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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by linkadge on October 9, 2005, at 10:14:21
OK, she came off the mellaril, and is NOT doing well. She went onto the zyprexa, but she didn't know her own name, or where she lived, this is not charateristic of her.
She went to the emergency room, and they told her to get off of the zyprexa.
So now she is going really loopy, not sleeping etc.
My dad had to take over her medications.
Can anyone offer any advice. She's been on mellaril for like 20 years, and now she's on nothing, and she's totally paranoid etc.
I asked before, but I forgot to take it down. What, still available, is most similar to mellaril ?
THe problem, as I see it, is that she's had like zero activity at her d1,d2 receptors, and that the zyprexa isn't blocking them enough.
Ideas ?
Linkadge
Posted by zeugma on October 9, 2005, at 10:56:29
In reply to Help!! mom needs serious help, posted by linkadge on October 9, 2005, at 10:14:21
Possibly the cognitive dysfunctions she is experiencing on Zyprexa are due to Zyprexa's high affinity for the muscarinic receptor.
Seroquel is similar in sedation and dosage equivalence to to Mellaril. Among the older typicals, Stelazine or perphenazine?
-z
Posted by linkadge on October 9, 2005, at 11:18:13
In reply to Re: Help!! mom needs serious help » linkadge, posted by zeugma on October 9, 2005, at 10:56:29
We're going to try seroquel next.
failing that we might try stelazine.
Thx.Linkadge
Posted by Declan on October 9, 2005, at 14:15:13
In reply to Re: Help!! mom needs serious help, posted by linkadge on October 9, 2005, at 11:18:13
I didn't think that Stellazine was at all like Mellarill. Largactil seemed closer. What was Nulactil, I never took it.
Declan
Posted by linkadge on October 9, 2005, at 14:23:37
In reply to Re: Help!! mom needs serious help, posted by Declan on October 9, 2005, at 14:15:13
THe problem with AP's is that when you take them for 20 years, your brain probably molds itself around its sepecific chemical actions.
I don't want to even guess what will happen now, seeing as that part of the brain that has been turned off for 20 years will now start to go into overdrive.
The atypicals may not hamper the dopamineric overdrive she will be experiencing.
Linkadge
Posted by ed_uk on October 9, 2005, at 15:57:41
In reply to Re: Help!! mom needs serious help, posted by linkadge on October 9, 2005, at 14:23:37
Hi Link
Stelazine is a high potency AP, very different to Mellaril.
Chlorpromazine (Largactil, Thorazine) is closer to Mellaril.
Mellaril is a strongly anticholinergic drug, much more so than Zyprexa. Abrupt withdrawal of Mellaril can cause delirium, it must always be tapered gradually.
Sudden withdrawal of Mellaril provokes an 'anticholinergic rebound'. Paradoxically, confusion is a symptom. Your mom needs an anticholinergic antipsychotic with significant D2 blockade. Ideally, your mom should return to Mellaril and taper gradually. If she doesn't have any Mellaril left, Largactil can be used as a substitute.
~Ed
Posted by ed_uk on October 9, 2005, at 16:00:18
In reply to Re: Help!! mom needs serious help, posted by linkadge on October 9, 2005, at 14:23:37
Take care Link, Seroquel isn't much like Mellaril. Largactil is closer.
~ed
Posted by linkadge on October 9, 2005, at 16:49:03
In reply to Re: Help!! mom needs serious help » linkadge, posted by zeugma on October 9, 2005, at 10:56:29
Could you ballpark a dose that might replace say 150mg of mellaril ?
Linkadge
Posted by zeugma on October 9, 2005, at 17:06:10
In reply to Re: Help!! mom needs serious help, posted by linkadge on October 9, 2005, at 16:49:03
> Could you ballpark a dose that might replace say 150mg of mellaril ?
>
>
> Linkadge
since according to the reference I have the two drugs have similar dose ranges, i suppose 100-200 mg seroquel is similar to 150 mg mellaril.Seroquel is weaker at the D2 receptor than mellaril. But its ratio as far as I can tell among D2, muscarinic and serotonin 2A blockade is roughly equivalent to Mellaril's (both drugs within a range of 2:1 among those 3 receptors). Zyprexa is about 6 times more potent at the muscarinic than D2 receptor.
Is your mother's dr. totally clueless? That is a scary thought.
also, what do you think of Ed's advice? I'm sorry, I am very uncomfortable giving out pharmacological advice.
-z
Posted by ed_uk on October 10, 2005, at 12:56:36
In reply to Re: Help!! mom needs serious help, posted by linkadge on October 9, 2005, at 16:49:03
Hi Link,
>Could you ballpark a dose that might replace say 150mg of mellaril?
I'd recommend starting chlorpromazine (Largactil) at 25mg three times a day. The dose could be increased to 50mg three times a day if necessary. It would be sensible to have an anticholinergic on hand in case of EPS.
Kind regards
~Ed
Posted by linkadge on October 10, 2005, at 16:14:43
In reply to Re: Help!! mom needs serious help » linkadge, posted by ed_uk on October 10, 2005, at 12:56:36
Yes, she is everything, delerious, angry, suspitious, energetic, impatient, list goes on.
Linkadge
Posted by linkadge on October 10, 2005, at 19:18:29
In reply to Re: Help!! mom needs serious help, posted by linkadge on October 10, 2005, at 16:14:43
Yeah, the mellaril had a strong anti-"ive wasted my life" effect in her. And now that is gone, she's having i've wasted my life backlash, its freaky !!
Linkadge
Posted by ed_uk on October 11, 2005, at 16:21:40
In reply to Re: Help!! mom needs serious help, posted by linkadge on October 10, 2005, at 19:18:29
How's your mom doing today Link?
~Ed
This is the end of the thread.
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