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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by pretty_paints on September 24, 2005, at 16:41:58
Hiya,
I am really worried, I've been on Clozapine for 2 months and I haven't noticed any improvements at all. I'm anxious because everyone says the drug should start working in a few weeks. Does this mean the drug will not work for me?
Secondly, here are my side effects. They are becoming a nightmare for me and show no signs of lessening.
- Extreme tiredness (about 18 hours a day, although I do try to fight it)
- Nausea (being sick in the mornings - and no I'm not pregnant!)
- Weight gain/bloating
- Constipation ALL the time :( I have been told to drink flippin 3 LITRES OF WATER A DAY. Are they having a laugh?? Not only is that practically impossible for little me, but if I do drink that much, it doesn't help with incontinence... which leads me onto...
- Incontinence at night. Have to sleep wearing a sanitary towel incase I loose control of my bladder (*HOW* embarrassing I know, but I know it's down to Clozapine because other people in hospital who were on it said they wet the bed a lot)
- Drooling
So you see, I am a big, fat, bloated, dribbling, incontinent fool. Am getting no relief from this drug and lots of annoyances.
I am on 400mg now. I did go up to 425mg, but recently the doc says we should go back down to 400mg and see if the side effects wear off over the next month. Then they can go back to gradually increasing the drug. If the side effects remain bad, he said he can compliment the Clozapine with another antipsychotic. I'm really worried about this option. For ages, Clozapine has been my only hope of *getting better*. If I can't go up to the theraputic dose due to stupid side effects it will be like flushing this whole Clozapine option down the toilet.
I am annoyed.
Lots of love, Kate xx
Posted by med_empowered on September 24, 2005, at 17:15:39
In reply to CLOZAPINE - side effects, posted by pretty_paints on September 24, 2005, at 16:41:58
hey! Don't despair :-) One option, although not done terribly often, would be adding a stimulant to the antipsychotic. LOW-DOSE stimulants can actually help with the negative symptoms of psychiatric disorders, and would presumably have an anti-depressant effect of sorts. Although in the past low-dose Ritalin and Dexedrine were used for this, Provigil would probably be a good option these days; its gentle, there's some data indicating it helps with cognition, and the risk of inducing psychosis/worsening positive symptoms is lower than with the old-school stimulants. As for weight gain...I don't know about clozapine, but with zyprexa there's some indication that co-prescribing Meridia (sibutramine) and presumably other, older drugs, helps significantly with the weight gain. I also seem to recall some studies showing co-administration of some anti-diabetes drugs helped both with the weight gain and with the metabolic weirdness that so often accompanies atypical antipsychotic usage. Are you actively psychotic right now? Cause, if you're not, your doc should probably lay off RXing an add-on antipsychotic...combining antipsychotics is increasingly popular, but there really isnt any good evidence that it helps anybody (except drug companies). Also, although back in the day it was considered really important to either induce pseudo-Parkinson's or reach a "therapeutic dose," informed docs these days realize that the important thing with antipsychotics is *improvement*, not dosage, and it takes a while to adequately *sses the effectiveness of any dose of an antipsychotic. Finally, I don't know what exactly you're taking antipsychotics for, but you might want to consider adding a mood-stabilizer--it helps a lot of people with "moody" schizophrenia, bipolar disorder, and even those who appear to have relativley "classic" schizophrenic symptoms. Tegretol is a classic addon, but Trileptal would be much better tolerated; Lithium is still used, but it does terrible things combined with some antipsychotics (ex: haldol+lithium=brain damage, possibly death). Benzos aren't usually co-prescribed with Clozapine, but I think opinion on that might be changing...ativan (lorazepam) and klonopin (clonazepam) are both pretty popular for psychosis and mood-stabilization; xanax (alprazolam) and valium also are of value in depression. Good luck!
Posted by Phillipa on September 24, 2005, at 19:16:36
In reply to Re: CLOZAPINE - side effects, posted by med_empowered on September 24, 2005, at 17:15:39
Hi Kate, sorry you're having so many problems. Have you talked with Ed? He isn't on the Board now much since he's working so much. But I know you have his E-mail address. Hope you find some answers soon and I wouldn't want the side effects you're experiencing. Fondly, Phillipa
Posted by ed_uk on September 25, 2005, at 10:35:33
In reply to CLOZAPINE - side effects, posted by pretty_paints on September 24, 2005, at 16:41:58
Hi Katie!
So pleased to hear from you :-) I've been missing you and your great sense of humour.
>I haven't noticed any improvements at all
Does your doctor think it's helping? Perhaps it's reduced your delusions.
>Constipation ALL the time :( I have been told to drink flippin 3 LITRES OF WATER A DAY. Are they having a laugh??
Drinking vast amounts of water doesn't help constipation. It's a myth. So long as your fluid intake is adequate, increasing it even more won't help. You'll need a laxative to treat the constipation. Ask your doc to prescribe something.
>Incontinence at night.
Yep, this is definately a side effect of clozapine :-(
>Clozapine has been my only hope of *getting better*.
It's certainly not your only hope. Other medications and non-medical treatments can help.
Seroquel seemed to work quite well for you, apart from the sedation. Combining a low dose of Seroquel with another antipsychotic might help to minimise the side effects and enhance its efficacy. I wonder whether Seroquel + Abilify might work well eg. 300mg Seroquel at night + 10mg Abilify in the morning.
Love Ed xx
Posted by med_empowered on September 25, 2005, at 19:46:09
In reply to Re: CLOZAPINE - side effects » pretty_paints, posted by ed_uk on September 25, 2005, at 10:35:33
hey! I know in my previous post I was a little dismissive of neuroleptic combos but...sometimes they do help. One study I read used 20mgs Zyprexa with 15mgs Abilify. To me, this seems like overkill, but apparently the combo improves positive/negative symptoms and overall functioning in those with schizophrenia switching from high-dose conventional neuroleptic treatment (which, of course, results in much higher D2 blockade than atypical treatment) while minimizing side-effects. I think the seroquel+abilify combo could be a good call; since Abilify has a pretty high D2 occupancy compared to other atypicals (it just has a good EPS profile b/c of the dual agonist/antagonist thing), 10mgs could provide pretty substantial relief w/ minimal side effects, and the seroquel could help with anxiety, sleep, and residual symptoms...the combo could also help reduce the dosages of both meds involved, which could possibly lead to an overall reduction in side effects and medication adjustments. Zyprexa+abilify would be another alternative; I think 10mgs Abilify+5-10mgs Zyprexa, possibly with additional Zyprexa (2.5-5mgs) for as-needed use/symptom control, could be extremely helpful. Also, adding propranolol and/or benzodiazpenes can help to reduce your neuroleptic dose and reduce akathisia, tension, anxiety, and agitation. I imagine that mixing a typical with an atypical could be helpful; if done *very* carefully, you could get symptom reduction but keep the benefits of using atypicals. Loxapine is kind of atypical-ish, so it might be a good call...perphenazine, particularly in Triavil, could be a nice, relaxing add-on. Good luck!
Posted by Racer on September 25, 2005, at 20:45:27
In reply to Re: CLOZAPINE - side effects » pretty_paints, posted by ed_uk on September 25, 2005, at 10:35:33
>
> >Constipation ALL the time :( I have been told to drink flippin 3 LITRES OF WATER A DAY. Are they having a laugh??
>
> Drinking vast amounts of water doesn't help constipation. It's a myth. So long as your fluid intake is adequate, increasing it even more won't help. You'll need a laxative to treat the constipation. Ask your doc to prescribe something.
>
>Thank you so much for posting this! I was just talking about this very thing to my husband this morning -- because I've been constipated lately, and Dr CattleProd keeps saying that the way to avoid constipation is to drink adequate water!
"Uh, Doc? I'm the one whose anorexia has led to polydipsia? I'm the one who drinks a gallon and a half or more water per day -- every day? I'm the one who collapsed from drinking too much water? Exactly how much more water, precisely, would you like me to drink?"
And, by the way, have I mentioned being constipated?
Thank you for posting what you did. I don't know why it makes such a difference to read that, but it's as though you've just released me from feeling as though it must be my fault. Even if I kinda know that it isn't my fault. Clear as mud, huh?
Thanks, Ed.
Posted by ed_uk on September 26, 2005, at 16:24:18
In reply to [off topic] Thank you!!! » ed_uk, posted by Racer on September 25, 2005, at 20:45:27
LOL Racie, have you tried Metamucil?
~Ed
This is the end of the thread.
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