamictal is patience because of it's titration schedule.
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Jackie aka mom2one
Forums moderator, FRT
Mom to Mr. 17 (dx'd at age 4), Bipolar, Psychotic Disorder, Anxiety Disorder, PDD, Cognitive Disorder
Meds: Seroquel 900 mg., Risperdal 4.5 mg., Fanapt 12 mg., Lamictal 600 mg., Lithium 1250 mg., DDAVP, and Synthroid .150 mcg
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My son just started on lamictal at 25 mg once a day for 2 weeks, then he will go up to 25 mg twice a day. 75-150 mg is too much even if the dr insists. If you are looking for something that works quickly, look at antipsychotics and anti-anxiety meds, you can tell that they are working even at small doses, right away.
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ds age 16 - lithium, abilify, namenda, klonopin
I agree that your pdoc is not following standard practice for starting lamictal. It will take awhile to be effective due to the slow titration required, so people often need to also be on an AP at the same time.
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Brenda,50, CABF Parent to Parent Volunteer
Mom to A, 16, BP, Tourette's, OCD, ADHD: Eskalith CR, Trilafon, Lamictal, Seroquel, Cytomel
E, 14, BP,AS, hypothyroidism: Seroquel, Eskalith CR, levothyroxin, inositol
B, 13 & H, 10
Married 17 years to DH, 49
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FROM CABF: Do not start, stop, or change medications or other treatments for yourself or your child based on what you read on this Website or elsewhere on the Internet. Information presented here should not replace the considered judgement of a doctor who knows you or your child.
My 12-year old son also recently started using Lamictal, in addition to Intuniv and Eskalith CR. His psychiatrist started him on 12.5 mg per day for one week, then 25 mg for two weeks, and just a couple of days ago it was increased to 50 mg per day. The doctor says he intends for this to be his target dosage for a good while. My son weighs 103 lbs.
However, the book I have been reading, which also strongly recommends a gradual ramping up of the dosage, states that the target for a child of this size (90-112 lbs) should be 100 mg per day. So, 150 mg does seem quite aggressive, but it also depends on the physical size of your child.
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Tim
Lamictal works for some people at a low dose (50mg), but most people need to get at least to 100 - 200 mg. Children sometimes metabolize it more quickly and require dividing the dose twice a day.
--
Brenda,50, CABF Parent to Parent Volunteer
Mom to A, 16, BP, Tourette's, OCD, ADHD: Eskalith CR, Trilafon, Lamictal, Seroquel, Cytomel
E, 14, BP,AS, hypothyroidism: Seroquel, Eskalith CR, levothyroxin, inositol
B, 13 & H, 10
Married 17 years to DH, 49
If CABF has helped you, please help CABF. Donate today. http://www.bpkids.org/donate?campaign=forums2010
FROM CABF: Do not start, stop, or change medications or other treatments for yourself or your child based on what you read on this Website or elsewhere on the Internet. Information presented here should not replace the considered judgement of a doctor who knows you or your child.