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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by novelagent on January 30, 2012, at 19:49:17
Inderal doesn't quite quell my restlessness, caused by Invega Sustenna, quite like dexedrine.But my doc is being a prude about titration, keeping me on 20mg of dexedrine spansules/day "for awhile" (I think another month) before going up to the 30mg/day I already know I require before receiving any relief from restlessness.
In the meantime, might bromocriptine work for akathsia?
Posted by ed_uk2010 on January 31, 2012, at 11:07:11
In reply to does bromocriptine work for akathsia?, posted by novelagent on January 30, 2012, at 19:49:17
I don't think it would be sensible to use bromocriptine (a dopamine agonist) to treat the side effects of a dopamine antagonist (Invega).
If a dose reduction of Invega is not possible, it might be useful to try a different antipsychotic. Alternatively, it might be beneficial to add a low dose of an anticholinergic such as benztropine (Cogentin), trihexyphenidyl (Artane) or procyclidine.
Posted by bipolar11 on January 31, 2012, at 16:08:10
In reply to Re: does bromocriptine work for akathsia?, posted by ed_uk2010 on January 31, 2012, at 11:07:11
Bromocriptine didnt work for my akathisia with antipsychotics.. i recommend propranolol or ativan.. much better
Posted by papillon2 on January 31, 2012, at 20:48:56
In reply to Re: does bromocriptine work for akathsia?, posted by bipolar11 on January 31, 2012, at 16:08:10
Even if it did work, wouldn't it be shooting yourself in the foot in the long term?
Think about it. Your doc is unlikely to increase your Inderal dose if s/he sees your akathsia remitting on what s/he thinks is just 20mg Inderal, rather than 20mg Inderal + Xmg of whatever else.
Perhaps the Inderal will take time to achieve its full effect?
Posted by novelagent on February 2, 2012, at 18:36:50
In reply to Re: does bromocriptine work for akathsia?, posted by papillon2 on January 31, 2012, at 20:48:56
I'm not sure what you mean-- I take Inderal 40mg 2x/day, and don't notice any increased benefit from higher doses.
Indersl works, but it doesn't work as well as amphetamine does. It'll be a couple more weeks at least before I get from 20mg to 30mg of Dexedrine. I think you mean increasing mydex dose?
> Even if it did work, wouldn't it be shooting yourself in the foot in the long term?
>
> Think about it. Your doc is unlikely to increase your Inderal dose if s/he sees your akathsia remitting on what s/he thinks is just 20mg Inderal, rather than 20mg Inderal + Xmg of whatever else.
>
> Perhaps the Inderal will take time to achieve its full effect?
Posted by iforgotmypassword on February 2, 2012, at 22:38:43
In reply to Re: does bromocriptine work for akathsia? » papillon2, posted by novelagent on February 2, 2012, at 18:36:50
Posted by iforgotmypassword on February 2, 2012, at 22:40:14
In reply to does bromocriptine work for akathsia?, posted by novelagent on January 30, 2012, at 19:49:17
Posted by papillon2 on February 3, 2012, at 1:40:03
In reply to Re: does bromocriptine work for akathsia? » papillon2, posted by novelagent on February 2, 2012, at 18:36:50
Sorry, yes, I meant the dex dose.
Posted by SLS on February 3, 2012, at 7:08:24
In reply to does bromocriptine work for akathsia?, posted by novelagent on January 30, 2012, at 19:49:17
> In the meantime, might bromocriptine work for akathsia?
That's a very logical question. However, if bromocriptine were effective, I think you would see it (or other DA agonists) used as a primary treatment for EPS. It has been studied for this purpose. Results have been disappointing.
I tend to agree with Ed_Uk2010.
Actually, adding bromocriptine might backfire. It may stimulate presynaptic receptors (agonist) while leaving postsynaptic receptors occupied by the neuroleptic AP. In this scenario, dopamine synthesis and release are inhibited without a compensatory increase in the stimulation of postsynaptic receptors. Low dosages of bromocriptine are well known to produce sedation and reduce locomotor activity. Coadministration of a neuroleptic should approximate this dynamic. Of course, this is only an idea that occurred to me as I was replying to your post. I have little evidence to support it.
http://www.comawakening.com/coma.html
"At low doses of bromocriptine, presynaptic activity exceeds postsynaptic activity, and antidopaminergic activity prevails.( )"
Another silly thought I had is that bromocriptine might help akathisia, even though it does not reduce other EPS. Different tracts are responsible for akathisia EPS compared to movement EPS. Using low dosages of bromocriptine (< 10 mg) might be effective to treat akathisia. So, your idea cannont be ruled-out.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1031710/pdf/jnnpsyc00532-0080.pdf
"There is strong animal evidence that
akathisia may be related to blockade of
dopamine in the prefrontal cortex rather
than the striatum.""I have treated several cases of tardive akathisia with low dosages of bromocriptine (less than 10 mg/day). This chemotherapeutic intervention was selected because the dopamine agonist, bromocriptine, preferentially stimulates presynaptic autoreceptors with the consequence of decreased dopamine synthesis and release."
So, which of my two competing theories is most attractive to you?
Here we have a phenomenon that we see on Psycho-Babble all of the time. People make up their own theories and suggest to others that they act upon them despite the existence of alternative theories or a lack of clinical evidence. From my perspective, most of us - including me - are relative simpletons compared to the researchers in neuroscience and psychiatry. Because bromocriptine can provoke psychotic reactions, I would err on the side of caution and look for other treatments for akathisia first. If you elect to try bromocriptine, keep the dosage low.
* Research the use of low-dose Remeron (mirtazapine) to treat akathisia.
- Scott
Posted by iforgotmypassword on February 3, 2012, at 15:03:02
In reply to does bromocriptine work for akathsia?, posted by novelagent on January 30, 2012, at 19:49:17
just wanted to emphasise the emerging role cannabinoids and 5-ht1a agonism in the treatment of dystonia and parkinsonism. i believe COMPLETELY that these represent mechanisms, in fact the healthiest mechanisms so far, to treat akathisia and friends. again special emphasis on cannabidiol.
Posted by phidippus on February 8, 2012, at 16:01:22
In reply to Re: does bromocriptine work for akathsia?, posted by bipolar11 on January 31, 2012, at 16:08:10
bromocriptine? no way
propanolol
amantadine
congentin
artane
requipmuch better alternatives
Eric
Posted by novelagent on February 8, 2012, at 18:00:22
In reply to Re: does bromocriptine work for akathsia? » bipolar11, posted by phidippus on February 8, 2012, at 16:01:22
> bromocriptine? no way
>thanks. I find amphetamine works the best... but I'm going to give this list to mydoc, because there's a kid at my clinic that paces a lot. almost done titrarting on amphetamine-- at the adequate dose, it works for me.
propanolol
> amantadine
> congentin
> artane
> requip
>
> much better alternatives
>
> Eric
Posted by novelagent on February 8, 2012, at 18:10:48
In reply to Re: does bromocriptine work for akathsia? » bipolar11, posted by phidippus on February 8, 2012, at 16:01:22
I thought the literature, and my doc also said this, says congentin doesn't work for restlessness -- proprananol does (although only at 40mg, not 20mg for me)-- but not cogentin. I think cogentin is assumed to by too many docs because it acts on other EPS symptoms...
>
bromocriptine? no way
>
> propanolol
> amantadine
> congentin
> artane
> requip
>
> much better alternatives
>
> Eric
Posted by phidippus on February 10, 2012, at 12:21:02
In reply to Re: does bromocriptine work for akathsia? » phidippus, posted by novelagent on February 8, 2012, at 18:10:48
Cogentin worked fine for me!
Eric
This is the end of the thread.
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