Q:  Questions re: Lamictal

I'm taking Lamictal for depression and possible BPII. I'm taking 100mg once at bedtime and am wondering what feedback you've had on AM versus PM dosing and even splitting dose morning and night.

I've been having vivid bad dreams on Lamictal and didn't know if switching dose time to AM or splitting dose (50mg twice daily) might help.

I'm also having a problem with warm feeling in temporal lobes and a little burning of eyes at doses BELOW 125mg. It's amazing that these side effects go away as I increase dose. Unfortunatly, if I go above 100mg I feel washed out.

I have also noticed a mild nagging joint pain in my hip joint. Can Lamictal cause this? My doctor told me "your just getting older" and laughed it off as there is no way Lamictal can cause this, I'm 40 by the way.

Lamictal seems to be a good med but unfortunetly doctors in this area don't know alot about it, even though they prescribe it.

Your input would be greatly appreciated.
 

Dear Ted -- 
Haven't seen single-joint pain on lamotrigine; I think I may have had a patient or two talk about multiple joint pain.  "Arthritis" is on the list of "infrequent" problems associated with lamotrigine (I had to go look that up to be sure; and I think I recall looking it up once before with a patient), as well as bursitis, and "joint disorder", the latter obviously rather vague, but bursitis might be closer to what you're describing.  Since I'm a good deal older you, I say can with confidence that the "40" explanation is not as strong is it might have been if you were 50!

As for the timing, at this dose a "once daily" approach is commonplace and seems (in my experience, at least) to work out fine, and time of day to make little difference. 

But the "washed out" thing sounds like one of the most limiting factors here.  That's too bad.  I don't see that, at this dose, at all in my patients (only in a few, over 200 mg).  

Hope that all helps a little. 

Dr. Phelps
 

Published Jan. 2005