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I have been on zyprexa zydis for 5 days now and I know it's very early but I have not had the insatiable hunger side effect at all. I've been eating my normal amount at most. I think it's the topiramate and the metformin helping and the exercise. I haven't stepped on the scale but I will wait a bit longer for that.

But I remember instant hunger just non stop last time on the pills of zyprexa at 20 mg. I let the zydis melt under my tongue completely. I don't want to increase my dose for fear of side effects. I know pdoc will push for an increase to 20 mg on Friday. What should I do?

But is this good news? That I don't feel the terrible hunger so far? Have I experienced the unthinkable (no excessive hunger on zyprexa)? Can I avoid weight gain like this? 

 

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That sounds like good news to me! Hopefully, you can avoid the weight gain that's so infamous from Zyprexa.

How well are your symptoms being controlled with the current dose? (10 mg) (Maybe it's too early to tell?) I don't know what to say about what to do should your pdoc try to push for an increase. I guess it depends on how well under control your symptoms are.

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That sounds great! I'm so glad you're not getting that insatiable Zyprexa hunger. (Strangely, I got it at 5 mg when I was 18, but now I'm at 15 mg and no longer have it.... so I don't know what fuels, it really. Maybe my body chemistry changed?) 

I've managed to lose 55 lbs on 15 mg of Zyprexa, along with seroquel and lithium and latuda. So you'd think it would be possible to maintain weight on it. I don't know how big of a difference there is between 20 and 15 mg, though. But I'm on 15 and don't have that rabid hunger either.

OTOH, I know how personal and individual this med stuff is. I remember the Zyprexa hunger like it was yesterday. It was just awful. But here to let you know -- in my case, at least, it was possible not only to maintain weight on a sizable amount of Zyprexa but to lose it as well. I just don't have the hunger this time. Fingers crossed that you won't, either, or if you do that you can work something out with your doc. 

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Great news Wonderful. Zyprexa never made me hungry and was one of the first drugs that worked for me. Unfortunately, antipsychotics never work again when I try them for the second time so I dare not change unless I have to.  

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The hunger is easier to manage if you don't eat much sugar and have slow-release carbs (low-GI). That will likely reduce cravings dramatically. This website gives some good information on low-GI foods (http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html?referrer=https://www.google.com.au/). Some of the low-GI foods like lentils are extremely cheap (they swell a lot when you cook them). 

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Thank you all for all the nice comments and info. 

Up to 20 mg now I guess. Pdoc insisted. We will have to see if I get side effects now. I'm pretty disappointed. I wanted to stay at 10 mg. :(

 

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Doesn't help anyone now but thought I would throw out there that they are working on a new combo med that mixes olanzapine/samidorphan. They say it reduces the incidence of metabolic disturbances from olanzapine and there was less weight gain in trials. You'd have to prove it doesn't increase glucose and lipids to convince me though.

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On 2/11/2018 at 5:13 PM, browri said:

Doesn't help anyone now but thought I would throw out there that they are working on a new combo med that mixes olanzapine/samidorphan. They say it reduces the incidence of metabolic disturbances from olanzapine and there was less weight gain in trials. You'd have to prove it doesn't increase glucose and lipids to convince me though.

What kind of med is samidorphan? I would bet this would be super expensive too. Not something affordable. Or would both be generic meds luckily so they could be prescribed singly and not as a combo pill? I hope it does help to not increase glucose or lipids too. That would be great. 

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11 minutes ago, Wonderful.Cheese said:

What kind of med is samidorphan? I would bet this would be super expensive too. Not something affordable. Or would both be generic meds luckily so they could be prescribed singly and not as a combo pill? I hope it does help to not increase glucose or lipids too. That would be great. 

Samidorphan is an opioid antagonist similar to naltrexone. I wonder if combining olanzapine with naltrexone would produce similar results?

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1 hour ago, Wonderful.Cheese said:

What kind of med is samidorphan? I would bet this would be super expensive too. Not something affordable. Or would both be generic meds luckily so they could be prescribed singly and not as a combo pill? I hope it does help to not increase glucose or lipids too. That would be great. 

Samidorphan was being investigated for addiction treatment with potentially fewer side effects than naltrexone.

Buprenorphine is an opioid agonist that is used with naloxone to treat opioid addiction. It has shown antidepressant effect in some trials. Combining it with samidorphan reduces incidence of euphoria and substance dependence. Alkermes has the buprenorphine/samidorphan in trials as an adjunct to existing antidepressant therapy to improve response and potentially reduce side effects.

As for the olanzapine/samidorphan combo, I'm not sure if the reduced incidence of weight gain is due to a reduced appetite or if samidorphan actually causes weight loss. However, I haven't found anything yet that shows impact on lipids and glucose compared to olanzapine monotherapy.

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I don’t know if this is helpful or if you have tried it but eating low carb really put a damper on my cravings when I was on seroquel. I can’t speak for being on Zyprexa (I only use it PRN) but I thought I would throw that in. I managed to lose around 40 pounds on seroquel and maintain that for a few years without any medication to help me. I gained it partly back but mostly because I stopped being vigilant about my diet. 

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14 hours ago, mikl_pls said:

Samidorphan is an opioid antagonist similar to naltrexone. I wonder if combining olanzapine with naltrexone would produce similar results?

 

12 hours ago, browri said:

Samidorphan was being investigated for addiction treatment with potentially fewer side effects than naltrexone.

Buprenorphine is an opioid agonist that is used with naloxone to treat opioid addiction. It has shown antidepressant effect in some trials. Combining it with samidorphan reduces incidence of euphoria and substance dependence. Alkermes has the buprenorphine/samidorphan in trials as an adjunct to existing antidepressant therapy to improve response and potentially reduce side effects.

As for the olanzapine/samidorphan combo, I'm not sure if the reduced incidence of weight gain is due to a reduced appetite or if samidorphan actually causes weight loss. However, I haven't found anything yet that shows impact on lipids and glucose compared to olanzapine monotherapy.

Interesting! Thanks for the info! It will be something to watch for sure. I wonder how it will all play out. We will have to wait and see I guess. 

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12 hours ago, saintalto said:

I don’t know if this is helpful or if you have tried it but eating low carb really put a damper on my cravings when I was on seroquel. I can’t speak for being on Zyprexa (I only use it PRN) but I thought I would throw that in. I managed to lose around 40 pounds on seroquel and maintain that for a few years without any medication to help me. I gained it partly back but mostly because I stopped being vigilant about my diet. 

Thanks for the info! I don't think I eat a terrible amount of carbs but I guess the only way to find that out is to track my diet with my fitness pal app. I really need to do this. I'm not having increased appetite that I can tell so far on the 20 mg and I don't think I'm eating more either. But I need to track I think.

In fact I lost a lb in a week when i got weighed at the Dr's office. But I do worry.

And it's not just weight gain. It's the diabetes possibility and the high cholesterol possibility too. Diabetes runs in my family a lot. I feel I'm doomed to get it anyway. With bad genetics I just think it is bound to happen unfortunately. Even though I exercise a good amount and eat a normal diet. My mom who weighs probably 110 lbs and is very active and eats way healthy and barely eats at all in fact, got type 2 diabetes about 2 years ago. That's scary. 

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1 hour ago, Wonderful.Cheese said:

Thanks for the info! I don't think I eat a terrible amount of carbs but I guess the only way to find that out is to track my diet with my fitness pal app. I really need to do this. I'm not having increased appetite that I can tell so far on the 20 mg and I don't think I'm eating more either. But I need to track I think.

In fact I lost a lb in a week when i got weighed at the Dr's office. But I do worry.

And it's not just weight gain. It's the diabetes possibility and the high cholesterol possibility too. Diabetes runs in my family a lot. I feel I'm doomed to get it anyway. With bad genetics I just think it is bound to happen unfortunately. Even though I exercise a good amount and eat a normal diet. My mom who weighs probably 110 lbs and is very active and eats way healthy and barely eats at all in fact, got type 2 diabetes about 2 years ago. That's scary. 

Olanzapine's diabetegenic effects can be independent of weight gain although your experience of still managing to lose weight on 20mg of olanzapine is certainly unusual and in my mind actually quite impressive lol.

@mikl_pls is right. Theoretically, you could get the same effects of the investigational olanzapine/samidorphan combo by just taking naltrexone. In fact samidorphan's longer chemical name is actually 3-carboxamido-4-hydroxynaltrexone. But there are pharmacological differences. Naltrexone is an opioid antagonist at mu, kappa, and delta opioid receptors. Whereas samidorphan also works on all three but is more preferential to mu-opioid antagonism, which may cause fewer side effects.

Bupropion/naltrexone (Contrave) is already approved as a weight loss option.

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38 minutes ago, browri said:

Olanzapine's diabetegenic effects can be independent of weight gain although your experience of still managing to lose weight on 20mg of olanzapine is certainly unusual and in my mind actually quite impressive lol.

@mikl_pls is right. Theoretically, you could get the same effects of the investigational olanzapine/samidorphan combo by just taking naltrexone. In fact samidorphan's longer chemical name is actually 3-carboxamido-4-hydroxynaltrexone. But there are pharmacological differences. Naltrexone is an opioid antagonist at mu, kappa, and delta opioid receptors. Whereas samidorphan also works on all three but is more preferential to mu-opioid antagonism, which may cause fewer side effects.

Bupropion/naltrexone (Contrave) is already approved as a weight loss option.

Well, thanks! :)

I am on topiramate and metformin. I see a weight loss dr at a medical weight loss program. She doesn't know I'm on zyprexa zydis yet. I wonder what she will think. I don't see her for another maybe 6 weeks now. I'm having some success I have lost 10 lbs since starting the topiramate and metoformin. Well maybe 11 lbs now I guess lol.

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1 hour ago, Wonderful.Cheese said:

Well, thanks! :)

I am on topiramate and metformin. I see a weight loss dr at a medical weight loss program. She doesn't know I'm on zyprexa zydis yet. I wonder what she will think. I don't see her for another maybe 6 weeks now. I'm having some success I have lost 10 lbs since starting the topiramate and metoformin. Well maybe 11 lbs now I guess lol.

Oh well then taking naltrexone as well would be excessive, because I'm pretty sure the point with opioid antagonists is to reduce appetite and subsequently weight. But topiramate reduces appetite fairly effectively, and you're already taking metformin to combat any potential increase in glucose.

My pdoc and I discussed this when he started me on olanzapine. He said that depending on the person's weight he might test blood sugar and lipids up front. If blood sugar is <100 but in the upper end like 80s or 90s. Then he might consider starting them on olanzapine+metformin at the same time, particularly if the have a relatively close family history of type 2 diabetes and they're also overweight. Some endocrinologists though might argue that tolerability issues with metformin would outweigh any prophylactic benefit that it has as an adjunct.

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1 minute ago, looking for answers said:

What is zyprexa primarily used for? Deprsssion? Psychosis?

Psychosis in schizophrenia or schizoaffective disorder and bipolar mania primarily I'd say. But combined with an antidepressant it can be for treatment resistant depression or bipolar depression.

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For treatment resistant MDD, your options are an antidepressant plus either aripiprazole, brexpiprazole, quetiapine, or olanzapine. Here's the catch though. While aripiprazole, brexpiprazole, and quetiapine are approved for treatment resistant depression in combination with any antidepressant, olanzapine is TECHNICALLY only approved for this indication with fluoxetine. None are approved as monotherapy for treatment-resistant depression.

Olanzapine is the only antipsychotic that is approved for use with an antidepressant (specifically approved with fluoxetine only) for bipolar depression. Otherwise for bipolar depression your (FDA-approved) options are quetiapine or lurasidone (both either with or without lithium or valproate), but neither are approved for use as an adjunct to an antidepressant the way that olanzapine/fluoxetine is.

So it's really the olanzapine/fluoxetine combo that makes olanzapine's indications stand out compared to other antipsychotics. Otherwise it really is no different in that as monotherapy it is approved for both manic and mixed episodes in bipolar disorder in both adults and adolescents as well as the treatment of schizophrenia in adults and adolescents like most other antipsychotics.

Nevertheless, olanzapine does get a lot of use in the ER to really knock out acute manic episodes in particular because of its rapid effect on reducing agitation while also having a really positive effect on the dysphoric mood in bipolar mixed episodes or negative symptoms of schizophrenia. ER docs also use the anticholinergic effects of olanzapine to their advantage to reduce the risk of the patient developing EPS. This makes it more favorable for treating acute mania than say, haloperidol, which is another mainstay of the psych ER that has a much higher propensity for triggering EPS and usually has to be administered with benztropine. That being said, if the patient is agitated, but compliant and cooperative, then I've heard of IV lorazepam being used to avoid the side effects of APs altogether.

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23 minutes ago, looking for answers said:

After reading again there r other choices for treatment resistant depression besides antipsychotics correct?

With regard to treatment resistant depression, which is what I have, it really boils down to whatever works. Yes, lithium and other mood stabilizers are used as adjuncts to antidepressants. Stimulants too. But so are antipsychotics such as Abilify and Rexulti which specifically have depression as an indication. At the end of the day, it's whatever works for you.

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1 minute ago, jt07 said:

With regard to treatment resistant depression, which is what I have, it really boils down to whatever works. Yes, lithium and other mood stabilizers are used as adjuncts to antidepressants. Stimulants too. But so are antipsychotics such as Abilify and Rexulti which specifically have depression as an indication. At the end of the day, it's whatever works for you.

^^^ this.

Treatment-resistant can't be relegated to a quasi-class of medications that just carry the label saying they're FDA-approved for something. Augmentation, even off-label, is one of the most important tools in a pdocs toolbox to get the optimal effect. So in that regard an antidepressant could be augmented with any of the 4 antipsychotics I mentioned above that are actually approved for that label, or you could augment off-label with:

stimulants (amphetamine (mixed salts or dextro-) / methylphenidate (or dexmethylphenidate) / bupropion / modafinil (or armodafinil))

buspirone 

mirtazapine

Mood stabilizers like lamotrigine or lithium (but not usually valproate, being a less useful mood stabilizer for the depressive side of things)

 

Of the 4 approved adjuncts I've taken aripiprazole, brexpiprazole, and olanzapine. Aripiprazole was too agitating and I wasn't on it long enough to see what impact it would have on the depressed side of my mood. Brexpiprazole and olanzapine both work for me. However I also felt that asenapine (Saphris) had a positive impact on depressed moods for me even at 2.5mg and I wasn't even taking an antidepressant at the time. Something worth looking into if you haven't tried it.

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