Posted by Dr. Bob on November 18, 2000, at 11:16:56
In reply to Question for Risperdal users, posted by anita on November 17, 2000, at 18:49:20
> Has anyone ever heard of this happening?
I did something Rx Qx-like and passed this on to psycho-pharm (a list I belong to). I hope the below is helpful...
Bob
--
From: Dr. James Karagianis
I used a lot of risperidone when it first came out, but found a lot of patients pooped out on it by about 6 months. I use more olanzapine and have found higher success rates and lower relapse rates.
(funding from all makers of atypical antipsychotics in Canada)
From: John M. Talmadge, M.D.My experience has been that the antidepressant effects of olanzapine (Zyprexa) are superior to those of risperidone (Risperdal). This individual might want to try Zyprexa as an alternative to the Risperdal.
I would offer a suggestion as well that both venlafaxine (Effexor) and mirtazepine (Remeron) seem to do better in the apathy/lack of motivation department than Zoloft for most of my patients.
("goodies" from Lilly, Janssen, Astra-Zeneca, Wyeth-Ayerst, Organon, Pfizer)
From: Deborah Pines, MDI had a patient who needed a certain dose of Risperdal, and then after a while it wouldn't work any more. Raising the dose helped temporarily, but then it wouldn't work any more. This went on for several doses. At one point ... the dose [was] lowered to the original one. At which point he got better.
Risperdal has anti-cholinergic properties leading to sedation, lethargy, memory loss etc. Perhaps rather than raising the dose, this woman ought to try lowering it.
In addition, I found that Risperdal's D24 metabolism can be very influenced by other drugs, leading to more side effects.
From: Stephen J. WiederI have never been impressed with Risperdal functioning as an augmenter for antidepressants in a non-bipolar/non-psychotic patient even though I do have experience with Zyprexa working in this way. It is therefore interesting this post suggests that it can be. I would be very curious if others have seen Risperdal augment antidepressant response. In response to the questioner my first suspicion would be Zoloft poop-out as the likely cause independent of the Risperdal. I am unclear why he is taking Lamictal. Is he bipolar?
(associations with Forest, Pfizer, Wyeth-Ayerst, Shire-Richwood)
From: Jeffrey E. Kelsey, M.D., Ph.D.I wonder if this may be a result of a drug-drug interaction between the Zoloft (sertraline) and risperidone. Sertraline, as a weak to moderate 2D6 inhibitor, has the potential to increase risperidone levels. Since initial dosing was successful, and presumably at a low serum level, this patient might now have too high a risperidone level. Rather than raise the dose (certainly reasonable as a first step), they may do better on a much lower dose.
poster:Dr. Bob
thread:48989
URL: http://www.dr-bob.org/babble/20001115/msgs/49024.html