Posted by ed_uk2010 on January 9, 2015, at 9:30:53
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 9, 2015, at 3:47:21
>Okay, the options i see now are either replacing Zyprexa with Clozapine (although i wonder if it is any better in the Diabetes department??)
It isn't - clozapine and olanzapine both produce a high incidence of diabetes. Clozapine causes more side effects overall but is often substantially more effective than olanzapine for resistant psychosis.
>replacing it with amisulpride (although i heard that some of its side effects occur as frequently as with typical APs!)
Amisulpride is very different to olanzapine. It's much less sedating, and causes far less weight gain or diabetes. It causes movement disorders more frequently than olanzapine, but less frequently than typicals. The risk of movement disorders such as tremor and muscle stiffness is highly dose dependent, and can be minimised by cautious dose adjustment. Low doses produce very few or no movement problems, very high doses often produce a lot. Care is needed when adjusting - avoiding doses of more than 800mg per day (in divided/split doses) also makes major problems with movement less likely. It may be useful to have an anticholinergic on hand in case symptoms appear.
Like risperidone and paliperidone, amisulpride produces a very high incidence of prolactin elevation. As a result, women often experience menstrual disturbances. Lactation may occur if prolactin gets very high. Men often experience reduced libido. In spite of the prolactin elevation, those of amisulpride often experience fewer adverse effects overall than pts on other antipsychotics. It's a useful drug.
poster:ed_uk2010
thread:1074889
URL: http://www.dr-bob.org/babble/20150102/msgs/1074992.html