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Not what I'd hoped, but better than expected...I get his point that we need to keep things that work - though, given I've had intermittent psychotic symptoms for around a week, perhaps zyprexa isn't working great - but that's part of adding the loxapine.  

I was going to ask for something similar if he didn't go for a more weight-neutral AAP that I've tried before...so it's okay I guess.  Still freaked about the metabolic effects, but I'm hopefully decreasing helps with that.  My cholesterol/triglycerides really got bad with upping to 30mg - they'd gotten worse from prior to zyprexa, but really went out of control with the increase to 30mg.

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This seems like a smart way forward actually. Using an atypical as the main antipsychotic with an adjunctive typical antipsychotic at the lower end of the dosage range is definitely a tried and true method for some kinds of treatment-resistant psychosis that just require a little bit more dopamine antagonism than atypical antipsychotics are able to provide (yes, even at 30mg of Zyprexa).

Nice thing about loxapine is that because it's older, it's cheap, and it should be quite tolerable at low doses. If I recall correctly, it has worked fairly well for you in the past. Maybe loxapine and Zyprexa together will in fact be greater than the sum of their parts. I'm hopeful for you though.

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Thanks @browri!  That makes me feel even better.  I was on loxapine for a long time and it worked great.  So that part of it I like.  

I'm hoping to get down to 10-15mg of zyprexa.  We shall see.  

I haven't gotten the prescription yet because they pharmacy could read pdoc's writing.  And since I'm to take 10-20mg of loxapine, I wasn't sure how he'd written it.  Hoping pdoc's office gets back to the pharmacy today.  I've followed up with his admin.  

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On 2/27/2021 at 11:22 AM, jarn said:

Thanks @browri - I really appreciate it.  I've been through most AAPs and a couple of APs, this was one thing to try before clozapine.  

I showed your response to my husband and he is supportive of me asking to go off of zyprexa - I was thinking of trying Abilify again.  If I lose weight that will help my mood too.

Plus, it's not clear how well zyprexa is working - I've had mood issues off and on.  And in the last week I've had bad anxiety, a day of mild depression, and suicidal thoughts (I'm not suicidal - but me/not me voice tells me stuff like I could drown myself, and to 'do it now').  I see him next Thursday now.

I’ve never found Zyprexa to do anything for depression, but it is very effective for destroying mania, or the the manic portion of mixed states. It also stops hallucinations and delusions in their tracks. But for depression? Nada. For me, anyway. You seem to be having breakthrough psychosis even on a 30 mg dose. 

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3 hours ago, jarn said:

Thanks @browri!  That makes me feel even better.  I was on loxapine for a long time and it worked great.  So that part of it I like.  

I'm hoping to get down to 10-15mg of zyprexa.  We shall see.  

I haven't gotten the prescription yet because they pharmacy could read pdoc's writing.  And since I'm to take 10-20mg of loxapine, I wasn't sure how he'd written it.  Hoping pdoc's office gets back to the pharmacy today.  I've followed up with his admin.  

Hopefully you’ll get it today, and it will crush the psychosis that you’ve been experiencing. Did loxapine do anything for your mood or anxiety in the past?

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Zyprexa had mild effect on depression for me.  

Loxapine I don't remember - but my primary issue right now is the psychosis.  I think it's causing my anxiety and driving the depression (though I am having a great day today - I ACTUALLY worked out!  Imagine!).  And loxapine killed my psychosis (and was very helpful with hypo/mania).

The pharmacy is delivering the medication sometime after 3.  Thank goodness.  

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4 hours ago, jarn said:

Zyprexa had mild effect on depression for me.  

Loxapine I don't remember - but my primary issue right now is the psychosis.  I think it's causing my anxiety and driving the depression (though I am having a great day today - I ACTUALLY worked out!  Imagine!).  And loxapine killed my psychosis (and was very helpful with hypo/mania).

The pharmacy is delivering the medication sometime after 3.  Thank goodness.  

Let us know how things go. I imagine it was dispensed as 10mg capsules up to 2 daily?

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@browri is zyprexa zydis bad too?

Crap. Crap. Crap. I am nervous to take my up to 40 mg dose of zyprexa zydis (if I took total daily and PRN doses, 30 mg daily and up to 10 mg PRN). I should talk to my NP about getting off of it. Shoot I’m screwed. I do best on -pine meds. Seroquel I gain a million pounds, clozapine my current NP can’t do, saphris I ate the whole house, zyprexa I’m losing weight but it’s bad diabetes. I guess I’ll try saphris again. Or seroquel. 

I take metformin for weight control. Could I already have diabetes too? My fasting glucose was borderline high last summer. My GP didn’t do an A1C test last year. I don’t know why not. My cholesterol level was normal.

 

And, @jarn I’m glad for you that your appointment went ok. I hope you get things figured out to where you are comfortable and feeling good. Good job on the working out. I skipped today. Oops. 

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Cheese, I gained weight on Zyprexa, you've lost.  I'm sure that mitigates your diabetes risk (unlike me).  I wouldn't change anything with your meds at the moment, not without talking to NP.  You've had a lot of instability and getting your MI under control is very (more) important.  

I already have metabolic changes from the zyprexa (cholesterol and triglycerides).  If you don't that is a good thing.

Thanks re: working out.  I still need to do that today.

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On 3/6/2021 at 4:15 PM, Wonderful.Cheese said:

@browri is zyprexa zydis bad too?

Crap. Crap. Crap. I am nervous to take my up to 40 mg dose of zyprexa zydis (if I took total daily and PRN doses, 30 mg daily and up to 10 mg PRN). I should talk to my NP about getting off of it. Shoot I’m screwed. I do best on -pine meds. Seroquel I gain a million pounds, clozapine my current NP can’t do, saphris I ate the whole house, zyprexa I’m losing weight but it’s bad diabetes. I guess I’ll try saphris again. Or seroquel. 

I take metformin for weight control. Could I already have diabetes too? My fasting glucose was borderline high last summer. My GP didn’t do an A1C test last year. I don’t know why not. My cholesterol level was normal.

 

And, @jarn I’m glad for you that your appointment went ok. I hope you get things figured out to where you are comfortable and feeling good. Good job on the working out. I skipped today. Oops. 

I have hard that the Zydis form of Zyprexa MAY cause less weight gain. Perhaps less exposure in the digestive tract to olanzapine, which might change things metabolically to a certain degree. Hard to say. But like I said with @jarn, "If it ain't broke, don't fix it." Your cholesterol was normal last time you checked, and you're losing weight on the Zydis form. Plus the metformin. If there really was a problem, your pdoc would talk to you about it.

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11 hours ago, browri said:

I have hard that the Zydis form of Zyprexa MAY cause less weight gain. Perhaps less exposure in the digestive tract to olanzapine, which might change things metabolically to a certain degree. Hard to say. But like I said with @jarn, "If it ain't broke, don't fix it." Your cholesterol was normal last time you checked, and you're losing weight on the Zydis form. Plus the metformin. If there really was a problem, your pdoc would talk to you about it.

Thank you. I appreciate your help. I will talk to my NP but she will want me to stay on it. You’re right. If it ain’t broke don’t fix it. 

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On 2/24/2021 at 8:10 PM, Iceberg said:

It’s not unheard of to gain the weigh but still have reasonable blood sugar..

My mother has been obese most of her adult and has never had any issues with blood sugar. It’s not a given.

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Saw pdoc today.  I have been depressed here and there - upped loxapine to 20mg.  

Pdoc today agreed to reducing zyprexa to 15mg, and keeping loxapine at 20mg.  I told him eventually I want to go to 10mg on zyprexa but get it'll be a process.  He seemed fine with that.

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On 3/16/2021 at 3:15 PM, jarn said:

Saw pdoc today.  I have been depressed here and there - upped loxapine to 20mg.  

Pdoc today agreed to reducing zyprexa to 15mg, and keeping loxapine at 20mg.  I told him eventually I want to go to 10mg on zyprexa but get it'll be a process.  He seemed fine with that.

Seems like it’s going the way you’ve wanted with respect to the meds. Sorry that your depression has been acting up, though.

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