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Re: Cam:antipsychotic question » Cam W.

Posted by Chloe on December 28, 2001, at 9:31:41

In reply to Re: Cam:antipsychotic question » Chloe, posted by Cam W. on December 27, 2001, at 23:14:49

That info is so helpful and reassuring. Especially when you throw in the statistics! I am also glad Seroquel seems to even "more" safe in that it doesn't seem to bind over 80% at any dose.

> > Chloe - Yes, unfortunately the damage is done. The good news is that it is highly unlikely that Seroquel will add any more problems. It is thought that the loose binding of dopamine-D2 receptors by the atypical antipsychotics (like Seroquel), rather than the irreversible binding of dopamine-D2 receptors to the traditional antipsychotics (like Mellaril) helps to avoid EPS and TD.

> > With the atypicals, at any one time the D2 receptors are less than 79% blocked. Above this level is when one starts seeing EPS symptoms (and ultimately TD symptoms). I think that I read somewhere that with most of the atypicals you can obtain greater than 80% blockage of D2 receptors if you raise the dose high enough (Risperdal™ [risperidone] >6mg; Zyprexa™ [olanzapine] >35mg - approximately), except with Clozaril™ (clozapine) and Seroquel. I am fairly sure that they have tried, but have been unable to get Seroquel to block the D2 receptors at a level greater than 80%.

> > Yeah, SSRIs do seem to exacerbate TD and can even cause EPS in a minority of people. I don't really know why. It could be because when you increase serotonergic tone, you (in a roundabout way) decrease dopaminergic transmission. This is just a guess, though.

> > As for the use of Clozaril, has your doc ever considered a rechallenge, with a close watch on your blood cells? I have seen a few rechallenges where the second time around there has been no blood problems (so far). The downside to the cases that I know about is that the docs are a little jumpy about Clozaril rechallenges and keep the people on weekly blood tests forever (so far). That can be a real pain (where I wouldn't put a window).

In terms of a rechallenge, I am under the impression that it is illegal to take Clozaril again after one has had agranulocytosis. Is my info incorrect? Perhaps it's allowed in Cananda, but not here in the US? Or my pdoc is just too scared! But I don't think so.

After two days of Seroquel, my thinking is really clearing up and I am feeling a bit better. I think I am just going to have to accept my tongue movements and get on with my life. It is quite reassuring that it shouldn't get worse. Unfortunately, this tongue stuff was created a long time ago.

Thank you so much, again, Cam. It is such a gift that you are willing to share your expertise and experience with us. Happy 2002!




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