N and Lamictal interaction?

[tryingtoescape]

Would N interact with Lamictal at all? I am on 600 mg of Lamictal. I need to take it or I have constant panic attacks so bad I vomit, even if I stop for a day. High doses of LTG can rarely cause elevated liver enzymes, which can cause survival in N suicide attempts.

AEDs often drastically reduce the level of other drugs and other gaba increasing drugs, like Tegretol reducing benzodiazepine concentration by up to 80%. Because some are enzyme inducers, some inhibitors, depending on the enzymes they affect. They are both metabolized by the liver so this is crucial and this all depends on the enzymes they effect.
I can't find any information online about interaction between Lamictal and N, but I want to make sure, because N isn't used anymore so it may be undiscovered. I've been trying to do research on what enzyme it effects and which enzyme N is in the liver, which would make it clear, but I can't find information.

Most importantly what I'm most worried about, Lamictal can also cause elevated liver enzymes in high doses. This would affect N. I am currently on 600 mg because I'm on estrogen pills for severe acne and estrogen reduces the levels of Lamictal by half. I don't understand if the 600 mg is absorbed by liver when estrogen reduces the blood concentration of it. Elevated liver enzymes are a cause of extended coma in N suicides. I cant take N with elevated liver enzymes, which high doses of Lamictal can rarely cause, but I don't know if this is a risk because I don't know if the full Lamictal dose or half is still absorbed by the liver with the estrogen.
Is anyone who is taking N on Lamictal? Or have info or understanding of chemical interactions between them?

 

[Cathy Ames]

Maybe try one of those online drug interaction checkers? Or all four of them to cross-check results?

Drug Interaction Checker - Quickly Check Your Meds

Instantly check interactions between your medications, supplements, food, and alcohol. Use our trusted tool to avoid harmful combinations.

www.drugs.com

Drug Interaction Checker – Check for Interactions Between Prescription Medications

Use WebMD’s Drug Interaction Checker tool to find and identify potentially harmful and unsafe combinations of prescription medications by entering two or more drugs in question.

www.webmd.com

Drug Interactions Checker - Medscape Drug Reference Database

Analyze prescription and OTC drug interactions to determine which drug combinations your patients should avoid. Includes food, alcohol, and herbal supplements.

reference.medscape.com

Drug Interactions Checker - Check Your Brand and Generic Drugs - RxList

Check for drug interactions and learn what drug combinations to avoid with the RxList drug interaction checker tool.

www.rxlist.com

 

[tryingtoescape]

Maybe try one of those online drug interaction checkers? Or all four of them to cross-check results?

Drug Interaction Checker - Quickly Check Your Meds

Instantly check interactions between your medications, supplements, food, and alcohol. Use our trusted tool to avoid harmful combinations.

www.drugs.com

Drug Interaction Checker – Check for Interactions Between Prescription Medications

Use WebMD’s Drug Interaction Checker tool to find and identify potentially harmful and unsafe combinations of prescription medications by entering two or more drugs in question.

www.webmd.com

Drug Interactions Checker - Medscape Drug Reference Database

Analyze prescription and OTC drug interactions to determine which drug combinations your patients should avoid. Includes food, alcohol, and herbal supplements.

reference.medscape.com

Drug Interactions Checker - Check Your Brand and Generic Drugs - RxList

Check for drug interactions and learn what drug combinations to avoid with the RxList drug interaction checker tool.

www.rxlist.com

I did try but none showed up, however, elevated liver enzymes can cause N to fail according to Exit due to rapid clearance of drugs, and LTG (Lamictal) can rarely cause elevated liver enzymes in people on high doses, which I am. I am not sure, however, if full 600 mg dose of LTG is still absorbed when on estrogen which reduces its concentration in the blood. LTG is metabolized in the liver afaik (correct me if I'm wrong) so I don't know if while on both LTG and estrogen LTG is always at half the dose, or if it's first fully going to the liver at full 600 mg, potentially inducing liver enzymes, and then reducing blood concentrations while enzymes are still elevated.

If anyone has knowledge about this please share.

 

[Cathy Ames]

I did try but none showed up, however, elevated liver enzymes can cause N to fail according to Exit due to rapid clearance of drugs, and LTG (Lamictal) can rarely cause elevated liver enzymes in people on high doses, which I am. I am not sure, however, if full 600 mg dose of LTG is still absorbed when on estrogen. LTG is metabolized in the liver afaik (correct me if I'm wrong) so I don't know if while on both LTG and estrogen LTG is always at half the dose, or if it's first fully going to the liver at full 600 mg, potentially inducing liver enzymes, and then reducing blood concentrations whike enzymes are still elevated.

If anyone has knowledge about this please share.

Did you have elevated liver enzymes on your last blood work?

Elevated Liver Enzymes: What Is It, Causes, Prevention & Treatment

If your blood test shows high levels of liver enzymes, you may need treatment. Either liver disease or medication may cause elevated liver enzymes.

my.clevelandclinic.org

 

[tryingtoescape]

Did you have elevated liver enzymes on your last blood work?

Elevated Liver Enzymes: What Is It, Causes, Prevention & Treatment

If your blood test shows high levels of liver enzymes, you may need treatment. Either liver disease or medication may cause elevated liver enzymes.

my.clevelandclinic.org

I actually just called my doctor to ask for a blood draw script. Will need this!

 

[Cathy Ames]

I actually just called my doctor to ask for a blood draw script. Will need this!

I mean, I think this is how you would know whether or not they were elevated. Although it is highly ironic to go to the doctor for this reason. I'm awfully sorry.

 

[_Seeking]

I know a lot of older people are on many meds and are succeeding with N. Especially if you have 2 bottles, I don't think it should be a problem.

 

[Cathy Ames]

I know a lot of older people are on many meds and are succeeding with N. Especially if you have 2 bottles, I don't think it should be a problem.

Based on the lack of flagged interactions, that does seem likely, but OP asked and then asked again.

 

[wljourney]

That's a VERY specific question and something a pharmacy student or hepatologist could answer.

When you have your doc appointment you could ask how your meds & estrogen influence the clearance (metabolizing) of medications in general. Pretend to be curious and wanting to understand more.

On another note: the meds you are taking may have the side effect of increasing suicidal thoughts. Maybe another option is to ask if there are other treatments available? Other than Lamictal?

 

[tryingtoescape]

That's a VERY specific question and something a pharmacy student or hepatologist could answer.

When you have your doc appointment you could ask how your meds & estrogen influence the clearance (metabolizing) of medications in general. Pretend to be curious and wanting to understand more.

On another note: the meds you are taking may have the side effect of increasing suicidal thoughts. Maybe another option is to ask if there are other treatments available? Other than Lamictal?

I'm suicidal because of physical disease, I have tried every other mood stabilizer but was taken off due to side effects. Lamictal is the most effective one for me. I cant go off because my OCD becomes unbearable.

I'll be asking my Dr, and the pharmacist at my drug store. Going off Lamictal makes my existing terrible OCD and hypomania 10/10. But I am very afraid of extended coma.

 

[wljourney]

I'm suicidal because of physical disease, I have tried every other mood stabilizer but was taken off due to side effects. Lamictal is the most effective one for me. I cant go off because my OCD becomes unbearable.

I'll be asking my Dr, and the pharmacist at my drug store.

Ok yes I understand that and empathize with your situation.
Being out of other options is terrible.

Idea: when you ask about the metabolization of other drugs, give an example of something that is also metabolized in the liver. Like Tylenol.

"Would I have to take more Tylenol to make it have the same effect?"

 

[tryingtoescape]

Ok yes I understand that and empathize with your situation.
Being out of other options is terrible.

Idea: when you ask about the metabolization of other drugs, give an example of something that is also metabolized in the liver. Like Tylenol.

"Would I have to take more Tylenol to make it have the same effect?"

This is good advice. Thank you. I'll probably have to ask multiple pharmacists. If it does absorb the full dose and elevate liver enzymes, I'll have to reduce the dose. Surviving is traumatic to even think about, and elevated liver enzymes are almost the only causes of failure so I'd have to. So I need to find out for sure. I'll also be having blood drawn to check anything abnormal in the liver.

So desperate and despaired. The uncertainty too. If only my death was guaranteed.

 

[archipelago]

I have a similar situation. Not using the same meds as you, but I do use a known liver enzyme inducer and I've used it for a very long time.

I had the idea of getting tested too but for the life of me can't get my doctor to do it rn. I found a chart from a medical school website about liver enzyme inducers and inhibitors. I've read more thoroughly about which liver enzymes my medications induces, and I decided to use a liver enzyme inhibitor in the time leading up to ctb to somewhat counteract the effect of the enzyme induction. But be warned, that if you choose this route that it can potentially increase or decrease the levels of medication in your blood. You might get more side effects than usual, or you might have a level that's too low to control your symptoms. What you choose to do with this info is your responsibility.

At the very least, I've never once tested abnormally for liver enzymes, so I think this works in my favour.

I don't think the chart is a complete list by any means, but it could help

https://drug-interactions.medicine.iu.edu/MainTable.aspx

 

[Cathy Ames]

If it does absorb the full dose and elevate liver enzymes, I'll have to reduce the dose.

I thought the advice was to take a larger dose of N? In fact, I thought this was why the dose was so large in the first place.

 

[archipelago]

I thought the advice was to take a larger dose of N? In fact, I thought this was why the dose was so large in the first place.

I think they're referring to reducing the dose of the liver enzyme inducing medication

This whole thing irks me. I wish PN went into more detail about this in PPH, especially since most people who read it are on many meds.

 

[Cathy Ames]

I think they're referring to reducing the dose of the liver enzyme inducing medication

Yes, they are. And reducing the dose will make things very unpleasant for them (OCD and hypomania).

 

[archipelago]

Yes, they are. And reducing the dose will make things very unpleasant for them (OCD and hypomania).

I misunderstood at first, sorry. I see what you mean now.

It's a difficult situation all around.

 

[Cathy Ames]

@tryingtoescape Try this drug interaction checker. https://go.drugbank.com/
Enter estrogen, pentobarbital, and lamictal.

It appears that taking pentobarbital will potentially reduce the therapeutic effect of estrogen and decrease the serum concentration of Lamictal. IF it happens at all, given the single dose and short time frame. And then it advises to check with your doctor, so....

Seeing this, my big concern for you is that Lamictal has been shown to increase the risk of suicidal thoughts and/or behavior, and that very well may factor in to your decision-making despite your having the impression that ONLY the health problem is in play. These induced thoughts are pretty fricking powerful (ask me how I know). When you get them out of the picture or make them a much smaller part of the picture, the decision really CAN become far less obvious and other factors (such as concern about loved ones) can become a lot more pertinent... or at least that is what happened to me. And, yes, I saw it is the only drug that helps you OCD and hypomania. Possibly if the prescriber knew about the suicidal thinking they would come up with something else to try, though. Or an add-on that might help. [Adding a second drug to fluoxetine completely changed the picture for me, even though I continued taking fluoxetine and supposedly had even higher levels of it due to the second drug.] If you have anything in your life that would keep you here, this probably bears investigation.

 

[tryingtoescape]

@tryingtoescape Try this drug interaction checker. https://go.drugbank.com/
Enter estrogen, pentobarbital, and lamictal.

It appears that taking pentobarbital will potentially reduce the therapeutic effect of estrogen and decrease the serum concentration of Lamictal. IF it happens at all, given the single dose and short time frame. And then it advises to check with your doctor, so....

Seeing this, my big concern for you is that Lamictal has been shown to increase the risk of suicidal thoughts and/or behavior, and that very well may factor in to your decision-making despite your having the impression that ONLY the health problem is in play. These induced thoughts are pretty fricking powerful (ask me how I know). When you get them out of the picture or make them a much smaller part of the picture, the decision really CAN become far less obvious and other factors (such as concern about loved ones) can become a lot more pertinent... or at least that is what happened to me. And, yes, I saw it is the only drug that helps you OCD and hypomania. Possibly if the prescriber knew about the suicidal thinking they would come up with something else to try, though. Or an add-on that might help. [Adding a second drug to fluoxetine completely changed the picture for me, even though I continued taking fluoxetine and supposedly had even higher levels of it due to the second drug.] If you have anything in your life that would keep you here, this probably bears investigation.

I've only been on Lamictal for the past few months. I've been sure about suicide and in constant hell for 7 years, after I developed life altering diseases, before any medication usage. I have taken every ssri and one snri and I became hypomanic and my ocd became even worse. I've also taken several tricyclics and they worsened my vocal cord paralysis.
I'm suicidal because of intense tinnitus and a nerve disease that prevents me from walking. Anyone would be suicidal in my case. I've in constant despair and my quality of life is nonexistent.
And nothing in my life is worth staying here when I have these life altering torturous diseases which have both been referred to as "suicide diseases." The existence of mental illness makes the torture even worse. My mental illness before is night and day. I've been in unbearable torture and desired to die every day for 7 years since the onset of my diseases. Of course, it is always a good idea to make sure one is on the right medication regime. I'm glad changing medications help a lot of people's situations and it helped you, but it is unfortunatey not my circumstance.

@tryingtoescape Try this drug interaction checker. https://go.drugbank.com/
Enter estrogen, pentobarbital, and lamictal.

It appears that taking pentobarbital will potentially reduce the therapeutic effect of estrogen and decrease the serum concentration of Lamictal. IF it happens at all, given the single dose and short time frame. And then it advises to check with your doctor, so....

Seeing this, my big concern for you is that Lamictal has been shown to increase the risk of suicidal thoughts and/or behavior, and that very well may factor in to your decision-making despite your having the impression that ONLY the health problem is in play. These induced thoughts are pretty fricking powerful (ask me how I know). When you get them out of the picture or make them a much smaller part of the picture, the decision really CAN become far less obvious and other factors (such as concern about loved ones) can become a lot more pertinent... or at least that is what happened to me. And, yes, I saw it is the only drug that helps you OCD and hypomania. Possibly if the prescriber knew about the suicidal thinking they would come up with something else to try, though. Or an add-on that might help. [Adding a second drug to fluoxetine completely changed the picture for me, even though I continued taking fluoxetine and supposedly had even higher levels of it due to the second drug.] If you have anything in your life that would keep you here, this probably bears investigation.

And I did ask a pharmacist but they didn't really know much so I'm going to ask a few more and get my blood drawn. I may reduce my dose of Lamictal just to be on the safe side. Right now I'm just terrified about D not coming back. So afraid I am in the process of researching Pegasos and have emailed them. I hate how hard it is for people with life altering disease to just die. Assisted suicide for all people in these horrific circumstances should be an option in America as well.

 

[Cathy Ames]

I'm suicidal because of intense tinnitus and a nerve disease that prevents me from walking. Anyone would be suicidal in my case. I've in constant despair and my quality of life is nonexistent.

I'm very sorry that you have been going through these horrible diseases for so long without any relief. Not knowing (or understanding?) I felt the lamictal side effect was worth mentioning for similar reasons as what you said towards the end of your post. In my case, the change did help with the obsessive suicide ideation but didn't really help with anything else except for me to realize where that particular version of the thoughts came from. I certainly did not intend to diminish or dismiss the amount you are suffering, and I am very sorry it came across that way. I said I had a big concern? Well, now I no longer have that concern. Anyhow... go look at the interactions. It looks like pentobarbital affects the others but they do not affect it. I wish you the best.

 

[tryingtoescape]

I'm very sorry that you have been going through these horrible diseases for so long without any relief. Not knowing (or understanding?) I felt the lamictal side effect was worth mentioning for similar reasons as what you said towards the end of your post. In my case, the change did help with the obsessive suicide ideation but didn't really help with anything else except for me to realize where that particular version of the thoughts came from. I certainly did not intend to diminish or dismiss the amount you are suffering, and I am very sorry it came across that way. I said I had a big concern? Well, now I no longer have that concern. Anyhow... go look at the interactions. It looks like pentobarbital affects the others but they do not affect it. I wish you the best.

No, do not worry, it is always a good idea to make sure you are on the right medication regime and worth checking. I appreciate the concern and help. Don't want to come across as mad at all in that post, really hope I didn't, just want to make it clear to people that it isn't an impulsive situation, because it's hard to know why someone is killing themselves without background information. Sorry if it came off that way! No need to say sorry at all, I could tell you were just concerned and asking.
@Cathy Ames and again thank you for the concern. No need to apologize, I can tell you were trying to offer help in case since you don't know my background information of course from a post. You trying to check on me and make sure shows that you care and is greatly appreciated