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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on January 20, 2015, at 8:55:49
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 20, 2015, at 6:19:54
High dose antipsychotic treatment can include above maximum doses of single drugs, combinations which count as high doses when taken together, or in your case - both. In terms of physical monitoring, intermittent ECGs, pulse and blood pressure monitoring, and weight/BMI checks should be sufficient for you. Temperature monitoring is more important for the elderly, and in those treated with high-potency neuroleptics like haloperidol (due to the higher risk of neuroleptic malignant syndrome with these drugs).
Blood tests performed to monitor antipsychotic safety may include:
Plasma glucose, and possibly HbA1c - diabetes checks. Early morning glucose level after an overnight fast is useful.
Plasma lipids - cholesterol, triglycerides. Triglycerides in particular are often elevated by olanzapine. Quetiapine sometimes does the same. Amisulpride causes much milder metabolic changes.
Plasma electrolytes and kidney function - electrolytes such as potassium must be normal for high doses of antipsychotics to be used. Kidney function should be checked in metformin and amisulpride users. Amisulpride and metformin are eliminated predominantly by the kidneys. Olanzapine and quetiapine are excreted following metabolism by the liver.
Full blood count and liver function tests - may be performed occasionally. Quetiapine sometimes leads to abnormal results here but they are usually minor. Full blood counts are useful for general health monitoring, however.
Prolactin - can be measured if sexual dysfunction or loss of libido occurs, or once or a maintenance dose of amisulpride has been established, or after 3 months of treatment (in the absence of symptoms). It's useful to have a baseline before starting antipsychotics (or a new antipsychotic), but in your case it was probably normal or mildly elevated before starting amisulpride. Quetiapine rarely causes significant prolactin elevation. Olanzapine sometimes causes mild elevations, but marked elevations are uncommon. I think you should assume minor/insignificant elevation before starting amisulpride, and take that as your baseline. Prolactin is best measured around an hour after waking, and an hour after breakfast. Stress should be minimised because it can cause a spike in prolactin levels. It is often necessary to re-test if a moderate elevation is found. If it is normal, or if it is extremely high - that tells you more.
I imagine you'll be able to get most physical monitoring and blood tests through your non-psych doctor. Apart from prolactin, all the tests are very routine indeed.
Posted by Lamdage22 on January 21, 2015, at 5:59:55
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 20, 2015, at 8:55:49
i must say im not feeling very well and i suspect it is from amisulpride!
Posted by ed_uk2010 on January 21, 2015, at 6:57:55
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 21, 2015, at 5:59:55
> i must say im not feeling very well and i suspect it is from amisulpride!
In what way are you not feeling well? Also, have you changed the doses of your other meds? How much amisulpride are you on now?
Posted by Lamdage22 on January 21, 2015, at 10:40:05
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 21, 2015, at 6:57:55
Havent changed my other meds. 100mg of amisulpride and i feel like sh*t.
I havent been very motivated before but now?? Terrible
Posted by ed_uk2010 on January 21, 2015, at 10:59:15
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 21, 2015, at 10:40:05
> Havent changed my other meds. 100mg of amisulpride and i feel like sh*t.
>
> I havent been very motivated before but now?? TerribleSo you were more motivated on 50mg and less on 100mg?
To be honest, you're on three antipsychotics. You may not be able to tolerate amisulpride without reducing Zyprexa.
Posted by Lamdage22 on January 21, 2015, at 11:39:11
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 21, 2015, at 10:59:15
Initially i thought it was mood lifting.
Posted by ed_uk2010 on January 21, 2015, at 13:17:33
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 21, 2015, at 11:39:11
>Initially i thought it was mood lifting.
You're taking three D2 antagonists now. I don't think the mood elevation will reappear unless you reduce something. Too much D2 antagonism is usually unpleasant.
Has your doctor suggested how to reduce?
Posted by Lamdage22 on January 23, 2015, at 7:47:40
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 21, 2015, at 13:17:33
We have quit the project now.
I could not do therapy which is very important for the institution im in.
I will see that i take as little of zyprexa as possible.
Which for now means 12.5 mg
Posted by ed_uk2010 on January 23, 2015, at 11:13:28
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 23, 2015, at 7:47:40
Shame it didn't work out.
So... do you need to be on such a high dose of Seroquel as well as Zyprexa? Is that important for stability?
Posted by Lamdage22 on January 25, 2015, at 11:01:13
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 23, 2015, at 11:13:28
If i take less i cant sleep!
And if i take much less i indulge in psychotic thought.
I will ask my PD tomorrow if i can get something for sleep that is non-addictive and non diabetes forming.
Posted by ed_uk2010 on January 25, 2015, at 11:05:38
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 11:01:13
> If i take less i cant sleep!
>
> And if i take much less i indulge in psychotic thought.
>
> I will ask my PD tomorrow if i can get something for sleep that is non-addictive and non diabetes forming.How do you take the 900mg? I mean, how do you divide it across the day?
Posted by Lamdage22 on January 25, 2015, at 12:00:50
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 11:05:38
During the day: Seroquel prolong: 100- 0 - 300
At night : Seroquel 500
Posted by ed_uk2010 on January 25, 2015, at 12:10:54
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 12:00:50
> During the day: Seroquel prolong: 100- 0 - 300
> At night : Seroquel 500>Seroquel 900mg
Zyprexa 10mg
Lithium orotate 480mg
Metformin 1500mg
Effexor 20mgSo, is this list still correct? Are you diabetic or are you on metformin to help with weight gain on the antipsychotics?
Posted by Lamdage22 on January 25, 2015, at 12:25:07
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 12:10:54
Zyprexa 15.
Metformin for weight gain!
Posted by Lamdage22 on January 25, 2015, at 12:40:20
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 12:25:07
There you go.
Posted by ed_uk2010 on January 25, 2015, at 13:16:25
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 12:40:20
> There you go.
Thanks, so, how overweight are you and has metformin helped?
Posted by Lamdage22 on January 25, 2015, at 13:25:23
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 13:16:25
Maybe 20-30 pounds.
Yes it helped tremendously.
I wonder if i can lower my diabetes risk by going on, say 1500mg of Seroquel and ditching the Typrexa.
Posted by ed_uk2010 on January 25, 2015, at 13:31:14
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 13:25:23
>I wonder if i can lower my diabetes risk by going on, say 1500mg of Seroquel and ditching the Zyprexa.
I don't think there's any evidence that that would be safe or effective. Very high doses of Seroquel are occasionally tried, but they don't generally seem to be better than standard doses.
What happens if you reduce Zyprexa slowly while staying on Seroquel 900mg?
Posted by Lamdage22 on January 25, 2015, at 13:33:03
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 13:25:23
Doctors do this sometimes.
1800 even.
Posted by Lamdage22 on January 25, 2015, at 13:34:07
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 13:31:14
Then i usually cant sleep with 12.5 mg Zyprexa so i go and get another 2.5
....
Posted by Lamdage22 on January 25, 2015, at 13:37:48
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 13:34:07
I will talk to my doctor about the diabetes risk, the not falling asleep and all that. He wont like to hear my concerns.. He is in love with his AP meds.
I could get a low potency sedating AP for sleep or whatever.
Or trazodone. IDK.
Just something that doesnt pose a risk like Zyprexa.
Posted by Lamdage22 on January 25, 2015, at 13:41:06
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 13:37:48
perhaps taking the seroquel all at night will knock me out.
Posted by ed_uk2010 on January 25, 2015, at 13:51:35
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 13:41:06
>perhaps taking the seroquel all at night will knock me out.
You could consider taking more at night and less during the day assuming that your blood pressure and pulse are OK (both sitting and standing). I don't think it would be a good idea to try it unless you've had these tests. Several measurements should be taken on a few different occasions.
Do you know what your BP and pulse are, taken sitting and shortly (a couple of mins) after standing up?
Also, I think you would need to gradually reduce your daytime dose by 100mg and increase your night time dose by 100mg in several steps.
Posted by Lamdage22 on January 25, 2015, at 13:54:10
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 13:51:35
Ed, no i dont know.
I used to get dizzy upon standing up from lying but i dont anymore.
I will take this into consideration.
Posted by ed_uk2010 on January 25, 2015, at 14:08:24
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 13:54:10
>I used to get dizzy upon standing up from lying but i dont anymore.
That's a good sign. Be careful of the dizziness returning if you take more in one dose. The risk is fainting and falling. So, do it in stages if you do do it.
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