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Dr. Bob is Robert Hsiung, MD,
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Posted by Lamdage22 on January 9, 2015, at 10:56:54
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 9, 2015, at 10:19:35
Maybe the answer is to take both at a low dosage thus steering clear of trouble?
Posted by ed_uk2010 on January 9, 2015, at 13:51:10
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 9, 2015, at 10:53:33
>Is the diabetes risk with Zyprexa higher or lower than the risk of TD with Amisulpride?
I expect the diabetes risk with Zyprexa is considerably higher, except in the elderly. Of course, your Zyprexa/Seroquel combination can also cause TD.
Posted by Lamdage22 on January 10, 2015, at 4:47:10
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 9, 2015, at 13:51:10
Well i will talk to my Dr about it.
He wants to abandon Serouqel because he thinks that Zyprexa is NOT pro diabetic.
I will tell him im only up for replacing the Zyprexa.
Will see how it goes. I dont want to tell him that he is wrong.
Posted by ed_uk2010 on January 10, 2015, at 5:24:19
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 10, 2015, at 4:47:10
>He wants to abandon Serouqel because he thinks that Zyprexa is NOT pro diabetic.
How strange. Metabolic disturbance is well recognised with Zyprexa, more so that any other atypical apart from clozapine - which has a similar metabolic profile.
Posted by Lamdage22 on January 10, 2015, at 8:10:46
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 10, 2015, at 5:24:19
I bet amisulpride is better with weight than Zyprexa.
How is it with sex?
Posted by ed_uk2010 on January 11, 2015, at 12:38:25
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 10, 2015, at 8:10:46
> I bet amisulpride is better with weight than Zyprexa.
It is.
> How is it with sex?Similar to risperidone (and paliperidone depot) ie. it causes a problem to some people due to elevated prolactin.
..............
Aripiprazole (Abilify) does not elevate prolactin and causes less weight gain (in general) than Zyprexa. It may not be as effective overall as Zyprexa or amisulpride. Have you tried it?
Posted by Lamdage22 on January 11, 2015, at 14:50:17
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 11, 2015, at 12:38:25
Yeah i did. Akathisia hell.
But theres a new one coming out. Brexpiprazole?
Supposedly similar to Abilify with lower incidence of Akathisia.
Well see.
Posted by Christ_empowered on January 11, 2015, at 14:53:46
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 11, 2015, at 14:50:17
could you try abilify again? Maybe with a benzo or some other kinda sedative during start up?
I take 30mgs/day. That dose is less activating or whatever. Keeps me calm and minimizes all the crazy quite nicely. When I get really agitated, I take 200mgs neurontin+2mgs risperidone and I'm good to go.
I just think Abilify is more tolerable and probnably safer than a lot of other AP drugs out there.
Posted by Lamdage22 on January 12, 2015, at 6:31:48
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Christ_empowered on January 11, 2015, at 14:53:46
No christ empowered, cant try again. It was really hell.
Im gonna try the amisulpride. Tomorrow. Starting with 50mg
Posted by ed_uk2010 on January 12, 2015, at 8:57:58
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 12, 2015, at 6:31:48
> No christ empowered, cant try again. It was really hell.
>
> Im gonna try the amisulpride. Tomorrow. Starting with 50mg.I think you'll find it very tolerable at that dose. You may not notice anything different. Even low doses tend to elevate prolactin, but that usually takes time.
How are you planning to reduce your other antipsychotics? When used alone, the usual dose of amisulpride is between 400mg and 800mg per day (split into two doses) for those with prominent hallucinations and/or delusions. Close to 400mg twice a day is often optimal for acutely psychotic patients, but may cause some extrapyramidal symptoms. Around 200mg twice a day is suitable for less severe psychotic symptoms. Less than 300mg per day is used for the relief of negative symptoms and depressive symptoms associated with psychosis, but is rarely sufficient when obvious hallucinations and delusions are a problem (or have been a problem prior to treatment with other drugs). 50mg per day is not antipsychotic, but may improve mood.
Posted by Lamdage22 on January 13, 2015, at 12:21:18
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 12, 2015, at 8:57:58
Is there any way to decrease the prolactin? Alternative or meds?
Please no dopamine agonists as you sure know i cant take them.
Posted by Lamdage22 on January 13, 2015, at 12:33:18
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 13, 2015, at 12:21:18
I am not sure if i want a hormone that is made for breastfeeding in my body. Seriously.
Is there a chance that it DOESNT raise prolactin or is it a sure thing??
Posted by ed_uk2010 on January 14, 2015, at 0:32:53
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 13, 2015, at 12:33:18
> I am not sure if i want a hormone that is made for breastfeeding in my body. Seriously.
The hormone is always in your body (not just during breastfeeding). It is present both in men and in women. The level is raised by most antipsychotics however, especially risperidone, paliperidone and amisulpride.
>Is there a chance that it DOESNT raise prolactin or is it a sure thing??
Not always, but it usually raises it to some extent - the amount is very variable. It doesn't always cause any symptoms. You can also have a blood test to check the level.
Are you male or female?
Posted by ed_uk2010 on January 14, 2015, at 0:49:36
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 13, 2015, at 12:21:18
>Is there any way to decrease the prolactin? Alternative or meds?
The major medication used (in combination with other antipsychotics) is aripiprazole (Abilify). Naturally, you don't want to take that given your previous experience.
You shouldn't initially take anything. It may not be required. Treatment depends on several factors... whether you are male or female (to some extent), whether you have symptoms or not, and the blood prolactin level. There is a herbal remedy which has been looked at in trials: peony-glycyrrhiza decoction. The effective dose was 45g/day. The medicine may be available from Chinese medicine shops.
Posted by Lamdage22 on January 14, 2015, at 4:32:13
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 14, 2015, at 0:49:36
Thanks, ed for the information..
So this PGD does NOT cause any psychotic symptoms usually?
It sounds cool.
Posted by ed_uk2010 on January 15, 2015, at 13:03:01
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 14, 2015, at 4:32:13
>So this PGD does NOT cause any psychotic symptoms usually?
Not that I'm aware of. I don't know how easy it is to buy though. You'd need to speak to a Chinese herbalist.
Posted by Lamdage22 on January 16, 2015, at 3:12:40
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 15, 2015, at 13:03:01
Interesting. My mood seems slightly lifted with the 50mgs
Posted by ed_uk2010 on January 17, 2015, at 14:01:19
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 16, 2015, at 3:12:40
> Interesting. My mood seems slightly lifted with the 50mgs
It may be. The main psychological effect of very low doses is mild mood elevation.
Posted by Lamdage22 on January 18, 2015, at 5:19:41
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by ed_uk2010 on January 17, 2015, at 14:01:19
I hope it sticks with the higher doses.
Posted by Lamdage22 on January 18, 2015, at 5:20:38
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 18, 2015, at 5:19:41
I have headaches sometimes since i take amisulpride.
Posted by ed_uk2010 on January 18, 2015, at 6:53:27
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 18, 2015, at 5:20:38
>I have headaches sometimes since i take amisulpride.
Have you reduced your other meds? Amisulpride isn't a common cause of headaches. Maybe give it time and take paracetamol.
Posted by Lamdage22 on January 18, 2015, at 9:10:28
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals » Lamdage22, posted by ed_uk2010 on January 18, 2015, at 6:53:27
Should i measure my prolactin now as its not elevated by amisulpride yet to be able to compare?
Posted by Lamdage22 on January 18, 2015, at 9:22:59
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 18, 2015, at 9:10:28
How is Saphris'es side effect profile compared to Seroquel Zyprexa and amisulpride?
I have completely forgotten about it as an option.
Posted by ed_uk2010 on January 18, 2015, at 9:57:41
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 18, 2015, at 9:10:28
> Should i measure my prolactin now as its not elevated by amisulpride yet to be able to compare?
How do you know it's not elevated yet? Even low doses of amisulpride frequently elevate prolactin, and an increase in dose doesn't always elevate it much more. This is because low doses of amisulpride already produce relatively high levels in the pituitary gland, and a further increase in dose (with a correspondingly higher pituitary drug level) may not increase prolactin much further. It doesn't always work like that though - dose increases can produce more hyperprolactinaemia in some cases. Bear in mind that an increase in prolactin doesn't always cause any symptoms. Very large elevations are more likely to cause symptoms but do not always do so, especially in men.
Personally, I wouldn't bother measuring prolactin until you've.... a) been on your final/maintenance dose for several weeks or b) earlier, if symptoms occur. You can have it measured straight away if there are symptoms suggestive of hyperprolactinaemia.
I would not attempt to measure it now as a baseline because you're already on amisulpride ie. it wouldn't actually be a baseline. You can use the 'normal range' as a baseline in future. Assuming you have no symptoms, measuring prolactin now wouldn't tell you a great deal. It's likely to be somewhat above the normal range, but the final effect that amisulpride will have won't be clear yet because you've not been on amisulpride for long at all, and you're not at your final dose. Seroquel and Zyprexa normally only produce small elevations. I think it's fair to assume that your prolactin level before starting amisulpride probably floated around the upper end of the normal range. Prolactin levels do not remain constant, it goes up and down a lot, so one reading doesn't reveal much unless it's extremely high. A couple of readings may need to be taken to get an idea of what effect amisulpride has had, if indeed it has had an effect.
Amisulpride is a bit unusual in frequently producing hyperprolactinaemia even at low doses. Most antipsychotics (except Abilify, clozapine and Seroquel) produce variable but dose-dependent increases. The reason for this is that amisulpride doesn't penetrate the blood brain barrier very well. Subtherapeutic doses still produce high levels outside the BBB, and the D2 receptors of the pituitary are indeed outside the BBB. Therapeutic doses needed to produce adequate levels in the brain produce very high levels peripherally. Peripheral D2 receptors have several function apart from controlling prolactin release. One of their major functions appears to be in the control of the nausea/vomiting reflex and gastric emptying. D2 antagonists are therefore anti-nauseant, reduce gastric reflux, inhibit vomiting (to some extent) and speed up stomach emptying. D2 antagonists used primarily for this purpose include metoclopramide (Reglan, Maxolon) and in some countries, domperidone (Motilium). Levosulpride, similar to amisulpride, is used to treat nausea/vomiting and dyspepsia in some parts of the world, as well as depression and psychosis. Interestingly, Zyprexa appears to be one of the most potent anti-nausea drugs available, and is occasionally used to relieve severe nausea in terminal illness and during cancer chemotherapy when the usual meds have failed. It can be surprisingly effective. Haloperidol (Haldol) is often used in this situation but it's not as reliable. It is, however, inexpensive and less sedating than Zyprexa at the low doses normally used.
In young and middle-aged women, the menstrual cycle can be used as a guide to the significance of raised prolactin. If prolactin is elevated but regular menstruation continues as normal, you can assume that the increased prolactin has not interfered much with other hormones such as oestrogen. This is good to know. If menstruation stops, this is normally because the elevated prolactin has caused mild oestrogen deficiency. Because this predisposes to osteoporosis in the long-term, it's a good idea to check vitamin D levels and to prescribe calcium and vitamin D supplementation where appropriate. Vitamin D deficiency is extremely common, especially in people with a history of mental health problems. Supplementation may help to protect the bones.
Posted by ed_uk2010 on January 18, 2015, at 10:10:09
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 18, 2015, at 9:22:59
>How is Saphris'es side effect profile compared to Seroquel, Zyprexa and amisulpride?
Efficacy and side effects are both relevant, but I'm not especially familiar with asenapine (Saphris, Sycrest) to be honest. It's infrequently used here. It was rejected in the EU as a treatment for schizophrenia/psychosis because the studies which were submitted were not sufficient to convince the European Medicines Agency that it was an effective treatment. It showed some efficacy in acute mania, and was approved for this purpose only.
Trials of asenapine have tended to be very short. It is therefore difficult to assess its long-term impact on weight with any certainty. I expect it causes a similar amount of weight gain to Risperdal. Less than Zyprexa but more than amisulpride.
Zyprexa and amisulpride have been pretty consistent in showing good results in the treatment of psychosis. Zyprexa has also been studied for mania and proven effective. Amisulpride hasn't been studied much for bipolar mania.
Efficacy data for Seroquel are reasonable in psychosis, but it's probably less effective than Zyprexa or amisulpride, and the drop out rate seems highest with Seroquel. Seroquel does not seem more effective than typical antipsychotics in schizophrenia. Seroquel has shown useful effects as an add-on in depressive states, however, and as monotherapy in some cases of bipolar depression.
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Dr. Bob is Robert Hsiung, MD,
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