Q:  Concerned about Lamictal Increase

Dr. Phelps,
     I have been on 200mg of Lamictal for 6-7 months for bipolar II with no results positive or negative (a little anxiety with each increase in dosage).  My new doctor recently added 5mg Zyprexa and 100mg more of Lamictal.  My former doctor raised only in increments of 25 or 50mg's.  What is your view on this sharp of an increase?  I'm scared that I could respond between the 200 and 300mg mark or get the "rash".
 

Dear Tom -- 
Generally speaking the rash risk is much higher when you're first starting, but statistically I don't know if anybody's tried to separate out the fact that in the first 6 months people also usually finish the dose increasing also, so they're no longer exposed to steps up in exposure to the medication.  So, I'm not aware of any data to guide this particular decision, i.e. whether to still be taking 25 mg steps even after you've been on it more than 6 months.  

Obviously you're concerned, so perhaps you could just ask your doc' if it's all right with her/him that you increase in smaller steps?  It would be slower, and perhaps she is feeling that things need to mover more quickly than that; but you're thinking about the risk side, as well as that potential benefit, and hopefully he'll respect that or help you come to feel less concerned by presenting you with more information (i.e. that I'm not aware of but maybe she is...). 

Dr. Phelps

Published April, 2003