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Re: Latuda 101 fever. Should I continue? » ed_uk2010

Posted by Phil on January 8, 2015, at 11:53:05

In reply to Re: Latuda 101 fever. Should I continue?, posted by ed_uk2010 on January 8, 2015, at 10:59:32

> > OK, Zyprexa sent me to the hospital for 6 days of 103-104 fever. Six days! They ran every test in the book and the attending doc dx'd Fever NOS. My psychiatrist said NMS (Neuroleptic Malignant Syndrome).
>
> Neuroleptic malignant syndrome is the most serious form of antipsychotic-induced pyrexia but antipsychotics can also cause an elevated temperature not associated with NMS. NMS causes fever partly due to the presence of severe muscle rigidity - which generates a lot of heat, but also because antipsychotics impair temperature regulation. If there is no muscle rigidity, other causes of fever need to be looked into.

They ran many tests. Blood work, CT Scan. Tons. Lung cancer and on and on. This doctor had 5 interns shadowing him. I guess I was seeing 6 doctors at a time in a trauma center hospital.

In this situation, the antipsychotic may be contributing to the fever but may not be the only cause.
>
> In the absence of any other symptoms, fever is not NMS, but needs to be monitored closely in case it progresses to NMS. It seems that you do have other symptoms but they are currently vague.

...Seroquel helps with my symptoms. I'm treating underlying, residual depression. My therapist said it best. Your doctor has not been able to keep you stable for 1.5 years. I'm bipolar I. I'm looking for stability and occasional joy and quite possibly, a new doctor.

A medical assessment is therefore needed. NMS is diagnosed based on the combination of fever and widespread muscle rigidity, stiffness and/or tension. Mental state changes (often confusion) may be present. Sweating and increased pulse rate are common. Blood pressure may fluctuate up and down.

> In the absence of NMS, Zyprexa, Latuda and other antipsychotics can cause fever via impaired temperature regulation. Zyprexa, but not Latuda, is anticholinergic, which may lead to a further increase in temperature due to reduced sweating. D2 antagonists.
>
> Impaired temperate regulation means that the body is no longer efficient at maintaining its usual (almost) constant temperature. The body temperature is now affected by the environment. In cold weather, those on APs (usually the elderly), are at risk of hypothermia. In hot weather, there is a risk of hyperthermia/fever. In the presence of infection/illness, the risk of an abnormal body temp may be increased by APs.
>
> Is Latuda your only antipsychotic? Combinations of antipsychotics and high doses present a higher risk than low dose of single antipsychotics.

seroquel 600 mg, latuda 40 mg, lamotrigine 300 mg, clonazepam, 1.5 mg.
>
> >move slow and I ache
>
> Does it feel like a viral infection to you? Or are you muscles stiff and rigid? Achy muscles, rather than the typical NMS tension/rigidly are normally due to infection.

Right this moment I'm fine.
>
> >Tylenol
>
> Fever in NMS does not respond to Tylenol, but it can be reduced my cooling measures and muscle relaxants. Fever due to infections normally responds to Tylenol, and better still to ibuprofen (in the absence of contraindications to ibuprofen).

I take both Tylenol and ibuprofen. I think we can rule NMS out for now.
>
> >My question is do I run this experiment again tonight?
>
> No. Your fever last night was too high, particularly considering your bad response to Zyprexa in the past. You need to see a doctor. It's possible that you have a combination of a viral infection plus impaired temperature regulation due to the antipsychotic, which is causing more fever than you would normally experience. I think you should continue Tylenol for a few days until the muscle aching goes away (or ibuprofen, if appropriate). The doctor should take your pulse, BP, temperature and examine you.

I just had a physical a few weeks ago. My GP is one of the highest rated doctors in Texas. Nothing sinister.
>
> You're not on a high dose of Latuda but I recall you taking another antipsychotic, is this still the case or did you stop and start Latuda instead? You may need to stop treatment with Latuda temporarily at least, so you need advice from a professional here.

Thanks ed. Too weary for much more writing right now.


Day after day, alone on a hill, I'm amazed at the lack of humanity,that's killing us still.


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poster:Phil thread:1074947
URL: http://www.dr-bob.org/babble/20150102/msgs/1074951.html