Posted by e503 on February 11, 2002, at 8:25:13
In reply to Re: possible interaction carbamazepine risperidone? » e503, posted by Ritch on February 10, 2002, at 23:58:23
> > Today I gave ben 25 mg. zoloft in the a.m. and am going to give hiim 25 mg. tonight as opposed to all 50 mg. at might. Amazing,,,,he wasn't agitated much at all today!!!! What the heck is going on ? I thought zoloft only needed 1 a day dosing? He was still somewhat "active/manic", but he was definetly happier!
>
> Zoloft seems to cause this drowsy *foggy* feeling for the first 12 hours or so, and then tends to have this *activating*, in some cases agitating effect for much longer(personal experience). I think it has something to do with the difference between sertraline (the first pass med), and desmethylsertraline (the primary active metabolite). Sertraline has a half-life of 24 hrs or so, while desmethylsertraline has a half-life of 2-3 days. The "first-pass" sertraline is what he is probably responding well to. The active metabolite (IMO), is the agitating, destabilizing part of the picture. That is why I wonder if he might do better on another SSRI like Celexa or Paxil whose metabolites have little or no activity.
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> I do have neurontin at home (ben was on it up until last year) and was thinking about adding that (mitch) or (Jane) was also thinking about the risperdol increase. Unfortunately, my doc is out of town until thursday. Also, Mitch, you are right, I am sure the risperdol during the day was causing akathasia. That's what the pdoc thouoght. So, I really hate to decrease ben's zoloft, but he is still somewhat manic. Increase risperdol or add neurontin???? I had suggested neurontin to my pdoc a few weeks ago, and he said something about ben becoming "disinhibited" on it? What is he talking about?
> >
> > thanks,
> > elise
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>
> Well, if his pdoc thought that Risperdal was causing akathisia, I wouldn't increase the Risperdal for sure. Since you found that splitting the Zoloft dose seemed to help-I would continue to do that (keeping the same overall dose). The disinhibition the pdoc is referring to is something that is usually attributed to benzodiazepines. He might be afraid that it will worsen his impulsivity.
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> My overall impression...when you see his pdoc next-see if you can get him off the Risperdal (since it is low-dose anyhow), and perhaps switch him from Zoloft to Paxil or Celexa.
>
> MitchMitch-
Just curious, but, how do you know so much about this?Regarding the risperdol,,,,,when I did lower the dose at an earlier time, it made Ben have more self-stim behavior (remember he is autistic). So, I really don't want to get rid of the risperdol. So, what do you th ink?
thanks so much for your help....you are a life saver....I couldn't figure out what the deal is with the zoloft.
elise
poster:e503
thread:93523
URL: http://www.dr-bob.org/babble/20020208/msgs/93715.html