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Meds like geodon without weight gain


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People's reactions to AAPs are unpredictable. Tell your pdoc your concerns and try the med he/she recommends. You can't know how you will react until you try. I'm sorry I can't be more helpful but it really is trial and error.

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Ok thanks. The problem

is I stopped taking haldol and started taking latuda and since latuda is so pricey my insurance won't pay for more then 90 days. It's working great for me and I haven't gained weight from it. Haldol gives me massive anxiety and depression. Latuda has no side affects and helps me greatly. 

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Holy polypharmacy Batman! You're on two AAPs and a typical AP? Do you have treatment resistant psychosis or bipolar or something?

There aren't really any meds like Geodon, it's a very unique antipsychotic because, for one thing, it has SNRI properties—no other antipsychotic has that. It's also a 5-HT1B partial agonist instead of antagonist, which the only other antipsychotic like that is Saphris, but it's sedating and may have a propensity for weight gain (although it's very rare). It has an incredibly high 5-HT2A:D2 antagonism ratio (higher 5-HT2A antagonism than D2 antagonism), but many other antipsychotics have that, like Saphris, Clozaril (weight gain risk), Fanapt, Zyprexa (weight gain risk), Invega (probably weight gain risk?), Seroquel (weight gain risk), and Risperdal (weight gain risk over time). The typical antipsychotic Loxitane also has that too.

Geodon 20 mg, Haldol 2.5 mg, Latuda 120 mg... hmm...

That's a subtherapeutic dose of Geodon... But you say you're going through withdrawals trying to quit it? What kind of withdrawals?

Here's what I would ask my pdoc to do if I were in your situation. Just a couple of suggestions.

  • Drop the Geodon and Haldol and increase Latuda to the max of 160 mg (80 mg x2), or maybe keep the Haldol for breakthrough episodes.
  • If your pdoc still insists on polypharmacy, ask for an antipsychotic with a differing mechanism of action than Latuda, like instead of dopamine antagonism, maybe a dopamine partial agonist like Abilify, Rexulti, or Vraylar + Latuda, and ask to drop the Haldol since it's causing you depression. Those are all weight neutral, supposedly. I lost weight on Abilify, gained weight on Rexulti, and my weight fluctuated a lot on Vraylar and it was hard to lose weight.
    • So say Abilify + Latuda 120 mg, Rexulti + Latuda 120 mg, Vraylar + Latuda 120 mg)
      • The equivalent dose of Geodon 20 mg for Abilify is 2.5 mg.
      • The equivalent dose of Haldol 2.5 mg for Abilify is 9.375 mg.
      • Added together, 11.875 mg.
      • So your Abilify dose could be between 10 mg and 15 mg.
      • Sorry, but I don't know the dose equivalents for Rexulti and Vraylar. For Rexulti, you could start by titrating up to 2 mg or 4 mg, depending on your condition, and with Vraylar, you could start with 1.5 mg or 3 mg depending on your condition, and increase further to a max of 6 mg.
  • If your pdoc still insists on a typical antipsychotic, ask to switch to something that doesn't cause depression as much. My suggestion would be Stelazine. It has a particular mood brightening effect in lower doses, but I don't know about higher doses, I've only taken a max of 6 mg/day, which is equivalent to 3 mg Haldol/day. Stelazine is mostly weight neutral if you eat right.
    • Haldol 2.5 mg = 2.5 mg or 5 mg, depending on which chart you refer to. My pdoc would probably say 5 mg would be equivalent.
    • Try and drop the Geodon, because frankly, 20 mg is subtherapeutic.
    • Increase Latuda to 160 mg.
    • So Stelazine 5 mg (or 2 mg 3x/day for 6 mg) + Latuda 160 mg
  • There's always Saphris too, which is a dopamine antagonist like Latuda, which wouldn't really be an effective polypharmacy combo, but if your dropped the Geodon and Haldol, you could probably get away with taking just 5 mg just at night to help you sleep, or if your pdoc really thinks  you need it, you could take the Saphris two times a day as it's intended to be taken. Or you could take 2.5 mg twice daily.

In my humble and uneducated opinion, one shouldn't be on any more than two antipsychotics at a time—three at a time is overkill and redundant and won't do any more than two would. Two is used for treatment resistant and violent cases. Clozaril is another possibility, but that causes remarkable weight gain, and you seem to be concerned about weight gain (don't blame you, I am too).

Do you have any idea why your pdoc put you on such a cocktail?

 

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22 hours ago, Maria varkulla said:

Ok thanks. The problem

is I stopped taking haldol and started taking latuda and since latuda is so pricey my insurance won't pay for more then 90 days. It's working great for me and I haven't gained weight from it. Haldol gives me massive anxiety and depression. Latuda has no side affects and helps me greatly. 

it sounds like you want something like latuda that your insurance will cover?

Does your pdoc know you can't afford the latuda? Sometimes you can get samples from your doctor or the companies have programs. You may want to check out needymeds.org

abilify is supposed to be weight neutral, a lot of people find it activating, for me it is sedating. that might be a choice for a different aap that could be on your formulary.

I would work with your pdoc and your insurance company.

(I take a slew of meds but whatever works)

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