Janine Asks…

I was recently prescribed Lamictal and just started today. I’ve been online doing some research and noticed that a lot of people start off on 25 mg and slowly increase that dose. I currently started today on 100 mg. I’m supposed to take 100 mg a day for a week and then start on 200 mg next week. Is that too much too soon?

Dr. Fink Answers…

Most prescribers increase the dosage very gradually over the course of several weeks. This is done to prevent a very rare but serious (and potentially fatal) rash that has been attributed to Lamictal in at least one study.

GlaxoSmithKline offers a “starter pack” that ramps you up very slowly:

  • Weeks 1 & 2, you take one 25-mg tablet once a day.
  • Weeks 3 & 4, you take two 25-mg tablets once a day, which equates to 50mg of Lamictal per day.
  • Week 5, you take one 100-mg tablet once a day. These tablets are bigger and peach color.

I have used this technique for starting people on Lamictal and so far have not had anyone report serious skin reactions. When I have spoken to neurologists who have used this drug for years and who are very comfortable with it, they reassure me that this kind of very slow titration will reduce the risk of skin reactions dramatically.

If you are also taking Depakote, the titration rate is even more gradual – Glaxo offers a separate starter pack for people starting Lamictal who are already on Depakote. I have heard of some docs who titrate up from 5 mg per day – which is the most conservative approach that I am aware of.

Lamictal has been a successful treatment for many people in my practice – especially those with significant, recurrent depressive cycles. I am quite comfortable using it as long as we increase gradually and monitor closely – my patients know that they should contact me if they have any concerns during the process.

For more about Lamictal, check out Bipolar Medication Spotlight: Lamictal (Lamotrigine).