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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Zyprexa on November 12, 2014, at 2:59:26
I don't think its doing much and the zyprexa is working great. I see doc next week and going to suggest stoping p and going up to 20 on z. What do you think?
Posted by Zyprexa on November 12, 2014, at 3:05:15
In reply to Thinking of stoping perphenazine, posted by Zyprexa on November 12, 2014, at 2:59:26
My fear is that I will either get fat or discover the p was actually doing something. But on 15 z and weight has been stable for over a year now. Infact I've lost weight. I'm 185-190 lbs now.
Posted by Christ_empowered on November 12, 2014, at 5:34:19
In reply to Re: Thinking of stoping perphenazine, posted by Zyprexa on November 12, 2014, at 3:05:15
From what I've read, if you can avoid 2+ antipsychotics, you should. Apparently, 1 AP/AAP is ideal.
So....
...yeah, I'd go for it, personally. Your doc might know of a way to gradually reduce it or something that'll make the transition easier.
Have you ever been on a mood stabilizer? They help me, and I think it helps me avoid needing an additional AP (usually...). I take Trileptal and Lamictal.
Posted by SLS on November 12, 2014, at 6:47:53
In reply to Re: Thinking of stoping perphenazine, posted by Christ_empowered on November 12, 2014, at 5:34:19
> From what I've read, if you can avoid 2+ antipsychotics, you should. Apparently, 1 AP/AAP is ideal.
>
> So....
>
> ...yeah, I'd go for it, personally. Your doc might know of a way to gradually reduce it or something that'll make the transition easier.
>
> Have you ever been on a mood stabilizer? They help me, and I think it helps me avoid needing an additional AP (usually...). I take Trileptal and Lamictal.What symptoms or features of your illness was perphenazine chosen to treat?
You'll figure it out.
- Scott
Posted by Zyprexa on November 12, 2014, at 9:02:31
In reply to Re: Thinking of stoping perphenazine, posted by Christ_empowered on November 12, 2014, at 5:34:19
I've tried depakote and lamictal, both while on zyprexa. Niether did anything for me. Besides z is also a moodstabilizer!
Posted by Zyprexa on November 12, 2014, at 9:12:57
In reply to Re: Thinking of stoping perphenazine » Christ_empowered, posted by SLS on November 12, 2014, at 6:47:53
The p was ment to replace z, but I could not get off the z. So I took both for the last 6 years under the asumption that I could use less z. Not sure this is working, doc keeps reducing p. And wants me on one AP. I think I would function better on just z. But in the past I could not get down the dose of z or p. So I would just go up a little on z and stop p? Because its obiouse that I atleast need z.
Posted by Phillipa on November 12, 2014, at 10:59:55
In reply to Re: Thinking of stoping perphenazine, posted by Zyprexa on November 12, 2014, at 9:12:57
Zyprexa you do the best on zyprexa so just take that as when on it you are fine right. Phillipa
Posted by SLS on November 12, 2014, at 11:46:10
In reply to Re: Thinking of stoping perphenazine, posted by Zyprexa on November 12, 2014, at 9:12:57
> The p was ment to replace z, but I could not get off the z. So I took both for the last 6 years under the asumption that I could use less z. Not sure this is working, doc keeps reducing p. And wants me on one AP. I think I would function better on just z. But in the past I could not get down the dose of z or p. So I would just go up a little on z and stop p? Because its obiouse that I atleast need z.
I am still unclear as to what you are experiencing. What is your diagnosis? What are the primary symptoms of your illness that occur when you are left untreated? What was the purpose for adding perphenazine?
Keep up the good work.
- Scott
Posted by Christ_empowered on November 12, 2014, at 14:45:40
In reply to Re: Thinking of stoping perphenazine » Zyprexa, posted by SLS on November 12, 2014, at 11:46:10
OK. I'm not a doc or whatever, but...if your doc will do it, maybe go up on the zyprexa while gradually reducing the perphenazine? If you need additional sedation, maybe a non-AP option, like neurontin or something.Just my thoughts.
Posted by Zyprexa on November 14, 2014, at 5:13:34
In reply to Re: Thinking of stoping perphenazine » Zyprexa, posted by Phillipa on November 12, 2014, at 10:59:55
Yes I'm fine on z, always. After many med trials I ended up on the same thing. Why change what works. No more med trials for me.
Posted by Zyprexa on November 14, 2014, at 5:22:54
In reply to Re: Thinking of stoping perphenazine » Zyprexa, posted by SLS on November 12, 2014, at 11:46:10
I have schizoaffective disorder. I hear voices, holucinations that the tv is talking to me, catatonia, anxiety, racing thoughts, depression, psychosis, unable to sleep or eat, PTSD, social anxiety, etc... Delusional, paranoia. I could probably write a book on it. Yes my moods change, ups and downs.
Posted by Zyprexa on November 14, 2014, at 5:28:30
In reply to Re: Thinking of stoping perphenazine, posted by Christ_empowered on November 12, 2014, at 14:45:40
My plan is reduce p to 8mg x2, then go up to 20mg on z and down to 4mg x2 p, then 0mg p. Probably over a month.
I don't think I will need anymore sedation. Never did in the past when I only took z.
Posted by Phillipa on November 14, 2014, at 8:37:12
In reply to Re: Thinking of stoping perphenazine » Phillipa, posted by Zyprexa on November 14, 2014, at 5:13:34
As my old pdoc whom I dearly miss used to say "If it ain't broke than don't fix it". Stick with what you know works. Phillipa
Posted by phidippus on November 15, 2014, at 16:58:43
In reply to Thinking of stoping perphenazine, posted by Zyprexa on November 12, 2014, at 2:59:26
Why were you on it in the first place?
Eric
Posted by SLS on November 15, 2014, at 21:55:31
In reply to Re: Thinking of stoping perphenazine » SLS, posted by Zyprexa on November 14, 2014, at 5:22:54
> I have schizoaffective disorder. I hear voices, holucinations that the tv is talking to me, catatonia, anxiety, racing thoughts, depression, psychosis, unable to sleep or eat, PTSD, social anxiety, etc... Delusional, paranoia. I could probably write a book on it. Yes my moods change, ups and downs.
I know some people in your position who do well with a combination of typical and atypical neuroleptic antipsychotics. You might want to take a look at the Navane (thiothixene) as your typical. As far as atypicals are concerned, it is my impression that Saphris (asenapine) is good for paranoia and depression.
- Scott
Posted by Zyprexa on November 15, 2014, at 23:40:11
In reply to Re: Thinking of stoping perphenazine » Zyprexa, posted by phidippus on November 15, 2014, at 16:58:43
I tried switching from z to p. To lose weight. But now I've lost weight and not gaining it back. And still on the z. Guess its the generic that does not make me gain weight.
Posted by Zyprexa on November 15, 2014, at 23:58:11
In reply to Re: Thinking of stoping perphenazine » Zyprexa, posted by SLS on November 15, 2014, at 21:55:31
Why Navaine?
I realy did not need p, it was supposed to replace the z, because z was making me gain weight. But I lost the weight and back on high dose z and still not gaining. So maybe I don't need the p. I tried taking p with low dose z and it didn't work. So gradualy I have increased the dose of z back to where it was, and still maintaining my weight. Z works for all my symptoms, always has for 16 years.
I'm learning that taking z without alcohol around the dose taking time makes it work a lot better. So I cut down on drinking and taking z earlier in day. I'm starting to wonder if I can't just stop p and not go up to 20 on z. But won't know untill I stop the p. I've had problems coming off p also but was on lower dose z at time, 10mg.
I think generic z is a little less effective. So maybe I will need 20mg.
Posted by Christ_empowered on November 16, 2014, at 0:01:13
In reply to Re: Thinking of stoping perphenazine » phidippus, posted by Zyprexa on November 15, 2014, at 23:40:11
Perphenazine was chosen for the CATIE study and compared well with the newer drugs. A little more EPS, considerably less weight gain I think.
I would imagine that any reasonably dose, low-to-moderate potency old school AP would be fairly tolerable. Haldol is widely used for some reason, but it produces a neurotoxic metabolite and produces EPS and TD, even at low doses.
I've read good things about loxapine. Its not as commonly used, but its cheap and if you keep the dosing low, its apparently atypical-ish. High dosing, though, and its just like any other AP.
I seem to recall reading that adding Remeron to old school AP drugs makes them more tolerable and helps mood and negative symptoms. But you're already on 2 AD drugs, so...yeah.
Ummm...I did read that high(ish) doses of amoxapine, an old school TCA drug, can control psychotic disorders with Risperdal-like side effects. Speaking of which...Risperdal is generic now. Have you ever tried it? If the dose is low enough, its atypical. Higher doses, though, and you may as well be on Haldol.
Good luck!
Posted by Zyprexa on November 16, 2014, at 0:46:12
In reply to Re: Thinking of stoping perphenazine, posted by Christ_empowered on November 16, 2014, at 0:01:13
I took risperdal before zyprexa and it didn't do anything for my psychosis.
I want to stop p now because it is just getting so expensive. Talking $450-800 for the generic.. Z is only $66 for 20mg. And it works better!
Posted by Christ_empowered on November 16, 2014, at 2:44:03
In reply to Re: Thinking of stoping perphenazine » Christ_empowered, posted by Zyprexa on November 16, 2014, at 0:46:12
man...I didn't know perphenazine would be that crazy expensive. Kinda makes sense though...probably less popular than a lot of other drugs, but still enough of a market to raise prices up crazy high. Weird.
If you need a typical, I'd personally say low dose loxapine. Its cheap (I goodrx-d it when I was thinking about it) and low doses are atypical-ish. I think its a 2x daily thing.
Posted by Phillipa on November 16, 2014, at 19:13:34
In reply to Re: Thinking of stoping perphenazine » Christ_empowered, posted by Zyprexa on November 16, 2014, at 0:46:12
You know what works for you. Why the doc just tried to switch when working well for you was weight gain. I forgot did you try metformin for weight? Stay on the generic zyprexa. And stop drinking please? Phillipa
Posted by Zyprexa on November 22, 2014, at 2:33:36
In reply to Re: Thinking of stoping perphenazine » Zyprexa, posted by Phillipa on November 16, 2014, at 19:13:34
Looks like I will not be stoping the perphenazine. She does not want me to change anything. Which is good because this combo is working really well. Guess I will just have to pay the price... One thing I can do is get a script for 16mg pills and cut them, that will reduce the cost a lot. Still may end up in the gap.
This is the end of the thread.
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