Lamotrigine/Lamictal for pain

Hi all,

I started taking Lamotrigine (brand name Lamictal for you USA people) 12 days ago at 25mg per day, to be increased by 25mg every two weeks up to 200mg.

The neurologist wants me to take this because he believes I fit some of the criteria for a condition called SUNCTS. I have nasal congestion, watery eyes and sudden very intense pain attacks up either side of the face, from trigeminal area, up behind eyes and lower part of forehead.

I also take Pregabalin at 300mg/day.

Now, has anyone else taken this for neuropathic pain? If so, did it work? Furthermore, should I the full dose all at night or divided doses 2/3 times per day?

I did a search on here and found lots of references for treating bipolar, which it seems to work very well for, but not pain. I have read online that this drug is particularly effective specifically for SUNCTS, so that gives me hope. Am going up to 50mg tonight two days early since the pain attacks are really bad right now.

Any help appreciated!

Thanks, that's interesting, I know it is not one of the more commonly prescribed anticonvulsant drugs for neuralgia. Seems to be specifically for these types of headache disorders like cluster headaches or what I am suspected to have.

Just taken first 50mg and seems tolerable so far, if a bit heavy on the head. It does appear to work so far to a small degree so I am hopeful that the higher dose will provide significant relief

wow, when Lamotrigine was put on market many of the mental health doctors were saying to patients that also had pain condition that this may even help help your pain some. your the first person i have heard bring it up other than my ex-rheumatologist. you are right, it can help. it has affinity to bind with the sigma-opioid receptor as a agonist. it's primary effect keeps to much glutamate from remaining in nerve synapses. glutamate is a excitory neurotransmitter that can be neurodegenerative/neuroinflammatory. both the primary effect and it's binding with the sigma receptor will help control chronic and prob acute pain and will add to analgesic effect to the pregabalin and other pain meds. it was looked at for a approved fibromyalgia med but it's small risk of causing a rash called Stevens-Johnson's syndrome which can be a necrotizing skin disease. flesh eating rash that can spread over entire body fast and kill. it is the premier Bi-Polar mood stabilizer due to it's relative saftey and effectivness.

it also fights tolerance to opioids by antagonizing the NMDA/Glutamate receptor.

Hi Holy Diver,

I was on Lamictal for a little over a year, when my docs were questioning whether or not I was bipolar II (I am not). I was taking it as a mood stabilizer, not for pain. I was on 200 mg (the maximum dose), and I never really thought that it did anything for me, which is why we ultimately stopped it. I have heard some obscure things about it being used for pain, but it certainly did not help my pain at all.

Spinal soldier is right that lamictal is thought to have some NMDA receptor antagonist potential. However, the actual mechanism of action of this drug is still not completely understood. Current thought is that the NMDA receptor (or at least one subtype of NMDA receptors) is involved in the glutamatergic transmission of pain signals within the brain and spinal cord. However, the efficacy of NMDA receptor antagonists for the treatment of neuropathic pain is still controversial. NMDA receptor antagonists are use dependent on the molecular level, meaning that they exert their action only when the receptor is stimulated. Therefore, the effect of the drug is completely dependent on the level of activation of the targeted pathways. The more active the pathway, the stronger the block. It is a bit difficult to explain without getting into the actual neurochemistry. NMDA receptor antagonists are also thought to help reduce opioid tolerance, but again, this has not been scientifically proven, and is still controversial.

I do hope that your doctor stressed how dangerous starting this drug can be if not done exactly as directed. Please don't change your dose to twice daily (even if you are dividing a dose) unless told to do so, or okayed by your doctor. If you increase this medication too quickly, you can develop a life threatening condition, the first sign of which is a skin rash. Your doctor should have given you information about how to recognize this particular rash. However, if you develop ANY kind of rash while on or starting lamictal, you need to tell you doctor right away, and stop the drug immediately. It may be nothing, but it is not worth finding out. People DO die from the Steven-Johnsons rash. I don't mean to scare you or anyone else. The risk of developing the rash is slim, but the potential for it can't be emphasized enough, as if you are one of the few who gets it, it is very serious.

I hope the lamictal helps you! Keep us posted & let us know how it goes!

Skeye

I took mine at night for the majority of the time that I took it 1) because it was most convenient for me, and 2) because it theoretically can make you sleepy. I never noticed any side effects from it, though. At one point I did switch to twice daily divided doses. It certainly can be done, I just wouldn't do it without talking to your doctor first.

Skeye

Sounds rough nvrthesame, the skin rash condition does is kind of scary to think about. Am hoping I don't come out in any skin problems, since I feel the drug is doing some good already only a couple of weeks in.

I have noticed it that it potentiates the effect of the pregabalin which is very good. Only slightly troubling side effect is making it a more difficult to sleep. Am looking forwards to getting up to a higher dose and finally having proper relief from the pain attacks.

Thanks Skeye.

I am not too worried about the skin rash thing, it was barely mentioned when I was prescribed the drug anyway so I guess it is very rare.

It has been two weeks since I went to 50mg, so tomorrow I am going up to 75mg. Am not sure whether I will take 25mg in the morning or just the full 75 at night. Documentation says either is ok. Seems to make logical sense to take it twice a day, more consistent effect etc.