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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Lepus on September 20, 2011, at 18:48:40
I am on Klonopin (1mg 3x a day), Risperdal (.5mg once a day) and Nardil (15mg 2x a day, trying to increase dose).
It seems like every afternoon after I take Nardil I start to feel agitated and restless. My legs and arms feel like I have to keep moving them or tensing them. I feel more depressed and my thoughts race. I feel very uncomfortable. I have spoken to my pdoc about it. She really didn't have anything to say except maybe take some extra Klonopin and we will see what happens.
What is causing this? Is it the Risperdal or the Nardil? I'm supposed to increase the Nardil but I don't want to if this is how I'm going to feel.
What do I do? My God I need some relief and I am not getting it.
Posted by Christ_empowered on September 20, 2011, at 19:44:06
In reply to Nardil/riperdal akathisia, posted by Lepus on September 20, 2011, at 18:48:40
I can only think of 2 things: add in a small dose of propranolol and/or switch out the risperdal for something else, also in a low dose.
Posted by Lepus on September 20, 2011, at 20:06:58
In reply to Re: Nardil/riperdal akathisia, posted by Christ_empowered on September 20, 2011, at 19:44:06
I don't think I can take propranolol while on Nardil. So you think it is the Risperdal causing it rather than the Nardil? It seems odd that it starts after my afternoon dose of Nardil.
I'm not fond of Risperdal though. My periods have stopped too, although two doctors have told me this is fine for the short-term. I will not be on Risperdal long. It was just added to try to get me through the very bad patch I'm going through with anxiety and depression. I'm not even functional, but that isn't changing with the meds.
Posted by Christ_empowered on September 20, 2011, at 20:35:41
In reply to Re: Nardil/riperdal akathisia, posted by Lepus on September 20, 2011, at 20:06:58
oh, wow..I didn't know about the propranolol+nardil interaction. I was just throwing that out there because when I had neuroleptic-induced akathisia, that's what I was given.
Anyway, I'm not a doc, so I have no way of knowing what the problem is, but Risperdal is kind of rough. I mean, yes, its atypical or whatever, but it often causes EPS and I seem to recall reading that TD is more of a problem with Risperdal than, say, Zyprexa. Then again, you're on a tiny dose. But it sounds like even this dose is screwing with your body.
Sorry about your situation. I seem to recall reading that high doses of B6 help acute neuroleptic akathisia, but I don't know if that's the best idea while on Nardil (clueless about MAOIs here).
Good luck.
Posted by Lepus on September 20, 2011, at 20:45:11
In reply to Re: Nardil/riperdal akathisia, posted by Christ_empowered on September 20, 2011, at 20:35:41
B6 is fine with Nardil. In fact, Nardil is thought to deplete B6. I wonder if that could be part of the issue?!
I just am scared to increase the Nardil if it is what is causing the mood instability and the restlessness.
Posted by creepy on September 21, 2011, at 21:59:12
In reply to Nardil/riperdal akathisia, posted by Lepus on September 20, 2011, at 18:48:40
In a pinch maybe you can get by on benadryl to take the edge off. usually antihistamine / anticholinergic drugs are used to help with EPS and akathisia. Cogentin, Artane, etc.
Although, if you start getting a bit hypo when you take the afternoon dose, maybe reducing it or adding a small amount of an AAP would help?
Posted by Zyprexa on September 26, 2011, at 2:29:00
In reply to Nardil/riperdal akathisia, posted by Lepus on September 20, 2011, at 18:48:40
Do you take the risperdal in the morning? Its possible the risperdal is wearing off by the afternoon. Maybe a afternoon dose. But you don't like the risperdal, why? Should you take a different AP? Maybe abilify or zyprexa? Abilify would be more energizing, zyprexa more calming.
Posted by Chairman_MAO on September 29, 2011, at 18:58:51
In reply to Nardil/riperdal akathisia, posted by Lepus on September 20, 2011, at 18:48:40
What is the 0.5mg of risperidone for? Did you have these uncomfortable movements/contractions before the risperidone? Once I know that I could give you my [strictly layman's] opinion.
"Take some extra Klonopin" is not a good suggestion. It has a long half-life, and if you're taking it three times daily each day, you shouldn't be messing with the dose like that. I have no idea what your doctor is thinking. Yeah, yeah, I'm not a doctor. That is true. However, telling someone with a steady-state concentration of clonazepam to take PRN clonazepam is ludicrous.
If I had the money and this were a bet, I'd put a lot of money down that the risperdal is causing this. I could be wrong. If you want to find out on your own if perhaps that's the case, try taking 50mg of Benadryl and see if the twitching gets any better.
Posted by Lepus on October 4, 2011, at 18:33:37
In reply to Re: Nardil/riperdal akathisia, posted by creepy on September 21, 2011, at 21:59:12
> In a pinch maybe you can get by on benadryl to take the edge off. usually antihistamine / anticholinergic drugs are used to help with EPS and akathisia. Cogentin, Artane, etc.
> Although, if you start getting a bit hypo when you take the afternoon dose, maybe reducing it or adding a small amount of an AAP would help?
>I'm supposed to be increasing the Nardil so I don't think reducing it is going to be an option. Can I even take Benedryl with Nardil? I thought it was on the list of drugs I can't take.
As for a small amount of an AAP, I'm already taking Risperdal at a small dosage. I just don't know what is going on.
>
Posted by Lepus on October 4, 2011, at 18:38:29
In reply to Re: Nardil/riperdal akathisia, posted by Zyprexa on September 26, 2011, at 2:29:00
> Do you take the risperdal in the morning? Its possible the risperdal is wearing off by the afternoon. Maybe a afternoon dose. But you don't like the risperdal, why? Should you take a different AP? Maybe abilify or zyprexa? Abilify would be more energizing, zyprexa more calming.
I take Risperdal at night. So, it could still be wearing off.
My doctor says this restlessness can't be akasthisia because I don't get it every day.
I don't like Risperdal because it messes with my hormones. My periods are messed up, boobs hurt, I'm more emotional, I'm cramping when I shouldn't be...tons of fun.
I don't know about another AAP. My diagnosis is panic disorder and MDD. The Risperdal was given to try to calm me down while the Nardil kicks in. It isn't exactly working.
Posted by Lepus on October 4, 2011, at 18:43:36
In reply to Re: Nardil/riperdal akathisia » Lepus, posted by Chairman_MAO on September 29, 2011, at 18:58:51
The Risperdal was given to me while I was in the hospital. I was having severe depression and agoraphobia. I still am frankly. But he wanted to try to get me some relief so he added Risperdal while we waited for an AD to show some response.
I don't know about the Klonopin dosing but my current pdoc is the 3rd to suggest it, although before it was just for anxiety.
Can I take Benedryl? Also, my pdoc doesn't think this is akasthisia because it isn't constant. I can go for days with no symptoms. She said that shouldn't happen. True? I don't know who to trust anymore but I'm miserable.
Posted by Chairman_MAO on October 5, 2011, at 23:14:24
In reply to Re: Nardil/riperdal akathisia, posted by Lepus on October 4, 2011, at 18:33:37
I never had a problem with benadryl (up to 100mg).
Posted by Lepus on October 6, 2011, at 15:32:52
In reply to Re: Nardil/riperdal akathisia » Lepus, posted by Chairman_MAO on October 5, 2011, at 23:14:24
> I never had a problem with benadryl (up to 100mg).
Okay. Thanks for the info. I guess maybe it is just Benedryl with the decongestant?
Posted by Chairman_MAO on October 6, 2011, at 16:37:43
In reply to Re: Nardil/riperdal akathisia, posted by Lepus on October 6, 2011, at 15:32:52
One would definitely _not_ want to take an OTC decongestant. Regarding DPH, no, you should use caution:
http://meeting.chestpubs.org/cgi/content/abstract/134/4/c4002
I was saying that _I_ never had a problem. I'm sure scores of other people haven't, either.
http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2011.02234.x/full
I doubt this happens in most people given a sane does of DPH.
This is the end of the thread.
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