![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by cache-monkey on June 26, 2005, at 18:04:42
Hey all,
It seems like I'm somewhat stable these days on Zyprexa (2.5 mg/day) and Klonopin (1.25 mg/day). This combo is taking care of some core set of dysthymic (leaning toward depression at times) and anxious symptoms. There's also possibly a very soft BP thrown in the mix. Anyway, I think it's really the Zyprexa more than anything that is doing much of the trick.
My p-doc and I want to add a dopaminergic drug to help out with a set of residual/drug-induced symptoms. In subjective order of importance these are:
* Dependence on cigarettes (every time I quit, I get depressed/anxious, even when using non-pharmacological aids)
* Slight sexual dysfunction from drug combo
* Residual ADD-like stuff and anhedonia
* Increase in appetite from the ZyprexaMy p-doc and I are looking at the following list of DA drugs:
* Amantadine
* Bromocriptine
* Mirapex
* Pergolide
* ReQuip
* low-dose SelegilineAt this point I'm leaning toward Bromocriptine or Selegiline due to some studies showing benefits for quitting smoking. Amantadine would probably round out the top three.
But, I would very much appreciate your input on these meds.
Thanks!
cache-monkey
Posted by ed_uk on June 26, 2005, at 18:20:22
In reply to Which dopaminergic drug to add ????, posted by cache-monkey on June 26, 2005, at 18:04:42
Hi cm,
I'm glad to hear Zyprexa's helping :-)
>I think it's really the Zyprexa more than anything that is doing much of the trick.
Any chance you could taper off the clonazepam? Sexual function and ADD symptoms might be improved. I remember you saying that you didn't really like clonazepam. I thought you were taking lorazepam at the moment.
Kind regards
~Ed
Posted by cache-monkey on June 26, 2005, at 19:30:55
In reply to Re: Which dopaminergic drug to add ???? » cache-monkey, posted by ed_uk on June 26, 2005, at 18:20:22
Hey Ed!
Yup, I'm quite pleased with the Zyprexa. Given my response to it so far, I think I can keep the dose low enough to keep the diabetes and weight risks down. I ended up switching to back clonazapam a while ago because the lorazepam made me kind of irritable. For sure, the clonazepam might be the source of the sexual dysfunction, but I want to taper conservatively. But my gut says the Z isn't helping things.
Anyway, I figure if I can get something to help quit smoking that also helps in the sexual department...
Hope all is well.
Best
cache-monkey> Hi cm,
>
> I'm glad to hear Zyprexa's helping :-)
>
> >I think it's really the Zyprexa more than anything that is doing much of the trick.
>
> Any chance you could taper off the clonazepam? Sexual function and ADD symptoms might be improved. I remember you saying that you didn't really like clonazepam. I thought you were taking lorazepam at the moment.
>
> Kind regards
>
> ~Ed
Posted by ed_uk on June 26, 2005, at 20:01:51
In reply to Re: Which dopaminergic drug to add ???? » ed_uk, posted by cache-monkey on June 26, 2005, at 19:30:55
Hi CM,
>For sure, the clonazepam might be the source of the sexual dysfunction, but I want to taper conservatively.
Perhaps you could reduce it in 0.125mg steps once you've been on Zyprexa for a few weeks?
Kind regards
~Ed
Posted by Declan on June 26, 2005, at 21:33:01
In reply to Which dopaminergic drug to add ????, posted by cache-monkey on June 26, 2005, at 18:04:42
Hi CM
Of the drugs you mention my experience is with bromocriptine and low dose selegeline. Bromocriptine stuffed up my head, other than that it was OK, but I really do recommend low dose selegeline, even if the prosexual effects fall short of what you want. I've felt better with it and take a dose that doesn't make my sleep any worse. For me this is around 2mg/d.
Declan
Posted by cache-monkey on June 28, 2005, at 11:44:11
In reply to Re: Which dopaminergic drug to add ???? » cache-monkey, posted by ed_uk on June 26, 2005, at 20:01:51
Hey Ed,
Thanks for the suggestion on the taper. That seems like a reasonable dose increment, but how long would you recommend resting at each stage in the taper?
Best,
cache-monkey> Hi CM,
>
> >For sure, the clonazepam might be the source of the sexual dysfunction, but I want to taper conservatively.
>
> Perhaps you could reduce it in 0.125mg steps once you've been on Zyprexa for a few weeks?
>
> Kind regards
>
> ~Ed
Posted by cache-monkey on June 28, 2005, at 13:10:24
In reply to Re: Which dopaminergic drug to add ????, posted by Declan on June 26, 2005, at 21:33:01
Hey Declan,
Thanks for the info. I'm guessing that you are using the liquid form of selegiline. This doesn't seem to be available through my health plan. (Only the 5 mg incremented tabs and caps...) So, going up to, say 5 mg led to significant sleep problems for you?
As far as the bromocriptine, do you mean that it affected your sinuses?
Peace,
cache-monkey> Hi CM
> Of the drugs you mention my experience is with bromocriptine and low dose selegeline. Bromocriptine stuffed up my head, other than that it was OK, but I really do recommend low dose selegeline, even if the prosexual effects fall short of what you want. I've felt better with it and take a dose that doesn't make my sleep any worse. For me this is around 2mg/d.
> Declan
Posted by ed_uk on June 28, 2005, at 13:47:39
In reply to Which dopaminergic drug to add ????, posted by cache-monkey on June 26, 2005, at 18:04:42
Hi CM,
>That seems like a reasonable dose increment, but how long would you recommend resting at each stage in the taper?
I'd probably stay at each dose until withdrawal symptoms have passed and have been absent for a minimum of a few days. If you don't have any withdrawal symptoms at all, it might be sensible to stay on each dose for about a week. Check out the withdrawal board for info on SLS's flexible dosing strategy - it's most useful near the end of the taper.
~Ed
Posted by Declan on June 28, 2005, at 15:27:38
In reply to Re: Which dopaminergic drug to add ???? » Declan, posted by cache-monkey on June 28, 2005, at 13:10:24
Hi CM
The bromocriptine blocked my sinuse up, or tended to.
The tabs are OK. 5mg each. I'd make each one last 3 days, taking 1/3rd each am. (Cut them up). This is not an AD dose, but it is one I would notice eventually. 2.5 mg/d is a bit much for me.
Deprenyl's a nice drug, as long as you're not hoping for too much. Makes me feel a bit younger I think. Taken it for years for that and the neuroprotection thing.
Declan
Posted by Tepiaca on June 28, 2005, at 23:11:43
In reply to Which dopaminergic drug to add ????, posted by cache-monkey on June 26, 2005, at 18:04:42
Your doses of Zyprexa and Clonazepam are not
high. How much time have you been on them?
In case you have troubles reducing Clonazepam
you migth wait for a while on the same doses.
Time could help you to feel sexually better, wait
a little bit more.Good luck
Tep
Posted by cache-monkey on June 29, 2005, at 0:45:30
In reply to Re: Which dopaminergic drug to add ???? » cache-monkey, posted by Tepiaca on June 28, 2005, at 23:11:43
Hi Tepiaca,
I've been on the Klonopin for about a month and a half (after rotating through various benzos trying to find the right one). The Zyprexa is newer -- three weeks today. I will gradually reduce the Clonazepam when the time comes.
But I still would like to add on a pro-dopamine drug to help quit smoking. And this is actually a good window of opportunity for that in my life. (Wellbutrin doesn't work, BTW, which is why it's not on my list.)
Peace,
cache-monkey> Your doses of Zyprexa and Clonazepam are not
> high. How much time have you been on them?
> In case you have troubles reducing Clonazepam
> you migth wait for a while on the same doses.
> Time could help you to feel sexually better, wait
> a little bit more.
>
> Good luck
> Tep
Posted by Dave001 on June 30, 2005, at 13:20:15
In reply to Which dopaminergic drug to add ????, posted by cache-monkey on June 26, 2005, at 18:04:42
> Hey all,
>
> It seems like I'm somewhat stable these days on Zyprexa (2.5 mg/day) and Klonopin (1.25 mg/day). This combo is taking care of some core set of dysthymic (leaning toward depression at times) and anxious symptoms. There's also possibly a very soft BP thrown in the mix. Anyway, I think it's really the Zyprexa more than anything that is doing much of the trick.
>
> My p-doc and I want to add a dopaminergic drug to help out with a set of residual/drug-induced symptoms. In subjective order of importance these are:Not to sound discouraging, but it would seem that addition of a dopamine agonist would negate the therapeutic effects of Zyprexa, in addition to the dopamine-dependent side-effects.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.