gizmo Posted October 6, 2009 Share Posted October 6, 2009 For the past week or so, my BP symptoms have calmed down a bit. Except for the fact that I'm *EXTREMELY* restless. I don't work ATM, so I'm home all day. I can't stand to sit on the couch, so I can't watch tv for more than 20 minutes at a time, I get on the computer for a few minutes at a time, I go look in the kitchen to see if there's anything to cook, eat, or clean up. And it's steadily gotten worse over the past couple of weeks. I don't mood track (I know, but I'm bad at recognizing I'm in the firery pit of hell until I've been there for awhile) so I don't know if it began when old pdoc increased zpyrexa to 15mg from 10mg. Or if it's from new pdoc's addition of 100mg wellbutrin in addition to upping zyprexa to 20mg. All I know is that it took 3mg of xanax today to stop me from pacing an x in the floor today. I go see the doctor tonight, but I am wondering, has this happened to anyone else? Oh, I also started requip for RLS this week at a baby dose. Could that have something to do with it? Thanks for the input! Link to comment Share on other sites More sharing options...
helenllama Posted October 6, 2009 Share Posted October 6, 2009 Oh, I also started requip for RLS this week at a baby dose. Could that have something to do with it? This is both from NetDoctor Requip tablets and Requip XL prolonged-release tablets both contain the active ingredient ropinirole, which is a type of medicine called a dopamine agonist. Ropinirole works by mimicking the activity of a substance in the brain called dopamine. Olanzapine works by blocking the receptors in the brain that dopamine acts on. Link to comment Share on other sites More sharing options...
dancesintherain Posted October 6, 2009 Share Posted October 6, 2009 whew. seems like you've identified the problem, but have way too many variables about what could be causing it. going off very vague generalizations, I think of zyprexa as a sleep-inducing, rather than agitating sort of drug...like if you added more, it might wear you out, but that it wouldn't wake you up? wellbutrin can be actifying, but i can't imagine it happening that quickly. sorry--not much help. I'm glad that you get to see the doctor tonight and it'll be good to hear what his/her thoughts are. Link to comment Share on other sites More sharing options...
Velvet Elvis Posted October 7, 2009 Share Posted October 7, 2009 You're getting into high dose territory there so if you're susceptible to EPS, now's when it's going to kick in. Do H1 blockers help at all? They only thing that's ever given me Akathesia was Haldol, but man it was hell. I took benedryl 24/7 to try and block it but that just made me sleep. I gave up on it. It was one of the few meds I didn't give a full six week trial before deciding if I wanted to keep it or not. If you can't find another med to block the Akathesia, I say find another AP. Link to comment Share on other sites More sharing options...
gizmo Posted October 7, 2009 Author Share Posted October 7, 2009 You're getting into high dose territory there so if you're susceptible to EPS, now's when it's going to kick in. Do H1 blockers help at all? They only thing that's ever given me Akathesia was Haldol, but man it was hell. I took benedryl 24/7 to try and block it but that just made me sleep. I gave up on it. It was one of the few meds I didn't give a full six week trial before deciding if I wanted to keep it or not. If you can't find another med to block the Akathesia, I say find another AP. Ummm... I'm pharm stupid. Can you give me some names of H1 blockers? That way I can take the info to my pdoc and suggest it. ETA: I have Vistoril, which I believe is a H1 blocker. Does that mean that I could try it PRN for akathesia relief? I saw the pdoc tonight. He wanted me to stop the wellbutrin. Seeing as I took the full 20mg of zyprexa in October/November during a raging mania with no side effects, he said for me to stay on the full 20mg for now. He wanted me to drop my lithium to 600mg, which I thought was weird, but I'll do it for two weeks until the next appt. I asked about cogentin, and he said he'd rather (get this) have me take some xanax to calm down rather than use cogentin. So I told him about my history with xanax, just so he knew what he was getting into when he told me that. He was cool with it. So, all in all I'm a bit confused. Any input would be most appreciated. Link to comment Share on other sites More sharing options...
SashaSue Posted October 7, 2009 Share Posted October 7, 2009 It doesn't make a lot of sense to me that he'd rather give you xanax than something like cogentin. Did you ask him why? Link to comment Share on other sites More sharing options...
gizmo Posted October 7, 2009 Author Share Posted October 7, 2009 It doesn't make a lot of sense to me that he'd rather give you xanax than something like cogentin. Did you ask him why? I asked him about cogentin, he said he preferred I keep taking the xanax. Perhaps since I said it worked for me today. Perhaps I've had too many meds introduced and changed in my body lately. I don't know - I can't answer that question. Honestly, I was a total screwed up mess by the time I got to his office, so I wasn't in the state of mind to parry and thrust on medication decisions. Perhaps I will be on the appointment in two weeks. Link to comment Share on other sites More sharing options...
notfred Posted October 7, 2009 Share Posted October 7, 2009 Inderal (propranolol) is generic, cheap, and effective in treating Akathesia. My pdoc gave me some when he put me on Abilify as a just in case measure. It is a beta blocker used to treat high blood pressure. Lower doses are used for anxiety. nf Link to comment Share on other sites More sharing options...
Silver Posted October 8, 2009 Share Posted October 8, 2009 In no particular order: Could the Requip be involved: uh, yes. (eta - look -it's not as bad as, say, levodopa, but it does have this potential.) Does your psychiatrist know about the Requip? And when did the RLS start? (In other words, I'm wondering - is it RLS, or was that RLS diagnosis an early sign of akathisia? From your sig, it looks as though the RLS has been a long-term thing, and so I would think that whoever is treating it has already ruled out iron-deficiency anemia, etc. On the other hand, I don't know how long you've been on the Zyprexa.) This is one of those times when a timeline is really helpful for all the prescribers, maybe - a calendar with all the dates of symptom onsets/changes and prescription changes marked clearly on it so it is very visual. If there are multiple prescribers, everyone really needs to be on the same page here. Too much going on. Requip plus Wellbutrin? Huh. OK. Yeah, restlessness (or dyskinesias) would not be very surprising here. Yes, Vistaril/Atarax/hydroxyzine is a fairly selective H1 blocker, like diphenhydramine/Benadryl (or, for that matter, very-low-dose doxepin.) More is not necessarily better. You'd need to talk to your doc about dosing. And I <3 propranolol for akathisia (and anxiety.) And Mann's overview is a handy one. Used this one because you are, if I read correctly, describing an acute/abrupt onset problem, not an insidious, long-term one, as far as the identified akathisia goes. Link to comment Share on other sites More sharing options...
gizmo Posted October 8, 2009 Author Share Posted October 8, 2009 In no particular order: Could the Requip be involved: uh, yes. (eta - look -it's not as bad as, say, levodopa, but it does have this potential.) Does your psychiatrist know about the Requip? Thanks for the post. Let's see if I can answer your questions. Yes, the pdoc knows about the requip. And the zyprexa. I asked him specifically if I should stop taking the requip, and he said "it's ok for now." I'm only on 0.5mg at bedtime, so perhaps the small dose had something to do with it? I have to add, because this seems to be a theme, I was really a mess when I saw the pdoc. The things I normally question and bring up were just shit passing by like scenery out a moving car window. To be honest with you, I can't even remember the day I saw the pdoc - I have to go look at my google calendar to see. And when did the RLS start? (In other words, I'm wondering - is it RLS, or was that RLS diagnosis an early sign of akathisia? From your sig, it looks as though the RLS has been a long-term thing, and so I would think that whoever is treating it has already ruled out iron-deficiency anemia, etc. On the other hand, I don't know how long you've been on the Zyprexa.) The RLS started about 2 months ago. I've been on Zyprexa for 8 months. Started off at 5mg, went to 10mg 6 weeks later, went to 15 about 6 weeks ago, and 20 a week ago. The thing is I can't remember if I went to 15mg before or after the RLS started. I understand your talking about the chart thing. I know I need to chart this stuff, I'm just not that good at it. Requip plus Wellbutrin? Huh. OK. Yeah, restlessness (or dyskinesias) would not be very surprising here. Probably why the wellbutrin was pulled. It's been a year since I've been on an AD, I guess it wasn't time for me to get on one now. Today was better than yesterday, but I still needed to take a xanax to chill the hell out. But at least it was 1mg and not 3mg like yesterday. So that's an improvement, yes? Yes, Vistaril/Atarax/hydroxyzine is a fairly selective H1 blocker, like diphenhydramine/Benadryl (or, for that matter, very-low-dose doxepin.) More is not necessarily better. You'd need to talk to your doc about dosing. Thanks for the info. I go see the pdoc on the 21st. I should be in a much better state to ask about more traditional ways to cope with the side effects. But here's a question. I moved up from .25 of requip to .50 requip last night, and it was the first time in two months that my legs didn't twitch so bad I had to shake them enough to wake up my husband. It was like a miracle. Now if I could train myself to stop sleepwalking and waking up 3-4 times a night, I could actually sleep. Maybe I wouldn't be so tired during the day. Do I have to give up the requip to stay on the zyprexa? Is there another RLS med I can use while on the Z? Or am I just screwed? I can't give up the Z - I am more stable on it than anything I've taken since I was diagnosed. It's not perfect, but I'm hanging on by my claws, here. And I <3 propranolol for akathisia (and anxiety.) This is something I will ask for if I'm still having issues. And I should be more effective as a patient and providing more input to my treatment. Link to comment Share on other sites More sharing options...
Silver Posted October 8, 2009 Share Posted October 8, 2009 You sound totally effective, etc. And your chart should reflect this - it's just that without a centralized record to coordinate, this stuff is confusing. Since you are not expected to reform the health care system overnight (if you think you are, you need a LOT MORE ZYPREXA), then a little extra record-keeping might help. If you use Google Calendar, then maybe putting med date changes in there too on a sub-calendar would help? You can get dates prescribed from the docs... or, if you are like me, the dates they were actually filled from the pharmacists... and put those in as well. Not a sleep med expert, but clonazepam was, as I recall, preferred for sleepwalking (also for akathisia - for nothing else, for ease of dosing, as it's longer acting.) And there was something about Topamax, of all things, for sleepwalking. I had an old post on here about it, I think. Um, sleep study/PSG results? If you're talking about 'RLS' and sleepwalking both, sounds to me like you're in sleep med land now. I'll defer to May on that one... If the RLS is that new, and it never came up before, then it sort of seems like it might be something someone would look at as being associated with the Zyprexa, or as a precursor to akathisia. As VE said, you're right at the line. They did check for iron deficiency anemia, etc., right? And try to change the timing on the Zyprexa? If you have a history of problems with Xanax, I think it's reasonable to call your psychiatrist and ask him about Benadryl or Vistaril, or, if those don't work, low-dose propranolol. Oh, and I forgot: lithium plus antipsychotics can worsen EPS a bit, which is probably why he wanted to drop your lithium, but that's probably not reducing your subjective anxiety much... Link to comment Share on other sites More sharing options...
gizmo Posted October 9, 2009 Author Share Posted October 9, 2009 Well, I spent an hour last night walking around my bed because I couldn't stop my twitching leg (right leg, last night). I took a xanax, didn't do anything. So I took 50mg of hydroxyzine and went to sleep on the couch. I don't know if it was because it was 3am or the med, but I finally fell asleep. I'm also really tired and slept most of the day, and I read a drug checker interaction warning between zyprexa and requip that said it could cause excessive tiredness. So I don't know if it's the meds, or the fact that I'm up half the night. I don't think I've been this confused and screwed up in a LONG time. I called the pdoc, waiting for a call back. I'm going to ask some pointed questions about dropping the requip and getting some cogentin or inderal for possible akathesia from the zyprexa. I really appreciate everyone's input and support for me on this. I'm facing a lot of stuff right now, and this is just throwing me for a loop. I've just switched pdocs and now am dealing with all of this stuff that I'm clearly not prepared on or for. So your continued input is really appreciated. Link to comment Share on other sites More sharing options...
notfred Posted October 9, 2009 Share Posted October 9, 2009 I would try some benadryl, just to get me through the night until the pdoc calls. nf Link to comment Share on other sites More sharing options...
Silver Posted October 9, 2009 Share Posted October 9, 2009 My guess on the tiredness is the lack of sleep, rather than the Zyprexa plus Requip, but who knows. Hydroxyzine (and Benadryl) are also pretty sedating, so that could be a big part of it as well. If you took hydroxyzine at 3am, I'd expect it to hang around a good long while. Maybe try it earlier tonight? Hang in there, Gizmo, you're doing good work here slogging through this all. Link to comment Share on other sites More sharing options...
notfred Posted October 9, 2009 Share Posted October 9, 2009 Opps, I missed that you have Hydroxyzine. Sounds like a good idea. nf Link to comment Share on other sites More sharing options...
celestia Posted October 9, 2009 Share Posted October 9, 2009 gizmo, no way i could keep up but im thinking about you. Link to comment Share on other sites More sharing options...
gizmo Posted October 9, 2009 Author Share Posted October 9, 2009 The pdoc called. I am supposed to stop the requip, drop the zyprexa to 10mg, bump the lithium back up to 900mg (since I've taken it for years with no problems), take the xanax 3 times daily for the next three days (or longer if I'm still freaked out). He said it's ok to take the vistoril for now if it works on the restless legs, but he stopped short of writing a script for it, likely because I said I didn't have any problems of akathesia on 10mg of zyprexa. He actually wanted me to stop the Z completely, but I suggested that I did fine on the 10mg, and could we try going back to that, PLEASE??? I attribute that fiasco to new patient syndrome. I highly doubt he would have suggested that if he knew me well and knew I had taken zyprexa for 8 months. I'm just scared that this leg thing won't go away with dropping my zyprexa back down to 10mg, and I will be forever stuck with not being able to sleep at night. Link to comment Share on other sites More sharing options...
SashaSue Posted October 9, 2009 Share Posted October 9, 2009 I think it'll go away. That, at least, is my psychic prediction! Link to comment Share on other sites More sharing options...
Silver Posted October 9, 2009 Share Posted October 9, 2009 That all sounds dandy. Good for you for saying, "um, NO, let's not stop the Zyprexa." See? Advocating for yourself. Give yourself credit, Gizmo, you're great at this. You will get sleep. You did in the past, you will again, this is transient - I'm not minimizing this, I'm just trying to put it in perspective. And you know, being a Faithful Reader and all that, that you have the option of Benadryl should Vistaril run out. Keep us all posted, OK? Link to comment Share on other sites More sharing options...
gizmo Posted October 12, 2009 Author Share Posted October 12, 2009 Thanks again everyone for your help in getting me through the agony of the last week. It was definitely akasthisia, most likely caused by the increase in zyprexa, and exaggerated by the wellbutrin. The pity of the situation was that I commented on the restless legs on my last visit with my old pdoc, and she said it was the medication, and did nothing to fix it. I guess that's one of the many reasons why she's my "old" pdoc. I'm only mildly restless now, my creativity is in a higher swing that it's been in the past 6 months, and I only had to take 1 xanax today. I know I told the pdoc I'd take it 3x's daily, but who's gonna complain? Also, I'm sleeping so much better, with hardly any leg issues. I'm going to see how I do this week with the daytime sleepiness issue, and see if I can't conquer that. I'm keeping a blog of my symptoms and meds now, so we'll see if I can keep it up. Thanks again everyone. I couldn't have got through it without your advice and support. Link to comment Share on other sites More sharing options...
Silver Posted October 12, 2009 Share Posted October 12, 2009 good! out of curiosity, are you still taking the Vistaril? good work, Gizmo! Link to comment Share on other sites More sharing options...
gizmo Posted October 12, 2009 Author Share Posted October 12, 2009 good! out of curiosity, are you still taking the Vistaril? good work, Gizmo! No, I stopped taking the vistoril about 4 days ago. Thanks again. Link to comment Share on other sites More sharing options...
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