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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by phidippus on September 30, 2012, at 15:48:54
I have a tremor that affects my hands and sometimes my limbs. Is there anything I can take for this?
Which of my medications is to blame?
Abilify 10 mg
Bupropion XL 150 mg
Lithium 1200 mg
Viibryd 60 mg
Vyvanse 60 mgEric
Posted by zazenducke on September 30, 2012, at 16:27:53
In reply to Tremor. How do you get rid of it?, posted by phidippus on September 30, 2012, at 15:48:54
That's a common side effect of lithium. Propanolol is sometimes used for that.
> I have a tremor that affects my hands and sometimes my limbs. Is there anything I can take for this?
>
> Which of my medications is to blame?
>
> Abilify 10 mg
> Bupropion XL 150 mg
> Lithium 1200 mg
> Viibryd 60 mg
> Vyvanse 60 mg
>
> Eric
Posted by zazenducke on September 30, 2012, at 16:40:31
In reply to Tremor. How do you get rid of it?, posted by phidippus on September 30, 2012, at 15:48:54
Don't forget to check for interactions http://www.drugs.com/interactions-check.php?drug_list=440-0,1477-0,1956-0,233-109,3296-15039,1475-2533
Drugs.com
Drug Interactions ResultsDrug interactions for the following 6 drug(s):
Unsaved Drug List
bupropion
lithium
propranolol
Abilify (aripiprazole)
Viibryd (vilazodone)
Vyvanse (lisdexamfetamine)
Interactions between your selected drugs
lisdexamfetamine ↔ vilazodone
Major Drug InteractionApplies to: Vyvanse (lisdexamfetamine), Viibryd (vilazodone)
GENERALLY AVOID: Several case reports suggest that serotonin reuptake inhibitors may potentiate the pharmacologic response to sympathomimetic agents. The exact mechanism of interaction is unclear. In one case report, a patient experienced jitteriness, racing thoughts, stomach cramps, dry eyes, palpitations, tremors, and restlessness following a single dose of phentermine ingested approximately a week after she had discontinued fluoxetine. Because of the long half-life of fluoxetine and its metabolite, an interaction with fluoxetine is possible. Similar toxic reactions have been reported when fluoxetine was used concomitantly with amphetamine or phenylpropanolamine. Additionally, some sympathomimetic agents such as amphetamines may possess serotonergic activity and should generally not be administered with serotonin reuptake inhibitors because of the additive risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. The interaction was suspected in a patient treated with dexamphetamine who developed symptoms consistent with the serotonin syndrome approximately 2 weeks after the addition of venlafaxine. The medications were discontinued and the patient was given cyproheptadine for suspected serotonin syndrome, whereupon symptoms promptly resolved. A second episode occurred when dexamphetamine was subsequently resumed and citalopram added. The patient improved following cessation of citalopram on his own, and residual symptoms were successfully treated with cyproheptadine.
MANAGEMENT: In general, amphetamines and other sympathomimetic appetite suppressants should not be combined with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Close monitoring for enhanced sympathomimetic effects and possible serotonin syndrome is recommended if these agents must be used together. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.
bupropion ↔ vilazodone
Major Drug InteractionApplies to: bupropion, Viibryd (vilazodone)
MONITOR CLOSELY: The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, or any substance that can reduce the seizure threshold (e.g., carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, theophylline). These agents are often individually epileptogenic and may have additive effects when combined. The estimated incidence of seizures is approximately 0.4% for immediate-release bupropion hydrochloride at dosages between 300 to 450 mg/day (equivalent to 348 to 522 mg/day of bupropion hydrobromide), but increases almost tenfold between 450 mg and 600 mg/day (equivalent to 522 and 696 mg/day of bupropion hydrobromide). Data for sustained-release (SR) bupropion hydrochloride revealed a seizure incidence of approximately 0.1% at dosages up to 300 mg/day and 0.4% at 400 mg/day. Likewise, in clinical trials, an overall seizure incidence of approximately 0.1% has been reported with extended-release (XL) bupropion hydrochloride at dosages up to 450 mg/day and approximately 0.39% at 450 mg/day. The 0.4% seizure incidence may exceed that of other marketed antidepressants by as much as 4-fold.
MANAGEMENT: Extreme caution is advised if bupropion is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with a history of seizures or other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Bupropion as well as concomitant medications should be initiated at the lower end of the dosage range and titrated gradually as needed and as tolerated. The maximum recommended dosage for the specific bupropion formulation should not be exceeded. Bupropion should be discontinued and not restarted in patients who experience a seizure during treatment.
bupropion ↔ lisdexamfetamine
Major Drug InteractionApplies to: bupropion, Vyvanse (lisdexamfetamine)
MONITOR CLOSELY: The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, or any substance that can reduce the seizure threshold (e.g., carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, theophylline). These agents are often individually epileptogenic and may have additive effects when combined. The estimated incidence of seizures is approximately 0.4% for immediate-release bupropion hydrochloride at dosages between 300 to 450 mg/day (equivalent to 348 to 522 mg/day of bupropion hydrobromide), but increases almost tenfold between 450 mg and 600 mg/day (equivalent to 522 and 696 mg/day of bupropion hydrobromide). Data for sustained-release (SR) bupropion hydrochloride revealed a seizure incidence of approximately 0.1% at dosages up to 300 mg/day and 0.4% at 400 mg/day. Likewise, in clinical trials, an overall seizure incidence of approximately 0.1% has been reported with extended-release (XL) bupropion hydrochloride at dosages up to 450 mg/day and approximately 0.39% at 450 mg/day. The 0.4% seizure incidence may exceed that of other marketed antidepressants by as much as 4-fold.
MANAGEMENT: Extreme caution is advised if bupropion is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with a history of seizures or other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Bupropion as well as concomitant medications should be initiated at the lower end of the dosage range and titrated gradually as needed and as tolerated. The maximum recommended dosage for the specific bupropion formulation should not be exceeded. Bupropion should be discontinued and not restarted in patients who experience a seizure during treatment.
lithium ↔ bupropion
Major Drug InteractionApplies to: lithium, bupropion
MONITOR CLOSELY: The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), systemic steroids, or any substance that can reduce the seizure threshold (e.g., carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, theophylline). These agents are often individually epileptogenic and may have additive effects when combined. The estimated incidence of seizures is approximately 0.4% for immediate-release bupropion hydrochloride at dosages between 300 to 450 mg/day (equivalent to 348 to 522 mg/day of bupropion hydrobromide), but increases almost tenfold between 450 mg and 600 mg/day (equivalent to 522 and 696 mg/day of bupropion hydrobromide). Data for sustained-release (SR) bupropion hydrochloride revealed a seizure incidence of approximately 0.1% at dosages up to 300 mg/day and 0.4% at 400 mg/day. Likewise, in clinical trials, an overall seizure incidence of approximately 0.1% has been reported with extended-release (XL) bupropion hydrochloride at dosages up to 450 mg/day and approximately 0.39% at 450 mg/day. The 0.4% seizure incidence may exceed that of other marketed antidepressants by as much as 4-fold.
MANAGEMENT: Extreme caution is advised if bupropion is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with a history of seizures or other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Bupropion as well as concomitant medications should be initiated at the lower end of the dosage range and titrated gradually as needed and as tolerated. The maximum recommended dosage for the specific bupropion formulation should not be exceeded. Bupropion should be discontinued and not restarted in patients who experience a seizure during treatment.
bupropion ↔ aripiprazole
Major Drug InteractionApplies to: bupropion, Abilify (aripiprazole)
MONITOR CLOSELY: The use of bupropion is associated with a dose-related risk of seizures. The risk may be further increased when coadministered with other agents that can reduce the seizure threshold, including antidepressants, CNS stimulants, acetylcholinesterase inhibitors, phenothiazines, and dopaminergic blocking agents such as neuroleptics and metoclopramide. These agents are often individually epileptogenic and may have additive effects when combined. The estimated incidence of seizures is approximately 0.4% for immediate-release bupropion hydrochloride at dosages between 300 to 450 mg/day (equivalent to 348 to 522 mg/day of bupropion hydrobromide), but increases almost tenfold between 450 mg and 600 mg/day (equivalent to 522 and 696 mg/day of bupropion hydrobromide). Data for sustained-release (SR) bupropion hydrochloride revealed a seizure incidence of approximately 0.1% at dosages up to 300 mg/day and 0.4% at 400 mg/day. Likewise, in clinical trials, an overall seizure incidence of approximately 0.1% has been reported with extended-release (XL) bupropion hydrochloride at dosages up to 450 mg/day and approximately 0.39% at 450 mg/day. The 0.4% seizure incidence may exceed that of other marketed antidepressants by as much as 4-fold.
ADJUST DOSE: Coadministration with bupropion may increase the plasma concentrations of drugs that are metabolized by CYP450 2D6, including many antidepressants, neuroleptics, CNS stimulants (e.g., amphetamines), metoclopramide, and some acetylcholinesterase inhibitors (e.g., donepezil, galantamine). The mechanism is decreased clearance due to inhibition of CYP450 2D6 activity by bupropion and its metabolite, hydroxybupropion. Approximately 93% of Caucasians and more than 98% of Asians and individuals of African descent are extensive metabolizers of CYP450 2D6 and may be affected by this interaction. In a study of 15 male volunteers who were extensive metabolizers of CYP450 2D6, administration of a single 50 mg dose of desipramine following treatment with bupropion 150 mg twice daily increased the desipramine peak plasma concentration (Cmax), systemic exposure (AUC) and half-life by an average of 2-, 5-, and 2-fold, respectively. The effect was present for at least 7 days after the last dose of bupropion. A case report describes a 4-fold increase in plasma levels of imipramine and its metabolite, desipramine, in a 64-year-old woman following the addition of bupropion 225 mg/day. Plasma levels of desipramine were increased twofold more than the imipramine levels, which is consistent with the fact that desipramine is primarily metabolized by CYP450 2D6 while imipramine is also metabolized by other CYP450 isoenzymes. In another report, an 83-year-old woman became unsteady, confused, and lethargic following the addition of bupropion SR 300 mg/day. Her nortriptyline level was found to have increased by 185%. A later rechallenge prompted recurrence of the interaction. Likewise, a 62-year-old woman with no history of seizures developed a generalized tonic-clonic seizure in association with toxic trimipramine plasma levels following the addition of bupropion 300 mg/day. No further seizures occurred following dosage reductions of both drugs.
MANAGEMENT: Extreme caution is advised if bupropion is administered with any substance that can reduce the seizure threshold, particularly in the elderly and in patients with a history of seizures or other risk factors for seizures (e.g., head trauma; brain tumor; severe hepatic cirrhosis; metabolic disorders; CNS infections; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; diabetes treated with oral hypoglycemic agents or insulin). Bupropion as well as concomitant medications should be initiated at the lower end of the dosage range and titrated gradually as needed and as tolerated. The maximum recommended dosage for the specific bupropion formulation should not be exceeded. Clinical and laboratory monitoring may be appropriate for concomitant medications that are substrates of CYP450 2D6 whenever bupropion is added to or withdrawn from therapy. Bupropion should be discontinued and not restarted in patients who experience a seizure during treatment.
lithium ↔ vilazodone
Major Drug InteractionApplies to: lithium, Viibryd (vilazodone)
MONITOR CLOSELY: Lithium may enhance the pharmacologic effects of selective serotonin reuptake inhibitors (SSRIs) and potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. The exact mechanism by which lithium increases serotonergic activity is unknown. The interaction has been reported with fluoxetine and fluvoxamine and the serotonin-norepinephrine reuptake inhibitor venlafaxine. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea. Conversely, SSRIs may elevate the plasma concentrations of lithium and increase the risk of lithium toxicity. The interaction has been associated with fluoxetine, while citalopram and paroxetine reportedly do not cause the interaction. Excessive somnolence has been reported with lithium and fluvoxamine.
MANAGEMENT: Caution is advised if lithium is prescribed in combination with SSRIs. Lithium levels should be assessed regularly and the dosage adjusted accordingly. Patients should be closely monitored for symptoms of the serotonin syndrome during treatment. Particular caution is advised when increasing the dosages of these agents. The potential risk for serotonin syndrome should be considered even when administering serotonergic agents sequentially, as some agents may demonstrate a prolonged elimination half-life. For example, a 5-week washout period is generally recommended following use of fluoxetine before administering another serotonergic agent. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.
propranolol ↔ lithium
Moderate Drug InteractionApplies to: propranolol, lithium
MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.
MANAGEMENT: Caution is advised during coadministration of these agents. Close monitoring for development of hypotension is recommended. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.
lithium ↔ aripiprazole
Moderate Drug InteractionApplies to: lithium, Abilify (aripiprazole)
MONITOR: The concomitant administration of lithium with neuroleptic agents may increase the risk of extrapyramidal reactions and neurotoxicity. In addition, central nervous system-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.
MANAGEMENT: Patients should be monitored for altered efficacy and safety during coadministration. Dosage adjustment or discontinuation of one or both drugs may be necessary if an interaction is suspected.
propranolol ↔ aripiprazole
Moderate Drug InteractionApplies to: propranolol, Abilify (aripiprazole)
MONITOR: Phenothiazines and neuroleptic agents may potentiate the hypotensive effect of some medications secondary to their peripheral alpha-1 adrenergic blocking activity. Orthostatic hypotension and syncope associated with vasodilation may occur, particularly during initial dosing and/or parenteral administration of the phenothiazine or neuroleptic.
MANAGEMENT: Close clinical monitoring for development of hypotension is recommended if phenothiazines or neuroleptic agents are used in patients receiving antihypertensive medications or vasodilators. A lower starting dosage and slower titration of the phenothiazine or neuroleptic may be appropriate, especially in the elderly. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.
propranolol ↔ bupropion
Moderate Drug InteractionApplies to: propranolol, bupropion
ADJUST DOSE: Coadministration with bupropion may increase the plasma concentrations of drugs that are metabolized by CYP450 2D6 (e.g., selective serotonin reuptake inhibitors; tricyclic antidepressants; some beta blockers, antiarrhythmics, and antipsychotics). The mechanism is decreased clearance due to inhibition of CYP450 2D6 activity by bupropion. Approximately 93% of Caucasians and more than 98% of Asians and individuals of African descent are extensive metabolizers of CYP450 2D6 and may be affected by this interaction. In a study of 15 male volunteers who were extensive metabolizers of CYP450 2D6, administration of a single 50 mg dose of desipramine following treatment with bupropion 150 mg twice daily increased the desipramine peak plasma concentration (Cmax), systemic exposure (AUC) and half-life by an average of 2-, 5-, and 2-fold, respectively. The effect was present for at least 7 days after the last dose of bupropion. A case report describes a 4-fold increase in plasma levels of imipramine and its metabolite, desipramine, in a 64-year-old woman following the addition of bupropion 225 mg/day. Plasma levels of desipramine were increased twofold more than the imipramine levels, which is consistent with the fact that desipramine is primarily metabolized by CYP450 2D6 while imipramine is also metabolized by other CYP450 isoenzymes. In another report, an 83-year-old woman became unsteady, confused, and lethargic following the addition of bupropion SR 300 mg/day. Her nortriptyline level was found to have increased by 185%. A later rechallenge prompted recurrence of the interaction. Likewise, a 62-year-old woman with no history of seizures developed a generalized tonic-clonic seizure in association with toxic trimipramine plasma levels following the addition of bupropion 300 mg/day. No further seizures occurred following dosage reductions of both drugs.
MANAGEMENT: Caution is advised if bupropion must be used concomitantly with medications that undergo metabolism by CYP450 2D6, particularly those with a narrow therapeutic range. Concomitant medications should be initiated at the lower end of the dose range. Clinical and laboratory monitoring may be appropriate for some drugs whenever bupropion is added to or withdrawn from therapy.
lithium ↔ lisdexamfetamine
Minor Drug InteractionApplies to: lithium, Vyvanse (lisdexamfetamine)
The anorectic and stimulatory effects of amphetamines may be inhibited by lithium carbonate. The mechanism of interaction is unknown. Clinicians prescribing the combination should be aware of this potential interaction.
No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.
Other drugs that your selected drugs interact withbupropion interacts with more than 300 other drugs.
lithium interacts with more than 500 other drugs.
propranolol interacts with more than 400 other drugs.
Abilify (aripiprazole) interacts with more than 400 other drugs.
Viibryd (vilazodone) interacts with more than 200 other drugs.
Vyvanse (lisdexamfetamine) interacts with more than 100 other drugs.
Posted by jono_in_adelaide on September 30, 2012, at 18:05:47
In reply to Tremor. How do you get rid of it?, posted by phidippus on September 30, 2012, at 15:48:54
I'd try propanolol first, if this fails, maybe benztropine?
Posted by phillipa on September 30, 2012, at 18:28:22
In reply to Re: Tremor. How do you get rid of it?, posted by jono_in_adelaide on September 30, 2012, at 18:05:47
Lithium is known for tremor. Have you had your levels checked? Phillipa
Posted by phidippus on September 30, 2012, at 18:36:15
In reply to Re: Tremor. How do you get rid of it?, posted by zazenducke on September 30, 2012, at 16:40:31
Sh*t, I'm going to have a seizure.
Eric
Posted by phidippus on September 30, 2012, at 18:55:36
In reply to Re: Tremor. How do you get rid of it? » jono_in_adelaide, posted by phillipa on September 30, 2012, at 18:28:22
Yep, I'm right at 1.0 usually.
Eric
Posted by zazenducke on October 1, 2012, at 8:03:25
In reply to Re: Tremor. How do you get rid of it? » zazenducke, posted by phidippus on September 30, 2012, at 18:36:15
> Sh*t, I'm going to have a seizure.
>
> EricYour brain Your choice?
Posted by Christ_empowered on October 1, 2012, at 20:54:48
In reply to Re: Tremor. How do you get rid of it?, posted by zazenducke on October 1, 2012, at 8:03:25
Could you trim down the med list? Maybe...drop lithium (lithium+neuroleptic=more EPS, NMS risks), up the Abilify, drop the 2 ADs for a one multi-target drug, keep the Vyvanse?
I'm concerned about your health on such a cocktail.
Posted by SLS on October 1, 2012, at 21:38:23
In reply to Re: Tremor. How do you get rid of it?, posted by Christ_empowered on October 1, 2012, at 20:54:48
> lithium+neuroleptic=more EPS, NMS risks
I did not know that.
Would you happen to know if this risk is dosage dependent? I take Abilify 10 mg/day and lithium 300 mg/day. I wonder if it is the sort of thing that either shows up early or not at all.
Thanks, C_E
- Scott
Posted by phidippus on October 1, 2012, at 22:47:41
In reply to Re: Tremor. How do you get rid of it?, posted by Christ_empowered on October 1, 2012, at 20:54:48
I cant drop the lithium. I go crazy.
>drop the 2 ADs for a one multi-target drug
What would you recommend as a replacement?
I've been on this cocktail for nearly a year (except for the bupropion-added last week as a mood brightener). I'm doing very well on my regimen. I wouldn't change a thing.
I don't think my health has been effected by my cocktail.Eric
Posted by phidippus on October 1, 2012, at 22:52:25
In reply to Re: Tremor. How do you get rid of it?, posted by Christ_empowered on October 1, 2012, at 20:54:48
My cocktail has me perfectly treated. My OCD has diminished, my mood is great and my ADHD is under control. I'm not messing with my cocktail.
Eric
Posted by Christ_empowered on October 2, 2012, at 9:40:31
In reply to Re: Tremor. How do you get rid of it? » Christ_empowered, posted by phidippus on October 1, 2012, at 22:52:25
hey man. Yeah, from what I've read, lithium+neuroleptics=increased NMS risk (particularly in younger men...don't know where I read that, though), increased EPS+increased severity of EPS.
I also read one small study from way back in the day in which they found that bipolar I patients who were kept on long-term, usually low dose neuroleptics+lithium (I'm guessing the more psychotic and/or agitated ones) had significant cognitive impairment after several years. Something about a battery of cognitive tests showing more impairment than lithium patients or neuroleptic patients. Weird.
I imagine its affected by the choice of neuroleptic, other meds, underlying problem(s), and lithium dose/blood levels. My own experience with mood stabilizers (anticonvsulants, in my case) plus neuroleptics is that things work better when one or both are low dosed.
To me--as a complete non-expert--it seems that you're on a full dose of Abilify (lower end of the range, though), plus an anti-depressant dose of lithium. That's a lot different than, say, 30+mgs Abilify plus full on, anti-manic level lithium intake. Plus, there doesn't seem to be any EPS or TD or anything. If it was me, I'd pick one or the other (I'd probably pick the Abilify, just because its so easy to take), and either simply drop the lithium or work in a less hardcore replacement. Then again, you're on a fairly low dose.
Sometimes, lithium+neuroleptic combos are dangerous. Lithium+haloperidol, for instance, not only results in severe EPS (I would expect as much, personally), but it can also result in permanent brain damage. Some kind of drug induced encephalitis or something...I read about it only briefly. Scary. Makes me wonder what would happen with, say, high doses of Risperdal+lithium, given how risperdal isn't much better than Haldol once the dose gets high enough (thank you, "Mad in America" for this tidbit).
Anyway, yeah....I'm not an expert or anything, so feel free to completely ignore what I'm saying. I imagine Abilify+anything is a lot more tolerable than older (even some atypical) meds+anything.
Posted by b2chica on October 2, 2012, at 12:01:10
In reply to Tremor. How do you get rid of it?, posted by phidippus on September 30, 2012, at 15:48:54
try lowering vyvanse.
i had to lower adderall and my tremor quit.
Posted by SLS on October 2, 2012, at 12:12:52
In reply to SLS..., posted by Christ_empowered on October 2, 2012, at 9:40:31
> hey man. Yeah, from what I've read, lithium+neuroleptics=increased NMS risk (particularly in younger men...don't know where I read that, though), increased EPS+increased severity of EPS.
>
> I also read one small study from way back in the day in which they found that bipolar I patients who were kept on long-term, usually low dose neuroleptics+lithium (I'm guessing the more psychotic and/or agitated ones) had significant cognitive impairment after several years. Something about a battery of cognitive tests showing more impairment than lithium patients or neuroleptic patients. Weird.
>
> I imagine its affected by the choice of neuroleptic, other meds, underlying problem(s), and lithium dose/blood levels. My own experience with mood stabilizers (anticonvsulants, in my case) plus neuroleptics is that things work better when one or both are low dosed.
>
> To me--as a complete non-expert--it seems that you're on a full dose of Abilify (lower end of the range, though), plus an anti-depressant dose of lithium. That's a lot different than, say, 30+mgs Abilify plus full on, anti-manic level lithium intake. Plus, there doesn't seem to be any EPS or TD or anything. If it was me, I'd pick one or the other (I'd probably pick the Abilify, just because its so easy to take), and either simply drop the lithium or work in a less hardcore replacement. Then again, you're on a fairly low dose.
>
> Sometimes, lithium+neuroleptic combos are dangerous. Lithium+haloperidol, for instance, not only results in severe EPS (I would expect as much, personally), but it can also result in permanent brain damage. Some kind of drug induced encephalitis or something...I read about it only briefly. Scary. Makes me wonder what would happen with, say, high doses of Risperdal+lithium, given how risperdal isn't much better than Haldol once the dose gets high enough (thank you, "Mad in America" for this tidbit).
>
> Anyway, yeah....I'm not an expert or anything, so feel free to completely ignore what I'm saying. I imagine Abilify+anything is a lot more tolerable than older (even some atypical) meds+anything.
Thanks for the information and your insights. I really do appreciate it.I tried reducing my dosage of Abilify from 10 mg to 5 mg in the hopes of being able to discontinue it entirely. Within three days, I relapsed. I am concerned with the metabolic side effects, especially high triglycerides.
- Scott
Posted by phidippus on October 2, 2012, at 17:47:53
In reply to Re: SLS... » Christ_empowered, posted by SLS on October 2, 2012, at 12:12:52
How long have you been on the Abilify?
Eric
Posted by phidippus on October 2, 2012, at 17:59:08
In reply to SLS..., posted by Christ_empowered on October 2, 2012, at 9:40:31
I should get my lithium levels checked. As for quitting the Abilify, it will worsen my OCD.
I've been on other mood stabilizers and lithium is the only one that works for me.
I did add 160 mg of Propanalol, it doesn't seem to help much.
Eric
This is the end of the thread.
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