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So here are my current daily meds (dosages are total daily mg’s): Zyprexa Zydis 30 mg, Abilify 30 mg, Rexulti 2 mg, Gabapentin 1,200 mg, Prozac 40 mg, Vyvanse 60 mg, Synthroid 75 mcg, Yaz, Metformin ER 2,000 mg, Topamax 200 mg

I am wanting to streamline my meds. Does anyone have thoughts? @Iceberg @browri or anyone I’m forgetting?

I want off abilify. I honestly don’t think topamax is doing anything? And why the Metformin ER as I’m not diabetic? It causes me stomach problems still.

Anyone with any thoughts, experiences, ideas, etc. I would greatly appreciate it!

One more thing, I cannot have any med changes unless my tdoc and husband say so per my NP’s orders. It’s the same as being on a court order like I was before and I very much hate this. I don’t have a say in what I put in my body, once again. I don’t have a voice. 

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4 minutes ago, Wonderful.Cheese said:

One more thing, I cannot have any med changes unless my tdoc and husband say so per my NP’s orders

I know this topic has come up several times (I dont blame you for wanting off something) have you had any progress getting psych NP to vocalize a possible plan? 

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7 minutes ago, Iceberg said:

I know this topic has come up several times (I dont blame you for wanting off something) have you had any progress getting psych NP to vocalize a possible plan? 

The last time I asked her to please take me off abilify, she told me that I would need the approval of both my tdoc and my husband before the possibility of any med changes could be discussed. And that’s as far as I got. Husband wants me to stay on all meds. That I know. I don’t know what tdoc thinks, but I bet she sides with husband. I have no say. 

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I just need a PRN to really knock my socks off too. I am going to ask NP for something very strong like Thorazine. Because I have taken double the Zyprexa PRN and double my klonopin PRN and I’m a tiny bit drowsy but still as before, so obviously it’s not cutting it. Do I take more?

I’m upset. I can’t talk to NP either. I feel so uncomfortable around her. :( 

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51 minutes ago, Wonderful.Cheese said:

I just need a PRN to really knock my socks off too. I am going to ask NP for something very strong like Thorazine. Because I have taken double the Zyprexa PRN and double my klonopin PRN and I’m a tiny bit drowsy but still as before, so obviously it’s not cutting it. Do I take more?

I’m upset. I can’t talk to NP either. I feel so uncomfortable around her. :( 

I would be careful doubling PRN meds unless explicitly prescribed… np might be hesitant to change things if you’re dosing meds differently than what she thinks you’re taking 

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On 1/24/2022 at 8:30 PM, Wonderful.Cheese said:

I just need a PRN to really knock my socks off too. I am going to ask NP for something very strong like Thorazine. Because I have taken double the Zyprexa PRN and double my klonopin PRN and I’m a tiny bit drowsy but still as before, so obviously it’s not cutting it. Do I take more?

I’m upset. I can’t talk to NP either. I feel so uncomfortable around her. :( 

Like @Iceberg said, it might not be a good idea to double up on PRNs without NP knowing........There's no harm asking NP about the Thorazine, but as has been said before, many pdocs won't prescribe it any longer.

I think a good idea would be to talk to tdoc, about the meds you want to discontinue, and see what her opinion is.....Your husband might be more open about changing some things if tdoc thinks you might be able to do without them..

Why do you feel so uncomfortable talking to NP, and being around her?.....I'm sorry you're upset about this.

Edited by CrazyRedhead
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On 1/24/2022 at 8:02 PM, Wonderful.Cheese said:

So here are my current daily meds (dosages are total daily mg’s): Zyprexa Zydis 30 mg, Abilify 30 mg, Rexulti 2 mg, Gabapentin 1,200 mg, Prozac 40 mg, Vyvanse 60 mg, Synthroid 75 mcg, Yaz, Metformin ER 2,000 mg, Topamax 200 mg

I am wanting to streamline my meds. Does anyone have thoughts? @Iceberg @browri or anyone I’m forgetting?

I want off abilify. I honestly don’t think topamax is doing anything? And why the Metformin ER as I’m not diabetic? It causes me stomach problems still.

Anyone with any thoughts, experiences, ideas, etc. I would greatly appreciate it!

One more thing, I cannot have any med changes unless my tdoc and husband say so per my NP’s orders. It’s the same as being on a court order like I was before and I very much hate this. I don’t have a say in what I put in my body, once again. I don’t have a voice. 

Hey @Wonderful.Cheese!

I'm sorry to hear that you're feeling a little stuck right now wanting to streamline meds but being restricted in what you can do. I know it's hard to do in the moment, but remember that they do it because they care, particularly your husband. They want what's best for you. Even if you know that's not what's best for you, it's always good to remind yourself that their actions come from a good place.

Let's talk about the few items in pieces:

  • metformin: Doesn't surprise me that it causes you stomach problems. And 2000mg is no joke, even for the extended release. However, it's likely preventative at this point, primarily due to your max dose of olanzapine (Zyprexa Zydis). This is likely necessary to maintain normal metabolics.
  • topiramate: Do you remember what this was added for? 200mg is a significant dose of topiramate (Topamax) and it hasn't been shown to be effective in mood disorders. Nevertheless, some pdocs do use it off-label. I imagine that 200mg topiramate in tandem with your normal 1200mg of gabapentin is likely a more effective anticonvulsant-based mood stabilizing combo. However, they might also consider using valproate at that rate for its more potent anti-manic effects. Might even allow you to minimize the AAPs.
  • aripiprazole: It would seem that the 30mg olanzapine + 10mg PRN is your main AAP. It does make sense to discontinue aripiprazole, as you say. However, I do imagine that the brexpiprazole (Rexulti) dose will need to be increased further to fill in the gaps. In schizophrenia, the target dose could be 2mg-3mg but Rexulti can be dosed up to a max of 4mg.

It still isn't entirely clear to me why your NP is prescribing a combination of a dopamine antagonist (olanzapine) and two dopamine partial agonists (aripiprazole and brexpiprazole). Science says that if you are presented with an agonist and an antagonist at the receptor, the antagonist technically wins. If you're presented with a 60% partial agonist like aripiprazole and a 45% partial agonist like brexpiprazole plus an antagonist like olanzapine, then the receptor is blocked and the other partial agonists cannot activate the receptor anyway. If it were just aripiprazole and brexpiprazole, the winner would be partially dependent on affinity, but when present to concentrations of equal efficacy, the net effect would be 45%. Blocking always wins, so brexpiprazole wins because it has less of an activating and more of a blocking effect at D2 receptors. 

So really, in your current cocktail, both Abilify and Rexulti are redundant when taken with Zyprexa, and your Rexulti dose isn't very high. If you are able to successfully discontinue Abilify, it might be considered discontinuing the Rexulti as well in favor of the Zyprexa entirely.

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Thank you all so very much! Thank you because you have helped me so greatly you’ll never know! @Iceberg @CrazyRedhead @browri

I should explain better too. I took 2 PRN Zyprexa, but it says on my bottle I can take 1-2. So I misspoke when I said double the Zyprexa PRN. I meant I took 2 when I normally have been taking 1 only. Klonopin I did take double but I won’t do that anymore unless I am told I can. Thank you guys.

I saw my NP and I have good news! I can get off abilify very slowly (while increasing rexulti is her plan). I feel ready. I will write more later.

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I take metformin, but I am diabetic.  It does not cause me problems.  It can help with weight loss in some people.  If you are sure that is what is causing digestive side effects, it is known for that, let your doc know.

If the abilify and topomax are not giving you side effects, maybe hold off and make one change at a time.  That is just my opinion.  I did eventually get off lamictal because it was doing nothing for me so I do understand if you think they are not helping, but maybe they really are.

Are you under conservatorship or that is just the NP rules?  It may be a good idea but I would not like that either.  My husband is clueless about my meds, though.  It is probably good to have more people involved that know your history.

good luck!  

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18 hours ago, confused said:

If the abilify and topomax are not giving you side effects, maybe hold off and make one change at a time.

^^^ This. I cannot agree with those more whole-heartedly. Make one change at a time. Otherwise, you won't know what's doing what.

On 1/27/2022 at 11:39 AM, Wonderful.Cheese said:

Thank you all so very much! Thank you because you have helped me so greatly you’ll never know! @Iceberg @CrazyRedhead @browri

I should explain better too. I took 2 PRN Zyprexa, but it says on my bottle I can take 1-2. So I misspoke when I said double the Zyprexa PRN. I meant I took 2 when I normally have been taking 1 only. Klonopin I did take double but I won’t do that anymore unless I am told I can. Thank you guys.

I saw my NP and I have good news! I can get off abilify very slowly (while increasing rexulti is her plan). I feel ready. I will write more later.

Yay! Exciting that you were able to make some movement with your NP. Glad to hear it. Take the Abilify decrease slowly and work the Rexulti up. Let us know how your titration goes.

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