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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on January 18, 2015, at 12:18:35
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 18, 2015, at 11:40:52
> 40 000 IU a week.
I thought that's what you meant!
Usually, people take that dose for about 3 months and then reduce to a maintenance dose eg. 800-1000 units per day, or (alternatively) 20 000 units every 2 weeks. I wouldn't personally want to continue 40 000 units per week beyond ~3 months without a further blood test. If you're still deficient you can continue for longer, until the deficiency has been fully treated. If your vitamin D level is now normal, reduce to a maintenance dose.
Posted by Lamdage22 on January 18, 2015, at 13:50:31
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 18, 2015, at 12:18:35
Im having another blood test! After 3m.
Doesnt high prolactin mean low testosterone? Im not particularly amused about that so i do wanna take that herb you recommended if it is too high!
Posted by ed_uk2010 on January 18, 2015, at 15:15:25
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 18, 2015, at 13:50:31
>Doesnt high prolactin mean low testosterone?
I assume you are a man? Elevated prolactin in men often causes symptoms if tesotesterone levels are suppressed as a result. This is common if prolactin is very high, but not if it's marginally elevated. High prolactin causes symptoms in women more frequently than it causes symptoms in men. This is because it can induce lactation, disrupt the menstrual cycle and reduce oestrogen levels. Women who are not lactating normally have similar prolactin levels to men. In men, most symptoms of hyperprolactinaemia, if they occur at all, are due to moderately reduced testosterone levels. Reduced libido and erectile dysfunction can occur if testosterone levels are reduced (these symptoms are not permanent, they will disappear with treatment or a change in meds). Don't worry about it in advance, it may not happen.
If your prolactin is high, and you are a man, you can also have a blood test to check your testosterone. Gonadotrophins may also be checked. Testosterone is not usually measured in women. Aripiprazole (Abilify) is effective against elevated prolactin caused by most antipsychotics.... but is not very effective against amisulpride and you don't tolerate the side effects anyway. If you do experience high prolactin and blood tests also show low testosterone (assuming you're a man), testosterone supplementation could be prescribed if you have symptoms as a result. Testosterone gel might be suitable eg. the one you apply once daily to an area of skin, and it's absorbed into your body gradually over several hours. Mildly reduced testosterone not causing symptoms doesn't necessarily require any treatment. The herbal treatment I mentioned has been shown to be effective against the symptoms of hyperprolactinaemia... as well as improving the blood results. Sexual function was improved. I just don't know how easy it is to buy the correct product.
In the long term, obesity and diabetes caused by drugs like Zyprexa may cause more harm than the hormonal disturbances which are common with amisulpride. Diabetes causes erectile dysfunction very frequently, for example.
Posted by Lamdage22 on January 19, 2015, at 12:24:00
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 18, 2015, at 15:15:25
Thanks, ed. Yes im a man.
I hit the cr*pp*r 3 times today already oO.
Maybe i will hit it a fourth time.
Well, if its good for my overall health, so be it.
Posted by ed_uk2010 on January 19, 2015, at 13:19:09
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 19, 2015, at 12:24:00
So, when do you plan to increase amisulpride and decrease Zyprexa? Once you've increased amisulpride up to about 150-200mg twice a day you might be able to start tapering off Zyprexa slowly. You don't really want to be on three antipsychotics. If you suffer symptoms like insomnia during reduction of Zyprexa it may be useful to add a sleep med on a short-term basis. I suspect that trazodone will not be useful since its sedative properties are mainly due to activity at receptors already blocked by Seroquel (and Zyprexa). A small dose of zopiclone could be used temporarily, perhaps.
Do you have diarrhoea? Perhaps you could use rehydration sachets and a little bit of loperamide.
If you haven't already, you should have an ECG due to being on so many antipsychotics.
Posted by Lamdage22 on January 19, 2015, at 14:27:03
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 19, 2015, at 13:19:09
Hey ed.
No stool is normal.
Getting my heart checked out? Hmm my psychiatrist seems to not find that necessary.
He doesnt do squat, i havent had that i months!
Almost a year.
Posted by Lamdage22 on January 19, 2015, at 14:39:50
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 19, 2015, at 14:27:03
Is being a good psychiatrist SO hard??
Seriously. Why the heck cant i just rely on my doctor!!
Posted by ed_uk2010 on January 19, 2015, at 14:44:27
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 19, 2015, at 14:27:03
Maybe just wait until you're on a higher dose of amisulpride and then get your GP/doctor to do an ECG (12 lead). ECG monitoring is recommended for all high dose antipsychotic treatment. Your current treatment counts as high dose due to the greater than maximum dose of Seroquel plus two other antipsychotics. The ECG is a precaution.
Posted by Lamdage22 on January 20, 2015, at 6:19:54
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 19, 2015, at 14:44:27
Even more proof that my current psychiatrist is a dumbfuck.
Its really disheartening.
Posted by ed_uk2010 on January 20, 2015, at 8:27:46
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 20, 2015, at 6:19:54
Please can you write an up-to-date list of your current meds and doses. Not certain quite what you're on.
Posted by ed_uk2010 on January 20, 2015, at 8:55:49
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 20, 2015, at 6:19:54
High dose antipsychotic treatment can include above maximum doses of single drugs, combinations which count as high doses when taken together, or in your case - both. In terms of physical monitoring, intermittent ECGs, pulse and blood pressure monitoring, and weight/BMI checks should be sufficient for you. Temperature monitoring is more important for the elderly, and in those treated with high-potency neuroleptics like haloperidol (due to the higher risk of neuroleptic malignant syndrome with these drugs).
Blood tests performed to monitor antipsychotic safety may include:
Plasma glucose, and possibly HbA1c - diabetes checks. Early morning glucose level after an overnight fast is useful.
Plasma lipids - cholesterol, triglycerides. Triglycerides in particular are often elevated by olanzapine. Quetiapine sometimes does the same. Amisulpride causes much milder metabolic changes.
Plasma electrolytes and kidney function - electrolytes such as potassium must be normal for high doses of antipsychotics to be used. Kidney function should be checked in metformin and amisulpride users. Amisulpride and metformin are eliminated predominantly by the kidneys. Olanzapine and quetiapine are excreted following metabolism by the liver.
Full blood count and liver function tests - may be performed occasionally. Quetiapine sometimes leads to abnormal results here but they are usually minor. Full blood counts are useful for general health monitoring, however.
Prolactin - can be measured if sexual dysfunction or loss of libido occurs, or once or a maintenance dose of amisulpride has been established, or after 3 months of treatment (in the absence of symptoms). It's useful to have a baseline before starting antipsychotics (or a new antipsychotic), but in your case it was probably normal or mildly elevated before starting amisulpride. Quetiapine rarely causes significant prolactin elevation. Olanzapine sometimes causes mild elevations, but marked elevations are uncommon. I think you should assume minor/insignificant elevation before starting amisulpride, and take that as your baseline. Prolactin is best measured around an hour after waking, and an hour after breakfast. Stress should be minimised because it can cause a spike in prolactin levels. It is often necessary to re-test if a moderate elevation is found. If it is normal, or if it is extremely high - that tells you more.
I imagine you'll be able to get most physical monitoring and blood tests through your non-psych doctor. Apart from prolactin, all the tests are very routine indeed.
Posted by Lamdage22 on January 21, 2015, at 5:59:55
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 20, 2015, at 8:55:49
i must say im not feeling very well and i suspect it is from amisulpride!
Posted by ed_uk2010 on January 21, 2015, at 6:57:55
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 21, 2015, at 5:59:55
> i must say im not feeling very well and i suspect it is from amisulpride!
In what way are you not feeling well? Also, have you changed the doses of your other meds? How much amisulpride are you on now?
Posted by Lamdage22 on January 21, 2015, at 10:40:05
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 21, 2015, at 6:57:55
Havent changed my other meds. 100mg of amisulpride and i feel like sh*t.
I havent been very motivated before but now?? Terrible
Posted by ed_uk2010 on January 21, 2015, at 10:59:15
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 21, 2015, at 10:40:05
> Havent changed my other meds. 100mg of amisulpride and i feel like sh*t.
>
> I havent been very motivated before but now?? TerribleSo you were more motivated on 50mg and less on 100mg?
To be honest, you're on three antipsychotics. You may not be able to tolerate amisulpride without reducing Zyprexa.
Posted by Lamdage22 on January 21, 2015, at 11:39:11
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 21, 2015, at 10:59:15
Initially i thought it was mood lifting.
Posted by ed_uk2010 on January 21, 2015, at 13:17:33
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 21, 2015, at 11:39:11
>Initially i thought it was mood lifting.
You're taking three D2 antagonists now. I don't think the mood elevation will reappear unless you reduce something. Too much D2 antagonism is usually unpleasant.
Has your doctor suggested how to reduce?
Posted by Lamdage22 on January 23, 2015, at 7:47:40
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 21, 2015, at 13:17:33
We have quit the project now.
I could not do therapy which is very important for the institution im in.
I will see that i take as little of zyprexa as possible.
Which for now means 12.5 mg
Posted by ed_uk2010 on January 23, 2015, at 11:13:28
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 23, 2015, at 7:47:40
Shame it didn't work out.
So... do you need to be on such a high dose of Seroquel as well as Zyprexa? Is that important for stability?
Posted by Lamdage22 on January 25, 2015, at 11:01:13
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 23, 2015, at 11:13:28
If i take less i cant sleep!
And if i take much less i indulge in psychotic thought.
I will ask my PD tomorrow if i can get something for sleep that is non-addictive and non diabetes forming.
Posted by ed_uk2010 on January 25, 2015, at 11:05:38
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 11:01:13
> If i take less i cant sleep!
>
> And if i take much less i indulge in psychotic thought.
>
> I will ask my PD tomorrow if i can get something for sleep that is non-addictive and non diabetes forming.How do you take the 900mg? I mean, how do you divide it across the day?
Posted by Lamdage22 on January 25, 2015, at 12:00:50
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 11:05:38
During the day: Seroquel prolong: 100- 0 - 300
At night : Seroquel 500
Posted by ed_uk2010 on January 25, 2015, at 12:10:54
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 12:00:50
> During the day: Seroquel prolong: 100- 0 - 300
> At night : Seroquel 500>Seroquel 900mg
Zyprexa 10mg
Lithium orotate 480mg
Metformin 1500mg
Effexor 20mgSo, is this list still correct? Are you diabetic or are you on metformin to help with weight gain on the antipsychotics?
Posted by Lamdage22 on January 25, 2015, at 12:25:07
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by ed_uk2010 on January 25, 2015, at 12:10:54
Zyprexa 15.
Metformin for weight gain!
Posted by Lamdage22 on January 25, 2015, at 12:40:20
In reply to Re: Multiple mechanism with Zyprexa and some atyp, posted by Lamdage22 on January 25, 2015, at 12:25:07
There you go.
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Dr. Bob is Robert Hsiung, MD,
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