Posted by JEdwin on November 24, 2000, at 4:31:05
In reply to Re: Switching from Risperdal, posted by JohnL on November 23, 2000, at 6:31:32
Thanks for your advice. Since I'm not aware of the positive symptoms of schizophrenia its hard to answer if I have any, but I defintly have a lot of the negative symptoms, including social withdrawal, disorganization, paranoia, and auditory hallucinations (mostly negative but sometimes helpful). Also, I falied to mention that I'm already taking low doses of Wellbutrin and sporadic light therapy, both of which have done wonders for my depression.
Could you please elaborate on the positive symptoms of schizophrenia, or point me to a place where I can read more about them? My doctors have never mentioned that side of things.
As for what medication to switch to, I think Zyprexa would ideally be my main choice, but my main concerns about Zyprexa are the weight gain and the cost. My doctor recommended I take Topamax with it, so I would be taking three expensive medications which would probably be too big of a hit on my budget since I mostly pay out of pocket. I'm very curious about Moban, since it doesn't have much weight gain associated with it, but it seems like it isn't prescribed that often.
> JEdwin,
> You might want to check out the posts titled "Question for Risperdal users" starting on 11/17/2000. Dr Bob gathered some comments from other doctors concerning Risperdal that are very interesting. You may be able to play with Risperdal dose sizes, and may find lower is sometimes better than higher.
>
> I think Zyprexa or Amisulpride could be excellent choices to replace Risperdal. Your doctor can instruct you on how to switch from Risperdal to Zyprexa. Amisulpride is an excellent choice from Europe. Since it is only available from international mailorder pharmacies, and not FDA approved, I'm not sure your doctor would be able to participate. It is however a choice to keep on the back burner. Zyprexa would seem to me to be the very best choice at this time.
>
> Though each doctor probably would handle it differently, I don't see any need for a wash out period. But whether you do a washout, or just stop one and start another, or slowly decrease one while slowly add in another, I think you should expect some weirdness in that transition zone. After two years, no matter how a switch is accomplished it will likely involve some weird feelings during the change. So be on the lookout and be prepared. Hopefully it would go smoother than expected, but still some caution and respect is warranted. Make sure your doctor is easily reachable during a transition.
>
> I am curious. Do you primarily experience the positive symptoms or the negative symptoms of schizophrenia? Or is it a mixture of both? Is one more prominent than the other? There are two sides to schizophrenia, and I think which side you tend to experience the most could have a strong influence on which drugs should be used. For example, if you have primarily negative symptoms, then choices could be: 1)lower dose of Risperdal; 2)addition of Ritalin or Adderall to Risperdal; 3)addition of antidepressant to Risperdal; 4)Zyprexa; 5)low dose Amisulpride; 6)low dose Sulpiride. If you have primarily positive symptoms, then choices would more likely be something like: 1)increased dose of Risperdal, with another drug added to remedy the akathesia (if your doctor doesn't know what drugs do that, then yeah you probably need a new doctor); 2)Zyprexa; 3)mid-high dose Amisulpride; 4)mid-high dose Sulpiride.
>
> What's better, optimizing Risperdal or switching completely to Zyprexa? I generally think optimizing an existing drug is best. But in your case it might be better to think about trying Zyprexa for a month or so and see how it goes. All evidence suggests it could be a superior replacement. But in a worst case scenario, you could always return to Risperdal and begin optimizing techniques. Though I could see-saw back and forth considering the pros and cons of your alternatives, Zyprexa just seems to stand out as the best choice at this time. It's primary drawback might be a bit more sedation and weight gain than Risperdal.
>
> Hope something here is helpful.
> John
poster:JEdwin
thread:49274
URL: http://www.dr-bob.org/babble/20001115/msgs/49336.html