Jmizz: Lamictal taper suggestions

[Altostrata]

You may occasionally be taking more than 20mg inadvertently, causing the itching and nausea. If I were you, I'd take 18mg to be on the safe side.

 

You can measure 18mg by changing your dilution method, @brassmonkey will help you figure this out.

 

You may want to find a smaller 5mL or 1mL oral syringe.

[brassmonkey]

Hi Jmizz-- I'll be glad to help figure out how to make up the 18mgai dose if you're interested in going that direction.  I'll need to know all the details of how you're doing it right now, the pill strength you're using, how much water, how much you actually take in volume, all that sort a thing.

 

Brassmonkey

[Jmizz]

@brassmonkey

 

hey brass, thanks I’d appreciate it. The nausea is really really kicking my butt. Currently I take a medicine cup and fill it with 5ML of water, drop a 25mg pill in it and let it dissolve. Then I mix it as best I can and extract 1ML and drink the 4ML remaining for 20mg. I always get nausea, some days are better than others. I get a little itchy sometimes too but not everytime. Some days I get a sinusy head pressure and headache also. I think alto is right that some days I’m taking more and inconsistent doses inadvertently. 

 

I really want to begin to work my way down to a lower dose as safely as possible. Mentally I feel the best I’ve felt in months. But physically I’m getting destroyed.

[brassmonkey]

All the symptoms you're mentioning are fairly common with nausea being near the top of the list. As you decrease your dose the symptoms should start to decrease also. To be safe we need to do thins in a slow and careful manner, it's going to take a while but you should be seeing improvements as we  go along.

 

Accurate dosing is a key to successful tapering. Using a homemade water suspension of Lamictal can be pretty tricky because it does not dissolve in water, or much of anything else for that matter.  That means you are doing a suspension, where all the particles of the tablet need to be up in the water and evenly distributed.  This is fairly easy if you are taking a full dose. To be accurate on smaller doses it can be pretty hard, because it keeps trying to settle out as you try to draw out a measured amount.

 

This can be gotten around by using a suspending medium such as ora-plus. It's a thick liquid that will hold the particles up while you measure your dose.  It can be bought on line, but it will add a continuing expense to the process. Also you will need a syringe that will measure in 0.1mL units. It will be much easier to use this then to recalculate your dilution ratio every time your do a reduction.

 

The other alternative is to buy a scale, crush and weight the powder.  It's a lot easier than it sounds and can be quite accurate.

 

What are your ideas on which direction to go?

[Jmizz]

@brassmonkey

 

i think ill prob want to try the scale method. Can you explain how to do it and which scale you guys would recommend?

[Jmizz]

@brassmonkey @Altostrata

 

the issue alto and I were having is that I wasn’t stable on my dose of lamotrigene. I was told to updose until I reached 100mg and at 50mg it was too activating for me. I was also taking 50 all the morning, one dose. As a result alto and I decided to drop to 20 morning and 20 evening by spreading my doses an hour each day. The combination of dose times and dropping from 50-40 was tough. Once I got my doses separated by 12 hours for a few days I seemed to stabilize a lot mentally. Now I’m back to just feeling activated and nauseous throughout the day after my morning dose, with headaches at times too. Some days seem worse and it’s prob due to taking a different amount each day trying to mix it in water. It is possible I’m still feeling the effects of a 20% drop in dose, but my symptoms seem to be dose related and happen at the same times each day.

 

I’d really like to get myself a scale bc I feel this way would be the most accurate. I’d just like to buy one that maybe you guys have used or some others have commented about that is reliable and hopefully not too expensive.

 

and then if you could explain the process of how to crush the pill and weigh it without losing any and the easiest way to transfer from the scale. I’m assuming by crushing and weighing it, you still ingest it by mixing with water?

 

One question about the Ora plus. It says it retains suspending properties when mixed with 50% water. Do you guys recommend this to make it last longer? I’m just wondering how often I’d have to buy a bottle if I went that route.

[brassmonkey]

There are a variety of scales available at a reasonable price on line. The important thing is that it weigh to 0.001g or 1mg (two ways of saying the same thing). Many of the people here use the Gemini-20. When you order it also get a bag of 1000 "0" size gel caps, you'll need them to put the crushed powder in.

 

these threads will be quite helpful:

https://www.survivingantidepressants.org/topic/1596-using-a-digital-scale-to-measure-doses/

https://www.survivingantidepressants.org/topic/8382-putting-powders-into-capsules/

 

Diluting the ora-plus will give you more base liquid to work with, Then it is a matter of how much crushed tablet you add to get the strength you want.  The strength/volume ratio determines how much you take as a dose.  So adding water can stretch things a bit.

[Jmizz]

@brassmonkey

 

So by getting the gel caps then you could make your entire week or months worth of tapering pills in a day if you had time? Instead of fooling with it every day? I’ll check out the links you provided, thank you.

[Jmizz]

@brassmonkey

 

i checked those links out. I’m a little concerned with some of the feedback about the scales not being accurate, some scales being knock offs from China, and losing some of the medicine when crushing. These may have been older posts and things may have evolved some but I’m curious about the Ora plus. Is this pretty effective for most people.

 

@Altostrata what do you recommend, and how would you guys play it if you were in my shoes?

 

ive taken 1.25ml out the last two days. Which converts to 18.75 dose morning and night for 37.5 daily. The nausea hasn’t seemed as bad, I’m going to try and hold like this for a bit bc I’m wondering if maybe my nausea being so bad the last couple weeks is partially a result of the drop from 50 to 40mg as well as it still being too much medication for me.

[Jmizz]

@Rhiannon

 

can you please explain the details of how you do your water taper of lamotrigene? You use water or Ora Plus? What do you mix it in and what type of syringe do you use? 

[Jmizz]

@brassmonkey

 

sorry to keep blowing you up. I’m just trying to decide if i want to order a scale or Ora plus and I want to do it today if possible. So the only draw back to the Ora plus is the continuing expense? Otherwise it should be pretty accurate and could be used all the way down and off the drug if I got a syringe that reads 0.1ML?

[brassmonkey]

Expense is the main thing, have to keep it refrigerated too. Yea it can be pretty accurate, we have a number of members using it, I don't remember names, but I've seen it talked about on several threads.  It's a good way to go if you want to do liquid.

[Altostrata]

On 12/10/2019 at 3:51 PM, Jmizz said:

ive taken 1.25ml out the last two days. Which converts to 18.75 dose morning and night for 37.5 daily. The nausea hasn’t seemed as bad, I’m going to try and hold like this for a bit bc I’m wondering if maybe my nausea being so bad the last couple weeks is partially a result of the drop from 50 to 40mg as well as it still being too much medication for me.

 

This seems like a good solution. Why not stick with this for a bit?

[Jmizz]

I agree @Altostrata

 

im going to try to stay here for a while and settle completely. The only reason I was considering the Ora plus is bc I’m worried about some days taking more or less dose by mixing it in water. But I’ve been trying to be more diligent and quicker on the draw the past couple days.

 

[Altostrata]

The OraPlus is a syrup that keeps the particles in suspension.

 

You might do better by measuring with an oral syringe rather than your cup. Ask your pharmacist for one, they usually give these away.

[Jmizz]

What I do currently is measure 5ML of water out in the cup. Then I drop the tablet in and let it sit for 10-15 min. I then mix it up with the syringe and try to pull out 1.25ML as fast as I can. Dump the 1.25 and drink what’s left in the cup. It seems to work ok, just some days it seems like maybe I took a little more than what I’m aiming for. I will provide a daily symptom update tonight. 

 

Im assuming if I get the Ora plus the medication will dissolve in the syrup the same as water? 

 

 

 

 

[Jmizz]

@Altostrata

 

can I take allergy medication while on lamotrigene and trazodone?

[Altostrata]

You'll have to read our discussions about Ora-Plus in the Tapering forum. Someone who's used it can advise you how it works.

 

Please use the Drug Interactions Checker https://www.drugs.com/drug_interactions.php to see how another drug will mix with your drugs. Avoid adding drugs if possible.

 

[Jmizz]

Ok thanks @Altostrata

 

so I haven’t really posted symptoms lately bc I’ve been fighting some sort of sinus infection or respiratory virus and it’s hard to tell what I’m feeling.

 

i think taking doses 12 hours apart has helped a lot. I feel as stable as I have in months mentally. I still physically feel off around lunch when I’m assuming the full dose hits me, and then again when it’s close to nighttime dose. It’s manageable though. I will update once I get over this illness I’m fighting. Still taking 18.75 twice a day, it’s been about 10 days on this dose. How long do you recommend I stay on this dose before considering another small drop? 

[Jmizz]

@Rhiannon

 

if i read your signature correctly, you are down to 13mg of lamictal? You have used water solution the entire way down or have you ever used the Ora plus solution. I’m currently taking my 18.75mg doses twice daily in water, it seems to work fine I’m just worried that as the doses get lower it will be harder to consistently take the right dose. 

 

@Altostrata

i hate to ask, but are there any easily accessible threads you can link here about the Ora plus solution without causing yourself much trouble. I tried to go browse and find some but everytime I venture out away from my personal thread I get really discouraged and end up stumbling upon horror stories that get me down.

 

i also want to say thank you. I’m far from feeling great but I have made more progress talking with you guys the past month than I have for the last 8. I feel really good mentally and I’m finally feeling like there can be a light at the end of this long slow tunnel. Physically I still struggle but I’ve also had a lot of changes lately and plan to go very slowly with holds to help minimize that on the way down from this point forward.

[Altostrata]

You're welcome.

 

[Jmizz]

@SquirrellyGirl

 

hi squirrelly,

 

im relatively new here. I’m trying to reduce my lamotrigene and seem to have the same issues with my mixture settling too quickly in water. I noticed in the thread @Altostrata suggested for me to read that you made a liquid that seems to be exactly the sort of thing I had in mind. Once I get my dosage math correct. I will dissolve my  lamotrigene tablet(s) in water first and then I plan to buy some Ora plus and would add Ora plus at a ratio of 1 to 1 with the water. I haven’t done the math yet but it seems this is basically what you did. How did that work for you?

[Jmizz]

Ok @brassmonkey I need your assurance with the math. I think I’m going to attempt the Ora plus mixed 1:1 with water to try and alleviate possible inconsistent dosing. 

 

I currently attempt to take 18.75mg of lamotrigene twice daily. If I purchase the Ora plus pint for 23 dollars its 473ml. 

 

There is many diff ways to achieve this and I would need to know from yalls experience which route would work best. I would like to just start by mixing enough to take my doses for 1-2 days and see how it works.

 

if I dissolved 50mg in 5ML of water and then used the Ora plus to bring the solution to 10ML, I could extract 3.75ML twice a day for my 18.75mg doses. Doing this I could make the Ora plus bottle last a few days over 3 months. This may be too concentrated, this is where yalls experience would come in. If so I’d have to dilute it more to something like 50mg in 10ML of water and use 10ML of Ora plus for 20ML solution and then extract 7.5 ML two times a day for my doses of 18.75. Doing it that way the bottle would last around 1.5 months. 

 

Thoughts?

 

@Altostrata

[Altostrata]

Good question, Jmizz. Your plan sounds plausible. Does your local pharmacist do compounding? They'd have a lot of experience with Ora-Plus making up liquids for children. They'd be the best people to answer your specific mix questions. Whatever you find out, please add it to our Ora-Plus topic.

[brassmonkey]

Hi Jmizz-  That would work sorta.  There are better ways.  I'm about to go out for the afternoon, but will get back to you with details later.

[Jmizz]

Thanks @brassmonkey

 

 

[bottlehalffull]

Sorry for barging into your thread, I'm working in a lamotrigine taper too. Does anyone know how stable lamotrigine is in water (or Orasure)? I've been trying to taper by splitting pieces off a 100 mg pill but it's not very accurate....

 

I also feel like the split off pieces are a lot harsher on me than the whole pill. Like the whole pill takes longer to start absorbing, but the pill fragment starts falling apart in my mouth and then absorbs all at once and makes me feel nauseous and awful, giving me side effects the whole pills never gave me. So I kind of worry that a suspension would do the same thing.

[Jmizz]

@bottlehalffull

 

I’m currently trying to figure alot of this out myself! Are you weighing your split pieces or just eyeballing it? I found that I had a lot of trouble when I first moved from pills to mixing with water. Nausea, head pressure, headaches, dry mouth. Nausea was the worst. But I had also dropped 50 to 40 bc I was feeling to activated and also changed from taking my dose in the morning to taking my dose 12 hours apart. So I had a lot going on. Most of the side effects have settled a great deal, however some days I get them and I’m thinking it’s related to taking more or less some days bc the water solution is variable to some extent. This is why I’m considering the Ora plus however I can’t comment on that bc I havent tried it yet. I think like everything else with these meds, there is an adjustment. If you’re going to taper and the pill fragments cause issues, worrying about if the water solution will seems redundant. One way or another you’re going to have to make dose decreases. It’s prob best to just pick a method and stick with it. 

 

As far as stability? Are you referring to how it mixes or the efficacy Of the medicine when dissolved in these solutions. I have yet to read anything about the medicine losing effect when mixed in a solution. I dissolve mine in water, it doesn’t mix well but it does dissolve, so I try to just stir it up really fast and extract the amount I need to waste and then drink the rest. My hope is that If I try Ora plus, it will become a little more accurate.

 

How long have you been tapering? And what dose were you at before and taking now?  

 

Edit: I just read your backstory and can pretty much guarantee the nausea and awfulness you’re feeling is not related to breaking pieces of your pill and moreso related to goin down wayyy too fast. I dropped from 50-40 and felt nausea horribly for about a week. I think dropped to 37.5 and had effects again. Going from 100-30 in a few weeks is going to cause problems for certain. The mods can help you try to come up with a plan to level things off, they will prob get back to you on your thread shortly. Hang in there.

[brassmonkey]

Lamictal itself does not dissolve in water. Some of the filler material might, depending on what fillers they used to make the pills. The majority of the active ingredient will settle onto the bottom of the container if the mixture is allowed to stand still.  Shaking the mixture very hard just as you remove the excess will help get around this problem.  To prevent the settling we prefer to use a thicker liquid such as the ora-plus.  The pills need to be crushed into a very fine powder and mixed very well with the ora-plus to create what is called a "suspension".  It is called this because the powder is "suspended" in the ora-plus and will stay in place with out shaking. With the powder suspended in the liquid it is now possible to get more accurate and repeatable doses.

 

To help save money it is possible to dilute the ora-plus 1:1 with water and still have it hold the powder in place. This way you will get twice as much liquid for the price. To get a liquid that is the easiest to work with and have the least chance of making a mistake in the dose it is best to use a 1:1:1 dilution. That would be one part ora-plus, one part water and one tablet of medication.  You mentioned using 50mgai tablets, so I will use those for my calculations.

 

Our target is to make a liquid that has 1mgai of medication for every 1mL of liquid.  If we use a 50mgai tablet then we will need 50mL of liquid. That liquid is to be half ora-plus and half water. So for every 50mgai tablet we need to use 25mL ora plus and 25mL water.

 

We will start by measuring out 25mL of ora-plus and 25mL of water and combining them in a mixing/storage bottle.  Shake them up rally well and then let it sit for a few minutes.  While it is sitting we need to grind up one 50mgai tablet into as fine a powder as we can.  There are a lot of ways to do this, I like the two spoon method. Be very careful not to lose any of the powder.  Once we have it ground as fine as possible we want to start mixing it with the liquid. But we don't want to just dump it all in at once.  It is best to put 5-10mL of the liquid into a small mixing container and add the powder to that.  Mix it up really well into a thin paste.  Now add the paste to the container with the rest of the liquid, making sure you get every bit of it in.  Once it's all in shake it up really well.   Let it sit for a while and then shake it again, we want the paste to mix throughout the liquid.

 

To use the liquid all you do is measure out the volume that matches the mgai of the dose you want to take.  Above you mentioned wanting to do 18.75mgai twice a day.  So you would measure out 18.75mL in the morning and an additional 18.75mL in the evening.  Save the leftovers a and combine them with later batches so you don't waste any.  It will keep in the refrigerator for several days.

 

Hope that helps. 

[bottlehalffull]

9 hours ago, Jmizz said:

Are you weighing your split pieces or just eyeballing it? I found that I had a lot of trouble when I first moved from pills to mixing with water. Nausea, head pressure, headaches, dry mouth. Nausea was the worst. But I had also dropped 50 to 40 bc I was feeling to activated and also changed from taking my dose in the morning to taking my dose 12 hours apart. So I had a lot going on. Most of the side effects have settled a great deal, however some days I get them and I’m thinking it’s related to taking more or less some days bc the water solution is variable to some extent. This is why I’m considering the Ora plus however I can’t comment on that bc I havent tried it yet. I think like everything else with these meds, there is an adjustment. If you’re going to taper and the pill fragments cause issues, worrying about if the water solution will seems redundant. One way or another you’re going to have to make dose decreases. It’s prob best to just pick a method and stick with it. 

Eyeballing it. I only really get the nausea right after taking it for about an hour, plus some panic/anxiety and sudden exhaustion. The sudden exhaustion, maybe with some extra-tire crankiness, I felt on the full pill (100 mg) when I took it, that's why I only took it before bed, the other stuff is new. That's even with taking the pill fragment with food (I usually took the full pills on an empty stomach before bed).

 

9 hours ago, Jmizz said:

As far as stability? Are you referring to how it mixes or the efficacy Of the medicine when dissolved in these solutions. I have yet to read anything about the medicine losing effect when mixed in a solution. I dissolve mine in water, it doesn’t mix well but it does dissolve, so I try to just stir it up really fast and extract the amount I need to waste and then drink the rest. My hope is that If I try Ora plus, it will become a little more accurate.

Yeah I mean the efficacy if I dissolve it and add oraplus (or whatever the local equivalent is if there is one), how long will it be stable if I want to do a largish batch at once? I know some drugs if you keep them in solution at the wrong pH they start breaking down or converting to other non-active stuff. Maybe @brassmonkey knows?

 

I really just want to quit it now but I'm realizing some of the crazyness I had after high school was probably from cold turkeying celexa because I didn't trust my condescending child psychiatrist and didn't want to see him again. Looking at that time period from the windows and waves perspective, my random fits of agoraphobia and crippling (couldn't even talk to or look at a cashier) social anxiety over the following five or so years were probably linked to that. I wonder how much of my mood issues over the next.... almost 20 years? were caused from that one event. Don't give kids psych meds, guys!!

[Jmizz]

A few posts back @Altostrata dropped a link for a discussion on liquid tapering and the Ora plus solution. You should check that out.

[bottlehalffull]

Thanks, I will!

[Jmizz]

@brassmonkey

 

thanks for the advice. I have a question though. For me it seems like there are a lot of ways to end up losing some of the pill between crushing and making the paste. Residue getting stuck to instruments etc... the pill definitely doesn’t mix in water, it settles as we have discussed. However, it is dissolved by sitting in water for 15-20 minutes. Would this not be the same as crushing?...I guess I’m just wondering which part of the process I described possibly trying would steer me wrong? It seems like the pill would be in the same form as crushing it as it dissolves in water, and then adding Ora plus for a 1:1 ratio and giving it a thorough stir would create the same end product with less effort. I want to emphasize I’m asking, not second guessing. You may have a very clear answer as to why it won’t work as well, I’m just trying to learn.

 

from reading around it seemed as if @SquirrellyGirl was going to try this or was doing this in 2018 with her mirtazapine bc of the same issues with settling. If she still visits the site I’d love to hear how this worked for her if she tried it.

[brassmonkey]

You could try dissolving the tablet in the 25mL of water first, then mixing with the ora-plus. The important part is to get the tablet into the smallest pieces possible.

 

Bottle-- homemade liquids like this can be stored in the refrigerator for four days to a week. Any longer and there is the  chance of contamination, mold and the like. 

[Jmizz]

Thank you sir. I’ll prob give this a shot and report back once I get the Ora plus in.

[Jmizz]

@Altostrata

 

ok so im over whatever allergy attack or sinus infection I had.

 

i wanted to let you know how I’ve been feeling. I think the horrible nausea was most likely the result of spacing my doses and dropping 10mg from 50 to 40. The nausea has settled a great deal, I still feel it mildly at times but nothing like that week or 2 during the changes. I have not noticed any itching for some time. I haven’t taken any ativan in probably close to 3 weeks so this makes me happy. I had a weird day today, my mood has been better than it has been in a while for a week or so but today I struggled with some mild depression it seemed and kind of a brain fog. It’s been about 11 days since I dropped again to 37.5. So I’d assume maybe the drop is finally catching up to me and this could be the reason. It wasn’t bad, but my mood just wasn’t what it had been for the past week or so. 

 

Anyway physically my days have basically been going like this:

 

sleep pretty good, had a couple times the past week or so where I had to wake up to urinate, which isn’t the norm for me

6:30 I wake up, it hasn’t been as hard to get out of bed as it’s been in the past, still usually feel the restless legs when I wake up though

8:00am I take my 18.75mg water solution

9:30-11 I can feel the medicine usually, sometimes I’ll get some dry mouth or slight nausea during this period

12:30-2 I can usually tell the full dose hits my system, it’s tolerable and I usually just keep myself moving and busy to not think about it, but there is still some activation feelings

4-7 I usually feel pretty yucky in the afternoon, this has been the case for a long time though, before lamotrigene.  I’ll get a second wave of nausea during this time sometimes, and lately I’ve been feeling kind of withdraw-ish leading up to my 8:00pm dose

8:00pm- take my 18.75mg 

9:00- sometimes I can feel the nighttime dose before I take my trazodone and melatonin, other times I don’t.

9:30 traz and melatonin

 

My plan is to hold at least another couple weeks and see if it was the dose drops causing the nausea and other symptoms. If the random days or nausea continue I’ll prob give the Ora plus method a try and see if maybe it helps by providing better accuracy with doses.

 

as always your thoughts are welcomed!