Monday, August 8, 2011

Day 30, 75 mgs: Generic Lamotrigine Is Not Created Equal

When my pdoc first prescribed lamotrigine to me, he warned me that it was not all created equal.  The pills manufactured by Teva, he explained, have the same bioavailability as Lamictal, the brand name version.  The effective dose in a pill made by other manufacturers can vary dramatically.  If my generic got changed up on me, he said, I need to let him know.

This weekend, I titrated up to 75 mgs of lamotrigine.  I felt calmer, after having experienced some agitation toward the end of last week.  My mood was a bit lower.  Is this the "mood stabilizing" effect of lamictal? I wondered.  A few weeks ago I was feeling cheerful.  Is the higher dose bringing me down?

Yesterday I had my first late-afternoon mood dip in a few weeks; I felt vulnerable and slightly unbalanced, as if I was standing on the middle of a seesaw.  If the lamictal were really stabilizing me, I should be ... well, stable.  No mood swings.

Then it hit me -- I'd gotten my scrip filled at Costco, which uses generic lamotrigine made by NorthStar.  Walgreens, where I'd gotten my first scrip filled, used Teva.  Teva's got the highest effective dose of any of the generics.  Who the hell knows what dose NorthStar has?

What I do know is that 75 mgs of NorthStar is less effective than 50 mgs of Teva.  I emailed my doctor about this, so he'll know it as well.  We'll see what, if anything, he may want to do about it.

Today is also my first day off Zoloft completely.  I feel a bit better than I did yesterday, in terms of both mood and motivation, but I could just be imagining that.  I'm annoyed that the generic got switched up this weekend, because it will make it harder to tell the effects of removing Zoloft from the cocktail.

I do know that Zoloft effects me strangely.  I find it sedating, especially at higher doses (where a "high dose" is anything above 12.5 mgs), but I'm also more anxious when I'm on it.  I've read that it's the only SSRI that's dopaminergic, which might account for it -- except that simulants are also dopaminergic, and they help me relax.  On the other hand, stimulants stimulate everything in the brain, including the inhibitory chemicals that calm a person down.  To make matters even more confusing, SSRI's actually fight with stimulants, making them less effective.  Sometimes I feel like I need a PhD in neurochemistry to understand my own medical care.  Sigh.


  1. I've heard that generic Lamictal can cause problems. I'm glad to hear that there's at least one doctor who's familiar with the differences between the different generics!

    Once upon a time I was prescribed Ritalin, and also noticed a difference between the generics. Also generic birth control pills were horrendous on my moods compared to the brand name.

  2. Yeah, I've read of people getting the wrong generic and *really* getting messed up. The official "active ingredient", i.e., the drug itself, isn't always the only *active* ingredient ... each generic manufacturer puts their own mix of binders or whatever in there, and sometimes these can have their own weird effects.

    It's so irritating that these meds can vary as much as they can.


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