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1 hour ago, Butterflykisses said:

I am currently taking haldol 5mg 2x a day = 10mg. I see pdoc tomorrow morning. She talked about possibly increasing it. Does anyone know the dose range for Haldol to be effective in Schizoaffective Disorder- Bipolar type. I am also on Seroquel IR 700mg, Prozac 40mg, Propranolol 120mg, and Lithium ER 1125mg...

2

The typical dose for psychosis of Haldol is 0.5-5 mg 2-3 times per day, so the typical max is 15 mg/day, however, up to 100 mg has been used in severe, refractory cases.

You will likely experience more EPS if you increase your Haldol any more than 10 mg though, especially with Seroquel 700 mg.

Why hasn't your pdoc tried maxing out Seroquel to 800 mg/day? Also, have you tried Invega? It's specifically indicated for Schizoaffective Disorder.

Sorry, I just personally don't feel comfortable with your pdoc increasing you to such a high dose of Haldol while you're on such a high dose of Seroquel (even though Seroquel is known for not causing EPS).

If you don't mind my asking, what antipsychotics have you been on?

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23 minutes ago, mikrw33 said:

The typical dose for psychosis of Haldol is 0.5-5 mg 2-3 times per day, so the typical max is 15 mg/day, however, up to 100 mg has been used in severe, refractory cases.

You will likely experience more EPS if you increase your Haldol any more than 10 mg though, especially with Seroquel 700 mg.

Why hasn't your pdoc tried maxing out Seroquel to 800 mg/day? Also, have you tried Invega? It's specifically indicated for Schizoaffective Disorder.

Sorry, I just personally don't feel comfortable with your pdoc increasing you to such a high dose of Haldol while you're on such a high dose of Seroquel (even though Seroquel is known for not causing EPS).

If you don't mind my asking, what antipsychotics have you been on?

Thanks for your reply. I have been taking 800mg of Seroquel on bad nights (with pdocs instruction of course) and even with 800mg, I was still having psychotic breakthroughs. I have a 100mg lee way (I can either take 700mg or 800mg depending on the degree of psychosis. 

 

She doesn't want to add an atypical since I already am on the Seroquel, she is only comfortable trying a typical with my seroquel. Thats what she said when I mentioned invega to her. 

 

I have been on every AAP except Invega, Rexulti, and Fanapt. 

 

As far as typicals go I have been on Fluphenazine, Perphenazine, Thorazine, Navane, and now Haldol.

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25 minutes ago, Butterflykisses said:

Thanks for your reply. I have been taking 800mg of Seroquel on bad nights (with pdocs instruction of course) and even with 800mg, I was still having psychotic breakthroughs. I have a 100mg lee way (I can either take 700mg or 800mg depending on the degree of psychosis. 

 

She doesn't want to add an atypical since I already am on the Seroquel, she is only comfortable trying a typical with my seroquel. Thats what she said when I mentioned invega to her. 

 

I have been on every AAP except Invega, Rexulti, and Fanapt. 

 

As far as typicals go I have been on Fluphenazine, Perphenazine, Thorazine, Navane, and now Haldol.

 

Sounds like Seroquel isn't working for you that well... You might not do well with Fanapt because it requires a slow titration. Rexulti requires a titration, but it isn't very long at all (a matter of days). I don't know how efficacious it is for psychosis, though. If it were me, I would ask my pdoc to switch me to Invega. The equivalent dose, I believe, of Seroquel 700 mg is Invega 7 mg, and you can go up to Invega 12 mg. Don't quote me on that, though. I just think you could benefit from Invega more than Seroquel—Seroquel is a low-potency antipsychotic, whereas Invega is a high-potency antipsychotic.

You can combine two atypicals. If you have a dopamine antagonist, you can add a dopamine partial agonist (Abilify, Rexulti, Vraylar). The pharmacology is varied. But topping off with a typical antipsychotic is for very extremely resistant cases.

Do you feel like the Haldol is working for you? Obviously the Seroquel isn't working for you...

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1 minute ago, mikrw33 said:

Sounds like Seroquel isn't working for you that well... You might not do well with Fanapt because it requires a slow titration. Rexulti requires a titration, but it isn't very long at all (a matter of days). I don't know how efficacious it is for psychosis, though. If it were me, I would ask my pdoc to switch me to Invega. The equivalent dose, I believe, of Seroquel 700 mg is Invega 7 mg, and you can go up to Invega 12 mg. Don't quote me on that, though. I just think you could benefit from Invega more than Seroquel—Seroquel is a low-potency antipsychotic, whereas Invega is a high-potency antipsychotic.

You can combine two atypicals. If you have a dopamine antagonist, you can add a dopamine partial agonist (Abilify, Rexulti, Vraylar). The pharmacology is varied. But topping off with a typical antipsychotic is for very extremely resistant cases.

Do you feel like the Haldol is working for you? Obviously the Seroquel isn't working for you...

The seroquel has done wonders on my mood. I haven't had a manic episode in months. However, it just does not work on my psychosis. It does help me sleep, before seroquel I barely got any sleep.

 

I wish I could try the invega, but I really don't think pdoc approves of two atypicals for some reason...

 

The haldol has helped, however, I am getting some akathisia...I am taking cogentin and Benadryl to help that though...

 

 

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2 minutes ago, Butterflykisses said:

The seroquel has done wonders on my mood. I haven't had a manic episode in months. However, it just does not work on my psychosis. It does help me sleep, before seroquel I barely got any sleep.

 

I wish I could try the invega, but I really don't think pdoc approves of two atypicals for some reason...

 

The haldol has helped, however, I am getting some akathisia...I am taking cogentin and Benadryl to help that though...

 

 

 

But I mean what if you switched from Seroquel to Invega?

I'm not surprised you're getting akathisia from Haldol... What if you switched typical antipsychotics? Something with more anticholinergic and/or antiserotonergic effects? You could try Thorazine (chlorpromazine) (less chance for EPS but sedating/weight gain), Loxitane (loxapine) (usually weight-neutral), Compazine (prochlorperazine maleate) (may cause EPS), Mellaril thioridazine) (for treatment-resistant cases, may have less chance for EPS but may cause QT prolongation), or Stelazine (trifluoperazine) (may cause akathisia, no antiserotonergic or anticholinergic effects to speak of, but it's a darn good antipsychotic... you may have less EPS with it than with Haldol).

The approximate equivalent doses of Haldol 2.5 mg of all these antipsychotics are: (don't quote me on these! lol)
Thorazine 125 mg
Loxitane 12.5 mg (10-15 mg)
Compazine 18.75 mg (20 mg)
Mellaril 125 mg
Stelazine 2.5 mg (or 5 mg depending on which chart you look at)
 

How much Cogentin are you taking? You might be able to raise the Cogentin dose and drop the Benadryl.

Another thing that you might be able to do (you pdoc willing) is add a dopamine agonist, or something like amantadine (Symmetrel).

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On my brief start on Haldol I took 15 mg total a day. But I got scared of it and stopped it. I feel safer taking the atypicals (no logic to this, just my stupid brain freaking out). Hell, I'm on 3 atypicals right now. Invega (9 mg) and Abilify (35 mg) and Seroquel XR (800 mg). My pdoc has said I have treatment resistant psychosis. Clozaril is an option for me too but again, I freak out. And a different pdoc said to me once, why take 2-3 AP's when 1 (clozaril) will do the job? Maybe there is merit to that but I know I wouldn't be able to force myself to take the clozaril on a consistent basis. 

I am wanting to get off Seroquel due to excessive weight gain but like you, it has done wonders for my mood component of the SZA (no mania unless I try to come off of it) and I sleep at night (although too much lately). And I think it helps my anxiety somewhat. 

I am doing better with invega but I'm not sure I'd have protection from mania if I dropped Seroquel. Frustrating! I do not want to end up IP again, especially the state hospitals longer term. And I'm worried about dropping Abilify too because that is what finally got me out of a extremely long term stay in a state hospital. But perhaps it has pooped out on me. 

For now my pdoc is not wanting to drop any of the AAP'S I'm taking. I worry about being on 3 but I worry about being institutionalized again too. I've wasted too much of my life locked up. I've come so far and I can't go back. 

Invega is great, I don't think have any side effects from it. I don't know why your pdoc is against 2 AAP'S. I've been on 2 minimum, for nearly 10 years now. That's the only way I stay out of hospitals. Side effects can suck but at least I'm free (mostly). I used to be in hospitals more than out. 

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24 minutes ago, mikrw33 said:

But I mean what if you switched from Seroquel to Invega?

I'm not surprised you're getting akathisia from Haldol... What if you switched typical antipsychotics? Something with more anticholinergic and/or antiserotonergic effects? You could try Thorazine (chlorpromazine) (less chance for EPS but sedating/weight gain), Loxitane (loxapine) (usually weight-neutral), Compazine (prochlorperazine maleate) (may cause EPS), Mellaril thioridazine) (for treatment-resistant cases, may have less chance for EPS but may cause QT prolongation), or Stelazine (trifluoperazine) (may cause akathisia, no antiserotonergic or anticholinergic effects to speak of, but it's a darn good antipsychotic... you may have less EPS with it than with Haldol).

The approximate equivalent doses of Haldol 2.5 mg of all these antipsychotics are: (don't quote me on these! lol)
Thorazine 125 mg
Loxitane 12.5 mg (10-15 mg)
Compazine 18.75 mg (20 mg)
Mellaril 125 mg
Stelazine 2.5 mg (or 5 mg depending on which chart you look at)
 

How much Cogentin are you taking? You might be able to raise the Cogentin dose and drop the Benadryl.

Another thing that you might be able to do (you pdoc willing) is add a dopamine agonist, or something like amantadine (Symmetrel).

I forgot to mention I just tried up to 50mg of Loxitane and it made me worse off, so my pdoc took me off of it. Hence that's why we tried haldol. She mentioned trying thorazine if the haldol doesn't work.....I just don't know if I should know at this point if the Haldol is going to help me. 

I am only taking 0.5mg of cogentin at bedtime, I know for sure if I stay on the haldol I will need a higher dose of this.

12 minutes ago, Wonderful.Cheese said:

On my brief start on Haldol I took 15 mg total a day. But I got scared of it and stopped it. I feel safer taking the atypicals (no logic to this, just my stupid brain freaking out). Hell, I'm on 3 atypicals right now. Invega (9 mg) and Abilify (35 mg) and Seroquel XR (800 mg). My pdoc has said I have treatment resistant psychosis. Clozaril is an option for me too but again, I freak out. And a different pdoc said to me once, why take 2-3 AP's when 1 (clozaril) will do the job? Maybe there is merit to that but I know I wouldn't be able to force myself to take the clozaril on a consistent basis. 

I am wanting to get off Seroquel due to excessive weight gain but like you, it has done wonders for my mood component of the SZA (no mania unless I try to come off of it) and I sleep at night (although too much lately). And I think it helps my anxiety somewhat. 

I am doing better with invega but I'm not sure I'd have protection from mania if I dropped Seroquel. Frustrating! I do not want to end up IP again, especially the state hospitals longer term. And I'm worried about dropping Abilify too because that is what finally got me out of a extremely long term stay in a state hospital. But perhaps it has pooped out on me. 

For now my pdoc is not wanting to drop any of the AAP'S I'm taking. I worry about being on 3 but I worry about being institutionalized again too. I've wasted too much of my life locked up. I've come so far and I can't go back. 

Invega is great, I don't think have any side effects from it. I don't know why your pdoc is against 2 AAP'S. I've been on 2 minimum, for nearly 10 years now. That's the only way I stay out of hospitals. Side effects can suck but at least I'm free (mostly). I used to be in hospitals more than out. 

I have been on 3 AAP's before too, but for some reason my current pdoc doesn't agree with polypharmacy. I really like her so I don't plan to switch pdocs. 

 

Invega sounds promising, I am glad you have had some relief. And yes, the Seroquel was a god-send for my mood and sleep issues. 

 

My pdoc wants me to do PHP if the haldol fails me..., glad to hear from you, Cheese!

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1 minute ago, Butterflykisses said:

I forgot to mention I just tried up to 50mg of Loxitane and it made me worse off, so my pdoc took me off of it. Hence that's why we tried haldol. She mentioned trying thorazine if the haldol doesn't work.....I just don't know if I should know at this point if the Haldol is going to help me. 

I am only taking 0.5mg of cogentin at bedtime, I know for sure if I stay on the haldol I will need a higher dose of this.

5

Oh ok...

Yeah, definitely going to need more Cogentin than just that... You're going to need at least 1-2 mg to take 1-3 times per day for freakin Haldol...

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Glad to hear from you too butterfly! Although I wish you were feeling better. Psychosis is such a soul sucking thing. It's all encompassing and it just never seems to let its grip on you go away completely. There is always something going on in the background or foreground of my mind if seems. And I usually only realize and recognize it after the fact. Here's hoping for better days for you and for me. I'll be thinking of you and sending strength. I'm sorry to hear about your schooling too. But I have hope for you that when you get your mental health issues under control that you will then be able to finish. You are so amazing! Keep fighting, ok?

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Just some ideas of non-antipsychotic adjunctive ideas...

  • Carbamazepine (Tegretol, Tegretol XL, Carbatrol, Equetro)
  • Lamotrigine (Lamictal) (study says 50 mg/day)
  • Divalproex sodium (Depakote)
  • Clonazepam (Klonopin) ?
  • Topirmat (Topamax)
  • Lyrica (pregabalin)
  • Celecoxib (Celebrex) 
  • Sildenafil (Viagra/Revatio)
  • Glycine
  • D-Serine
  • D-Cycoserine
  • Sarcosine

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353603/

Glycine Transporter Inhibitors

  • Sarcosine (mentioned above)
  • D-serine (mentioned above)

Metabotropic Glutamate Receptor Agonists

  • "Pomaglumetad"

Second Messenger Activity

  • Sodium nitroprusside

http://link.springer.com/article/10.1007/s40473-015-0032-7 (lists a lot more than I'm listing)

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5 hours ago, mikl_pls said:

Good to hear she listened to you! Glad to hear you're getting off the Haldol, it's kind of a risky drug to be on as far as TD goes.

That's strange that no pharmacies carry Invega... It's generic now, as far as I know.

Yeah haldol is one of the worst. akathisia offenders known...so relieved I am no longer on it!

 

And yes, its very strange. All drug stores in my area were going to have to order it...I am anxious to start it!

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