Posted by med_empowered on August 3, 2005, at 11:23:16
In reply to Zypreza hand tremor??, posted by jclint on August 3, 2005, at 8:17:55
hmmm...this is a tricky one. Antipsychotics in general can lead to tremor (hence the muscle stiffness and soreness they also tend to cause), but its more pronounced and more common on the old-school antipsychotics, like Haldol and Thorazine. You might want to try reducing the dosage a bit, if that's feasible...lots of people take as little as 2.5mgs of zyprexa; many more take 5-7.5 (and lots of Symbyax users take only 6mgs). If that's not an option, the next question would be: wait it out or treat it (or switch again). The old "side-effect pills" used with stuff like Haldol are still very much in use; Cogentin is probably the most widely used and best known. It would kind of serve to moderate the D2 blockade that Zyprexa causes, so you'd see fewer shakes, tremors, etc. There's also propranolol, a non-selective beta blocker used in low-doses for everything from essential tremor to anxiety to cases like yours, where you have neuroleptic-induced undesirable movements. Its effective, but can cause heart weirdness if you already have circulatory issues...in addition, it causes/worsens depression in some people, so do aware of that possibility. The final option would be to switch. Although neuroleptics all have pretty similar mechanisms of action (D2 blockade; the newer ones also hit up lots of other spots), sometimes switching provides you with just the right med. Since you've already taken Seroquel, your remaining options would be Risperdal, Geodon, Abilify, and clozapine (clozapine is a last-ditch effort though). I wouldn't recommend Risperdal, since it seems to be pretty harsh as atypicals go. Geodon may help, but its 2X daily, kind of sedating, and can push people into mania in some med combos (like Geodon+an SSRI). It also cardiovascular effects kind of like you'd see in Mellaril. On the plus side, its more or less weight neutral, may have some antidepressant efficacy, and the sedation usually becomes manageable with long-term use. Abilify is the newest atypical around. It works a little differently than the other ones; there's a D2 antagonist/agonist and serotonin antagonist/agonist action that theoretically makes for a better side-effect profile. It is weight neutral, *usually* non-drowsy, and its a 1 a day med. I personally got akathisia on low-dose (2.5mgs) zyprexa and switched to abilify; I didn't have too many problems, although there were some problems. Abiify tends to be more "activating," but your mileage may vary. If you do switch and still have problems, you might want to re-visit the possibility of Cogentin, propranolol or possibly a benzo (these are good if you also get anxiety with your neuroleptic). Good luck!
poster:med_empowered
thread:537018
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