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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 Phil on January 8, 2015, at 10:17:18
OK, Zyprexa sent me to the hospital for 6 days of 103-104 fever. Six days! They ran every test in the book and the attending doc dx'd Fever NOS. My psychiatrist said NMS (Neuroleptic Malignant Syndrome).
For the last week or so I've felt a bit run down.
I've been on 40 mg of Latuda for 30 days or so. Last night I thought my face was on fire so I took my temp..101.7. I started popping Tylenol. Used a cool damp towel to chill. Went to sleep and woke up with no fever but still move slow and I ache.
My question is do I run this experiment again tonight?
I have no other symptoms.
Posted by Christ_empowered on January 8, 2015, at 10:51:17
In reply to Latuda 101 fever. Should I continue?, posted by Phil on January 8, 2015, at 10:17:18
I wouldn't, but that's me. Do you need a neuroleptic?
Posted by ed_uk2010 on January 8, 2015, at 10:59:32
In reply to Latuda 101 fever. Should I continue?, posted by Phil on January 8, 2015, at 10:17:18
> OK, Zyprexa sent me to the hospital for 6 days of 103-104 fever. Six days! They ran every test in the book and the attending doc dx'd Fever NOS. My psychiatrist said NMS (Neuroleptic Malignant Syndrome).
Neuroleptic malignant syndrome is the most serious form of antipsychotic-induced pyrexia but antipsychotics can also cause an elevated temperature not associated with NMS. NMS causes fever partly due to the presence of severe muscle rigidity - which generates a lot of heat, but also because antipsychotics impair temperature regulation. If there is no muscle rigidity, other causes of fever need to be looked into. In this situation, the antipsychotic may be contributing to the fever but may not be the only cause.
In the absence of any other symptoms, fever is not NMS, but needs to be monitored closely in case it progresses to NMS. It seems that you do have other symptoms but they are currently vague. A medical assessment is therefore needed. NMS is diagnosed based on the combination of fever and widespread muscle rigidity, stiffness and/or tension. Mental state changes (often confusion) may be present. Sweating and increased pulse rate are common. Blood pressure may fluctuate up and down.
In the absence of NMS, Zyprexa, Latuda and other antipsychotics can cause fever via impaired temperature regulation. Zyprexa, but not Latuda, is anticholinergic, which may lead to a further increase in temperature due to reduced sweating. D2 antagonists.
Impaired temperate regulation means that the body is no longer efficient at maintaining its usual (almost) constant temperature. The body temperature is now affected by the environment. In cold weather, those on APs (usually the elderly), are at risk of hypothermia. In hot weather, there is a risk of hyperthermia/fever. In the presence of infection/illness, the risk of an abnormal body temp may be increased by APs.
Is Latuda your only antipsychotic? Combinations of antipsychotics and high doses present a higher risk than low dose of single antipsychotics.
>move slow and I ache
Does it feel like a viral infection to you? Or are you muscles stiff and rigid? Achy muscles, rather than the typical NMS tension/rigidly are normally due to infection.
>Tylenol
Fever in NMS does not respond to Tylenol, but it can be reduced my cooling measures and muscle relaxants. Fever due to infections normally responds to Tylenol, and better still to ibuprofen (in the absence of contraindications to ibuprofen).
>My question is do I run this experiment again tonight?
No. Your fever last night was too high, particularly considering your bad response to Zyprexa in the past. You need to see a doctor. It's possible that you have a combination of a viral infection plus impaired temperature regulation due to the antipsychotic, which is causing more fever than you would normally experience. I think you should continue Tylenol for a few days until the muscle aching goes away (or ibuprofen, if appropriate). The doctor should take your pulse, BP, temperature and examine you.
You're not on a high dose of Latuda but I recall you taking another antipsychotic, is this still the case or did you stop and start Latuda instead? You may need to stop treatment with Latuda temporarily at least, so you need advice from a professional here.
Posted by Phil on January 8, 2015, at 11:53:05
In reply to Re: Latuda 101 fever. Should I continue?, posted by ed_uk2010 on January 8, 2015, at 10:59:32
> > OK, Zyprexa sent me to the hospital for 6 days of 103-104 fever. Six days! They ran every test in the book and the attending doc dx'd Fever NOS. My psychiatrist said NMS (Neuroleptic Malignant Syndrome).
>
> Neuroleptic malignant syndrome is the most serious form of antipsychotic-induced pyrexia but antipsychotics can also cause an elevated temperature not associated with NMS. NMS causes fever partly due to the presence of severe muscle rigidity - which generates a lot of heat, but also because antipsychotics impair temperature regulation. If there is no muscle rigidity, other causes of fever need to be looked into.They ran many tests. Blood work, CT Scan. Tons. Lung cancer and on and on. This doctor had 5 interns shadowing him. I guess I was seeing 6 doctors at a time in a trauma center hospital.
In this situation, the antipsychotic may be contributing to the fever but may not be the only cause.
>
> In the absence of any other symptoms, fever is not NMS, but needs to be monitored closely in case it progresses to NMS. It seems that you do have other symptoms but they are currently vague....Seroquel helps with my symptoms. I'm treating underlying, residual depression. My therapist said it best. Your doctor has not been able to keep you stable for 1.5 years. I'm bipolar I. I'm looking for stability and occasional joy and quite possibly, a new doctor.
A medical assessment is therefore needed. NMS is diagnosed based on the combination of fever and widespread muscle rigidity, stiffness and/or tension. Mental state changes (often confusion) may be present. Sweating and increased pulse rate are common. Blood pressure may fluctuate up and down.
> In the absence of NMS, Zyprexa, Latuda and other antipsychotics can cause fever via impaired temperature regulation. Zyprexa, but not Latuda, is anticholinergic, which may lead to a further increase in temperature due to reduced sweating. D2 antagonists.
>
> Impaired temperate regulation means that the body is no longer efficient at maintaining its usual (almost) constant temperature. The body temperature is now affected by the environment. In cold weather, those on APs (usually the elderly), are at risk of hypothermia. In hot weather, there is a risk of hyperthermia/fever. In the presence of infection/illness, the risk of an abnormal body temp may be increased by APs.
>
> Is Latuda your only antipsychotic? Combinations of antipsychotics and high doses present a higher risk than low dose of single antipsychotics.seroquel 600 mg, latuda 40 mg, lamotrigine 300 mg, clonazepam, 1.5 mg.
>
> >move slow and I ache
>
> Does it feel like a viral infection to you? Or are you muscles stiff and rigid? Achy muscles, rather than the typical NMS tension/rigidly are normally due to infection.Right this moment I'm fine.
>
> >Tylenol
>
> Fever in NMS does not respond to Tylenol, but it can be reduced my cooling measures and muscle relaxants. Fever due to infections normally responds to Tylenol, and better still to ibuprofen (in the absence of contraindications to ibuprofen).I take both Tylenol and ibuprofen. I think we can rule NMS out for now.
>
> >My question is do I run this experiment again tonight?
>
> No. Your fever last night was too high, particularly considering your bad response to Zyprexa in the past. You need to see a doctor. It's possible that you have a combination of a viral infection plus impaired temperature regulation due to the antipsychotic, which is causing more fever than you would normally experience. I think you should continue Tylenol for a few days until the muscle aching goes away (or ibuprofen, if appropriate). The doctor should take your pulse, BP, temperature and examine you.I just had a physical a few weeks ago. My GP is one of the highest rated doctors in Texas. Nothing sinister.
>
> You're not on a high dose of Latuda but I recall you taking another antipsychotic, is this still the case or did you stop and start Latuda instead? You may need to stop treatment with Latuda temporarily at least, so you need advice from a professional here.Thanks ed. Too weary for much more writing right now.
Posted by Phil on January 8, 2015, at 12:10:39
In reply to Re: Latuda 101 fever. Should I continue?, posted by Christ_empowered on January 8, 2015, at 10:51:17
> I wouldn't, but that's me. Do you need a neuroleptic?
Depends on your definition of need is. I think I need one but this has brought new resolve to test that hypothesis. Stop Latuda-stop Seroquel.
If you ask people that know me then most would agree, I need something! Feirce irritability for days..watchout. Dead tired and sleeping other days. I have little doubt about my BPI dx.
Neuroleptics are evil little drugs. Yes, they help people but they are still evil little drugs.
I won't continue the experiment. Too tired to write more for now.
Thanks C_e.
Posted by Phillipa on January 8, 2015, at 17:07:25
In reply to Latuda 101 fever. Should I continue?, posted by Phil on January 8, 2015, at 10:17:18
Phil could it be the flu? It's rampant right now all over the states? Personally I had similar symptoms with cough and had bronchitis. Phillipa
Posted by Phil on January 9, 2015, at 4:46:26
In reply to Re: Latuda 101 fever. Should I continue? » Phil, posted by Phillipa on January 8, 2015, at 17:07:25
No, thank what's his name. No chest condition, this is a random fever.
I came here for excellent info(and I get it)and feedback but I always make my own decisions. My doctor said this is something viral.
I asked so your saying stick with the med? Yes.
I slept great last night and still have a low grade fever some of the time.
This isn't Zyprexa, take 2. I'll have to see how it pans out.
When I hit the Medicare donut hole they will expect me to pay around $400 for Latuda. I'll be forced to get off of it.Thank your lucky stars if someone is supporting you insurance wise. Or you're supporting yourself.
Posted by ed_uk2010 on January 9, 2015, at 9:20:30
In reply to Re: Latuda 101 fever. Should I continue? » ed_uk2010, posted by Phil on January 8, 2015, at 11:53:05
Hi Phil,
>I guess I was seeing 6 doctors at a time in a trauma center hospital.
If everything came back normal, the problem with Zyprexa wasn't NMS or an infection. Most likely it was due to a drug-induced impairment of temperature regulation. This has been reported with most antipsychotics. The blockage of D2 receptors appears to impair the body's ability to maintain a constant temperature by interfering with the hypothalamus. This would not produce abnormal blood tests.
>I think we can rule NMS out for now.
I agree, but that doesn't mean Latuda was not part of the problem. I think you were sensible to stop it because you're already on a substantial dose of another antipsychotic. It may be that taking two antipsychotics was overkill and you may need to avoid such combos in future... instead sticking to one antipsychotic and adjusting the dose with care. Perhaps continue the Tylenol/ibuprofen for a few days.
>Thanks ed.
You're welcome Phil.
Posted by Phil on January 9, 2015, at 19:02:42
In reply to Re: Latuda 101 fever. Should I continue? » Phil, posted by ed_uk2010 on January 9, 2015, at 9:20:30
My 5th day in the hospital back when Zyprexa did whatever it did, I called a friend to pick me up. My temp was 98.6. I called him back 20 minutes later and said my fever is now 103.5. Forget the ride.
The nurse said looks like we have you for another day.
I was shaking uncontrollably and had to have help taking the pills. Chills then fever. God it sucks.
Posted by ed_uk2010 on January 10, 2015, at 0:53:06
In reply to Re: Latuda 101 fever. Should I continue? » ed_uk2010, posted by Phil on January 9, 2015, at 19:02:42
Such rapid and severe rise in temp is rare and serious. Bet you felt terrible.
Posted by Christ_empowered on January 10, 2015, at 9:46:10
In reply to Re: Latuda 101 fever. Should I continue? » Phil, posted by ed_uk2010 on January 10, 2015, at 0:53:06
dude, can you drop neuroleptics? I'd also be concerned with TD, since you're getting older. From what I understand, TD is more common in mood disorders and older adults. The problem with TD as you get older is that it can have a more rapid onset and persist after discontinuation, whereas younger people sometimes see symptom resolution after discontinuation.
That's scary stuff...high fevers and such.
Posted by ed_uk2010 on January 11, 2015, at 12:46:41
In reply to Re: Latuda 101 fever. Should I continue?, posted by Christ_empowered on January 10, 2015, at 9:46:10
>The problem with TD as you get older is that it can have a more rapid onset and persist after discontinuation, whereas younger people sometimes see symptom resolution after discontinuation.
That's very true. In fact, it resolves more often than not for young people who are able to stop meds, or switch to a low TD alternative such as clozapine. Apart from mild temporary withdrawal dyskinesias, TD does not readily resolve itself in those 70+.
Seroquel appears to be very low risk for TD though, except perhaps in the elderly. If Phil could take Seroquel as his only AP the risk isn't going to be high.
I don't know exactly how old Phil is.... but I think he might be in the medium/middle risk group!
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