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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Lamdage22 on August 27, 2014, at 16:34:58
The low white blood cell count that can occur. Is it reversible?
I am considering it as a replacement for zyprexa because i have tar dive dyskinesia symptoms.
Posted by Phillipa on August 27, 2014, at 18:21:24
In reply to Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 27, 2014, at 16:34:58
If not taking the clozapine I think it is reversible the blood should go back to normal. Phillipa
Posted by Christ_empowered on August 27, 2014, at 18:33:31
In reply to Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 27, 2014, at 16:34:58
can you take antioxidants? maybe...add a benzo, instead of zyprexa?
Posted by baseball55 on August 27, 2014, at 19:09:49
In reply to Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 27, 2014, at 16:34:58
> The low white blood cell count that can occur. Is it reversible?
>
> I am considering it as a replacement for zyprexa because i have tar dive dyskinesia symptoms.Not an expert, but my nephew got it and stopped the clozadine and was okay afterward.
Posted by SLS on August 27, 2014, at 23:26:37
In reply to Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 27, 2014, at 16:34:58
> The low white blood cell count that can occur. Is it reversible?
>
> I am considering it as a replacement for zyprexa because i have tar dive dyskinesia symptoms.Less than 1% of patients taking clozapine develop agranulocytosis. It is reversible by discontinuing the drug. It may take 2 - 3 weeks for WBC (granulocytes) to normalize.
- Scott
Posted by ed_uk2010 on August 28, 2014, at 14:11:27
In reply to Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 27, 2014, at 16:34:58
> The low white blood cell count that can occur. Is it reversible?
In spite of its side effects, clozapine appears to reduce overall mortality in schizophrenia. The main reason for this is that clozapine reduces suicidal thinking and behaviour.
The risk of death from agranulocytosis is less than 1 in 10 000 patients treated.... in contrast, the risk of death from suicide is high. Around 1 in 10 pts with schizophrenia eventually commit suicide. Death from suicide is therefore about 1000 times more likely than death from clozapine-induced agranulocytosis.
Clozapine causes a mild/moderate decrease in the white blood cell count much more commonly than in causes agranulocytosis. This is almost always reversible on stopping clozapine.
I think it's important to remember than although clozapine causes frequent side effects, its effectiveness is unsurpassed. It is therefore a highly important medication.
The risk of weight gain with clozapine is similar to olanzapine (Zyprexa). Clozapine cases more sedation than other antipsychotics, but since you already take Zyprexa and Seroquel in combination, you may not find it anymore sedating than these two drugs together.
One interesting fact about clozapine is that pts with schizophrenia treated with clozapine experience fewer abnormal movements than those on a placebo. This is probably because clozapine rarely causes movement disorders, but it does suppress movement disorders caused by other antipsychotics and movement disorders associated with psychosis.
Posted by Phillipa on August 28, 2014, at 18:45:55
In reply to Re: Is clozapine induced agranulocytosis reversible? » Lamdage22, posted by ed_uk2010 on August 28, 2014, at 14:11:27
Ed didn't know of that high a suicide risk. But I do remember the miracles this medication caused in a lot of my patients. Phillipa
Posted by Lamdage22 on August 29, 2014, at 6:06:01
In reply to Re: Is clozapine induced agranulocytosis reversible? » ed_uk2010, posted by Phillipa on August 28, 2014, at 18:45:55
My doctor doesn't want to prescribe clozapine for short term. Of course not, its not him spastically twitching facial muscle for the rest of his life if something goes wrong.
So i am forced to stay on Zyprexa unless i order clozapine online!
My target dose is 200mg Seroquel only. But as you know this may take a while.
Posted by Christ_empowered on August 29, 2014, at 8:56:01
In reply to Re: Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 29, 2014, at 6:06:01
can you get supplements in Germany? I'm so confused by how other countries regulate supplements.
Taurine has been studied to help treat and prevent TD and help mood swings. I take 4 grams daily, no TD yet (fingers crossed), although I do take a lot of other stuff, too. The combination of E and C helps some people.
Posted by ed_uk2010 on August 29, 2014, at 13:57:00
In reply to Re: Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 29, 2014, at 6:06:01
> My doctor doesn't want to prescribe clozapine for short term. Of course not, its not him spastically twitching facial muscle for the rest of his life if something goes wrong.
Hi,
But if clozapine was working well, you'd probably want to continue it, wouldn't you? It has a very low risk of TD, so it could be a good option to replace both of your current meds.
Posted by SLS on August 29, 2014, at 16:38:54
In reply to Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 27, 2014, at 16:34:58
I agree with Ed.
- Scott
Posted by Lamdage22 on August 30, 2014, at 0:50:19
In reply to Re: Is clozapine induced agranulocytosis reversible?, posted by ed_uk2010 on August 29, 2014, at 13:57:00
Well i think id rather be on (very) low dose Seroquel. Im talking 100-250 mg, whatever works. Clozapine has too many risks other than TD.
Heart, blood, diabetes.. arrggh i don't like. I just wanted to make a detour over clozapine for this time right now that i need a higher dose of APs and have signs of TD.
Hmm idk. It all doesn't sound too rosy. I hope research is making progress that we will receive antipsychotics with better side effect profiles. Something that works on Anandamide for example!
Posted by Lamdage22 on August 30, 2014, at 0:53:11
In reply to Re: Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 30, 2014, at 0:50:19
From what i have read and heard, Seroquel has the best side effect profile if you take away weight gain by using Metformin!
Posted by SLS on August 30, 2014, at 8:06:04
In reply to Re: Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 30, 2014, at 0:53:11
> From what i have read and heard, Seroquel has the best side effect profile if you take away weight gain by using Metformin!
What about Saphris (asenapine)? I have seen it work to produce antipsychotic and antidepressant effects. It may be particularly well-suited to treat paranoia. You could add it to your ongoing Seroquel treatment, just in case it doesn't confer sufficient antipsychotic activity. If you feel good, then you can try discontinuing the Seroquel. I don't think Saphris causes as much weight gain as Seroquel. Seroquel does have the potential to produce diabetes, but probably not to the same degree as clozapine. Latuda (lurasidone) is an antipsychotic that is not supposed to cause weight gain. I am guessing that there would be a reduced risk of diabetes. Very few people have tried it yet, and I really don't know how effective it is as an antipsychotic. However, it does have antidepressant effects. It produces NE alpha-2 antagonism (similar to Remeron (mirtazapine)), as well as 5-HT7 antagonism (similar to Brintellix (vortioxetine)).
- Scott
Posted by Lamdage22 on August 30, 2014, at 8:43:37
In reply to Re: Is clozapine induced agranulocytosis reversible? » Lamdage22, posted by SLS on August 30, 2014, at 8:06:04
> > From what i have read and heard, Seroquel has the best side effect profile if you take away weight gain by using Metformin!
>
> What about Saphris (asenapine)?Scott, weird, i asked for Saphris but it is only approved for bipolar mania where i am living! And i dont know the data on how frequently it causes motor side effects like and including tardive dyskinesia. Id only try it if it has the same low tardive dyskinesia incidence like Seroquel. And i would have to persuade a doctor to prescribe it(and pay it).
Do you have any data on Saphris's TD and motor side effect potential in relation to other atypicals?
I have seen it work to produce antipsychotic and antidepressant effects. It may be particularly well-suited to treat paranoia. You could add it to your ongoing Seroquel treatment, just in case it doesn't confer sufficient antipsychotic activity. If you feel good, then you can try discontinuing the Seroquel. I don't think Saphris causes as much weight gain as Seroquel. Seroquel does have the potential to produce diabetes, but probably not to the same degree as clozapine. Latuda (lurasidone) is an antipsychotic that is not supposed to cause weight gain. I am guessing that there would be a reduced risk of diabetes. Very few people have tried it yet, and I really don't know how effective it is as an antipsychotic. However, it does have antidepressant effects. It produces NE alpha-2 antagonism (similar to Remeron (mirtazapine)), as well as 5-HT7 antagonism (similar to Brintellix (vortioxetine)).
I tried Latuda (for like 1250 bucks a month.) Sedation and akathisia at once made me finish the experiment early! It was pretty unpleasurable.
>
> - ScottIn what areas do you suspect Saphris to be superior over Seroquel? Weight gain is not an issue as i take Metformin. Diabetes however would be an issue. As would be tardive dyskinesia. Those are my biggest concerns. TD almost more so than diabetes, as it is incurable in nature and literally makes you look like a moron. I can imagine future better diabetes treatments than now. Not so for TD.
Regards. Julian
Posted by ed_uk2010 on August 30, 2014, at 12:30:23
In reply to Re: Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 30, 2014, at 0:50:19
>Heart, blood, diabetes.. arrggh i don't like.
Clozapine isn't any worse for weight gain or diabetes than Zyprexa. Blood disorders and heart issues normally occur within the first few months if they are going to occur at all. It is very unusual for someone who has been stable on clozapine for a prolonged period without problems to develop myocarditis or agranulocytosis.
Posted by Lamdage22 on August 30, 2014, at 14:16:28
In reply to Re: Is clozapine induced agranulocytosis reversible?, posted by ed_uk2010 on August 30, 2014, at 12:30:23
Yeah, well Zyprexa is just a crisis management tool that i am withdrawing from and hopefully never look back.
Posted by phidippus on September 5, 2014, at 0:50:42
In reply to Is clozapine induced agranulocytosis reversible?, posted by Lamdage22 on August 27, 2014, at 16:34:58
Yes, it is reversible.
Eric
This is the end of the thread.
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