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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by jclint on August 3, 2005, at 8:17:55
Hi everyone.
I seem to have developed a mild hand tremor on 10mg of Zyprexa. It was noticable after a couple of days. I was wondering if this is a transient side effect or whether it was more serious than that. I should state that I didn't ramp up the dosage, and went on it a couple of days after quitting Seroquel... its my fifth day on Zyprexa now.
As you can understand its a bit of a worry, when I type its quite noticable! I've got enough to worry about with the insatiable hunger and sedation!
Thanks :)
Posted by jclint on August 3, 2005, at 8:18:40
In reply to Zypreza hand tremor??, posted by jclint on August 3, 2005, at 8:17:55
Posted by med_empowered on August 3, 2005, at 11:23:16
In reply to Zypreza hand tremor??, posted by jclint on August 3, 2005, at 8:17:55
hmmm...this is a tricky one. Antipsychotics in general can lead to tremor (hence the muscle stiffness and soreness they also tend to cause), but its more pronounced and more common on the old-school antipsychotics, like Haldol and Thorazine. You might want to try reducing the dosage a bit, if that's feasible...lots of people take as little as 2.5mgs of zyprexa; many more take 5-7.5 (and lots of Symbyax users take only 6mgs). If that's not an option, the next question would be: wait it out or treat it (or switch again). The old "side-effect pills" used with stuff like Haldol are still very much in use; Cogentin is probably the most widely used and best known. It would kind of serve to moderate the D2 blockade that Zyprexa causes, so you'd see fewer shakes, tremors, etc. There's also propranolol, a non-selective beta blocker used in low-doses for everything from essential tremor to anxiety to cases like yours, where you have neuroleptic-induced undesirable movements. Its effective, but can cause heart weirdness if you already have circulatory issues...in addition, it causes/worsens depression in some people, so do aware of that possibility. The final option would be to switch. Although neuroleptics all have pretty similar mechanisms of action (D2 blockade; the newer ones also hit up lots of other spots), sometimes switching provides you with just the right med. Since you've already taken Seroquel, your remaining options would be Risperdal, Geodon, Abilify, and clozapine (clozapine is a last-ditch effort though). I wouldn't recommend Risperdal, since it seems to be pretty harsh as atypicals go. Geodon may help, but its 2X daily, kind of sedating, and can push people into mania in some med combos (like Geodon+an SSRI). It also cardiovascular effects kind of like you'd see in Mellaril. On the plus side, its more or less weight neutral, may have some antidepressant efficacy, and the sedation usually becomes manageable with long-term use. Abilify is the newest atypical around. It works a little differently than the other ones; there's a D2 antagonist/agonist and serotonin antagonist/agonist action that theoretically makes for a better side-effect profile. It is weight neutral, *usually* non-drowsy, and its a 1 a day med. I personally got akathisia on low-dose (2.5mgs) zyprexa and switched to abilify; I didn't have too many problems, although there were some problems. Abiify tends to be more "activating," but your mileage may vary. If you do switch and still have problems, you might want to re-visit the possibility of Cogentin, propranolol or possibly a benzo (these are good if you also get anxiety with your neuroleptic). Good luck!
Posted by ed_uk on August 3, 2005, at 14:29:09
In reply to Zypreza hand tremor??, posted by jclint on August 3, 2005, at 8:17:55
Hi J,
Tremor is a symptom of neuroleptic-induced parkinsonism - an extrapyramidal side effect. I'd strongly recommend reducing the dose. 10mg is probably much too high, unless you're being treated for psychotic disorder.
I wondered why you were taking Zyprexa? I thought you were being treated for social phobia. Antipsychotics are not a first-line treatment for social phobia. More appropriate treatments are generally available, such as Nardil.
Kind regards
~Ed
Posted by jclint on August 3, 2005, at 14:52:40
In reply to Re: Zypreza hand tremor?? » jclint, posted by ed_uk on August 3, 2005, at 14:29:09
Hi Ed. You are right, that is part of my problem but its perhaps not the entire thing I once thought it was. Its perhaps, myself and my doc now think, secondary to my mood swings, and seeing as the antidepressant route hasn't worked we are experimenting a little. I know is sounds unorthadox but I have more faith in my current doc than any of my previous ones. There were definate changes during my seroquel trial which is why I am trying the Z, in combination with antidepressants.
Posted by ed_uk on August 3, 2005, at 16:05:58
In reply to Re: Zypreza hand tremor?? » ed_uk, posted by jclint on August 3, 2005, at 14:52:40
Hi J,
>You are right, that is part of my problem but its perhaps not the entire thing I once thought it was.
Ah I see, I didn't realise there was any uncertainty in your diagnosis.
>I know is sounds unorthadox....
Well not really, I just wanted to check that your doc had a good reason for prescrbing an AP.
Kind regards
~Ed
Posted by DanielJ on August 3, 2005, at 21:52:22
In reply to Zypreza hand tremor??, posted by jclint on August 3, 2005, at 8:17:55
You could try Artane which is an anti- parkinsonian with few side effects. My son has a swallowing difficulty caused by Zyprexa. He was taking 20 mg and is back to 15 mg now. It still bothers him a bit.
Posted by med_empowered on August 3, 2005, at 23:01:23
In reply to Re: Zyprexa hand tremor??, posted by DanielJ on August 3, 2005, at 21:52:22
hey! I think Ed is probably right about the dosage of Zyprexa. When all else fails, using an atypical neuroleptic can be very helpful for some people. But 10mgs of Zyprexa is a dosage more commonly used for psychotic disorders...you might benefit from a lowering of dose, or a switch.
Posted by jclint on August 6, 2005, at 11:02:54
In reply to Re: Zyprexa hand tremor??, posted by med_empowered on August 3, 2005, at 23:01:23
Sorry I forgot to say thankyou for your post. It was very interesting and informative, and I will certainly talk about this with my doc ASAP. Thanks for your time sir!
:)
Posted by yxibow on August 8, 2005, at 0:03:32
In reply to Re: Zyprexa hand tremor?? » med_empowered, posted by jclint on August 6, 2005, at 11:02:54
Akineton is another alternative to Artane and might be slightly stronger; they're similar.
Not to be pessimistic but I developed a hand tremor from Zyprexa and it didn't completely resolve; its hard to say though because I had a bad tremor at any dose of Zyprexa (unfortunately because in some ways it was more effective for my disorder) and I switched to Seroquel and its entirely possible the Seroquel causes (milder) pseudoparkinsonism, and discontinuation of all eventually would restore. At any rate not to naysay completely I think being on Zyprexa only for a short while would eventually cessate the pseudoparkinsonism if you stopped it, I could be very sensitive to medication. Additionally, there's the chance that either if you stop it, or if you continue the medication, this particular type of EPS would subsume and dissappear over time with treatment. I just wanted to post this for my experience, I hope it doesn't discourage you. Discuss it all with your doctor.
Cheers
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