Posted by med_empowered on June 5, 2005, at 5:53:20
In reply to Re: Suitable doses of typical APs..... Atypicals » SLS, posted by ed_uk on June 5, 2005, at 2:33:39
hi! There seems to be a little bit of controversy here regarding appropriate dosages, lol...I think that's great, since its a great way to share information. Anyway, my 2.5-5mgs zyprexa recommendation is based on my assumption that your mother is in need of minor dopamin-blocking action and something calming. Its probably also a good idea to take into account her current weight, eating habits, and whether she has diabetes or is at risk of developing it for any reason (genetics, lifestyle, whatever). Since you wrote that she needs something seddating, my #1 choice would be seroquel. Its usually dosed 2X daily, but I tried it at 3X daily and it worked well with less sedation...150-200mgs could be divvied up into 3rds so the nite time dose was relatively large (100mgs) while each daytime dose was relatively small (50mgs, perhaps). Still, because of the diabetes problems associated with the new antipsychotics, I still think Abilify at could be a good choice. Low-end therapeutic doses (10-15mgs) don't have many side-effects, and Abilify seems pretty harmless in terms of weight changes (very slight increase in weight over course of long-term treatment) and diabetes. For calming purposes, she could try a benzo+sleeping med, or something with less addictive potential, like hydroxyzine at low dases in the day and a higher dose at nite. If your mother doesn't responde well to atypicals and it appears that an older neuroleptic may be the way to go, I'd personally recommend loxapine (Loxitane in the US). It hasn't ever been that popular, especially compared to Haldol, but it seems to have something of an "atypical" profile in terms of side-effects and serotonin/dopamine action. Its also sedating. If your mother has depression issues and does best on old anti-psychotics, low-dose Triavil (perphenazine+Elavil) might be a good call. Traditionally, its used at high-end doses for "moody schizophrenia," schizoaffective disorder, and some more severe cases of psychotic depression. At lower end doses, its used for severe anxiety, agitation, severe depression, etc. Because of the Elavil content, Triavil does have the potential for "activating" mania, and Tricyclics can also induce or exacerbate psychosis; however, the Elavil dose is pretty low and the perphenazine acts as a sort of built-in mood-stabilizer....your mother's lithium would also help prevent unwanted side-effects. The final option I thought of was Asendin, or amoxapine. This is a tricyclic chemically related to loxapine that acts as a mild neuroleptic and antidepressant all in one pill. Like Triavil, its used for agitation, severe anxiety, and psychotic depression; recent research has found it useful for schizophrenia/schizoaffective disorders, and it seems to be a sort of "atypical" antipsychotic with strong antidepressant properties. Anyway, since its a tricyclic the small daytime doses could have a calming effect, while the larger nite time dose could act as something of a sedative. Loxapine and Amoxapine do carry the usual anti-psychotic risks, including neuroleptic malignancy sydrome and EPS+TD, but these risks appear to be less frequent than in other "conventional" antipsychotics. Triavil in low doses would carry about the same TD risk as low-dose Mellaril, but would have a higher EPS risk b/c perphenazine is an intermediate-potency neuroleptic. BTW- No matter what anti-psychotic your mother ends up taking, she might want to take antioxidants. Some research, and anecdotal evidence, suggests that Vitamin E supplements (small dose-200 IU or so) reduce the risk of TD. This makes sense, since a 1994 Harvard Study suggested that TD, as well as the changes in brain structure seen with prolonged administration of conventional neuroleptics, may be due to an "oxidizing" effect from the antipsychotics. Personally, I take a combo Vitamin C/Vitamin E softgel along with a multi-vitamin just in case (There have been scattered reports of possible TD from newer anti-depressants). I also make sure to eat plenty of fruit+vegetable and drink lots of red, black, green or white tea. Good luck!
poster:med_empowered
thread:507544
URL: http://www.dr-bob.org/babble/20050601/msgs/507897.html