Starting Saphris again.Switching from Geodon...what to expect?

[Amethyst674]

I had been posting my story from the post entitled No Sex Drive on Geodon.  I took Saphris many years ago when it was fairly new.  I took it for about 3 years.  This was before my Latuda-Abilify-Vraylar days.  It was actually between 2012 and 2015. I realize it hasn't been that long but I have taken a few meds in between. Mostly vraylar which gave me TD and now Geodon with its awful GI effects and no sex drive.  So in about 4 weeks once the PAP approves my Saphris I should be able to start it again.  I recall I got off of it because I felt it was making me flat and unmotivated.  However, back then I was not on adderal, which really helps me with motivation.  I am weighing more now than I weighed back when I took Saphris the first time. I was about 180 back then and now I am 215.  I do not expect to lose weight on it, although I will only be taking 5 mg.  But I would like to be able to start exercising and eating better so I could lose weight.  And I am hoping all these GI issues caused by the GEODON will go away and I will feel better to exercise.  My concern is the apathy I remember Saphris causing me.  I have pretty much exhausted all my options when it comes to AAPs.  So I am going to have to counteract that somehow.  is anyone here on saphris?  How is it treating you weightwise, moodwise and energywise?  I do recall it did not affect my sex drive.  Thanks.  Any help would be appreciated.

[HydroCat]

Saphris is an antagonist of 5HT2C and alpha2... which would theoretically increase serotonin/noradrenaline/dopamine availability.

I would expect more of an antidepressant, maybe energizing effect.

Theory aside, you will know best when you try it.

With AAPs, generally, lower doses cause less of a flat affect than higher doses.

[mikl_pls]

6 hours ago, HydroCat said:

Saphris is an antagonist of 5HT2C and alpha2... which would theoretically increase serotonin/noradrenaline/dopamine availability.

I would expect more of an antidepressant, maybe energizing effect.

Theory aside, you will know best when you try it.

With AAPs, generally, lower doses cause less of a flat affect than higher doses.

Agreed. Perhaps just the 2.5 mg dose even would be better for you. But 5 mg may be just right. (I've never personally tried the 2.5 mg dose before...)

Saphris's affinity for the 5-HT_2A, 5-HT_2C, and α_2A is higher than that of the D₂ receptor, meaning it will antagonize these receptors before it will antagonize the D₂ receptors, assuming the dosage is just right; however, the affinity for the H₁ receptor is also greater than that of the D₂ receptor, so that could theoretically lead to sedation and weight gain. But the higher affinity for the 5-HT_2A, 5-HT_2C, and α_2A receptors should, as @HydroCat pointed out, lead to increased release of serotonin, norepinephrine, and dopamine. It's also a 5-HT_1A partial agonist, albeit weaker than as a D₂ antagonist, meaning it will hit D₂ receptors before it will hit 5-HT_1A receptors. But this should increase downstream dopamine release and decrease food intake. 

Just know that in my experience that at 5 mg QHS only, I didn't gain any weight at all; in fact, I lost weight, but that was probably because of the dextroamphetamine (Dexedrine) I was taking at the time (which I'm back on).

Also, my pdoc said that Saphris stopped sending samples to her, and that usually means that they're about to go generic... I can only hope so because I was kinda hoping to try Saphris again myself... I think Abilify is screwing with my cholesterol and I was wanting to try something else that my insurance would actually cover...

[HydroCat]

4 hours ago, mikl_pls said:

Agreed. Perhaps just the 2.5 mg dose even would be better for you. But 5 mg may be just right. (I've never personally tried the 2.5 mg dose before...)

Saphris's affinity for the 5-HT_2A, 5-HT_2C, and α_2A is higher than that of the D₂ receptor, meaning it will antagonize these receptors before it will antagonize the D₂ receptors, assuming the dosage is just right; however, the affinity for the H₁ receptor is also greater than that of the D₂ receptor, so that could theoretically lead to sedation and weight gain. But the higher affinity for the 5-HT_2A, 5-HT_2C, and α_2A receptors should, as @HydroCat pointed out, lead to increased release of serotonin, norepinephrine, and dopamine. It's also a 5-HT_1A partial agonist, albeit weaker than as a D₂ antagonist, meaning it will hit D₂ receptors before it will hit 5-HT_1A receptors. But this should increase downstream dopamine release and decrease food intake. 

Just know that in my experience that at 5 mg QHS only, I didn't gain any weight at all; in fact, I lost weight, but that was probably because of the dextroamphetamine (Dexedrine) I was taking at the time (which I'm back on).

Also, my pdoc said that Saphris stopped sending samples to her, and that usually means that they're about to go generic... I can only hope so because I was kinda hoping to try Saphris again myself... I think Abilify is screwing with my cholesterol and I was wanting to try something else that my insurance would actually cover...

The patent on Saphris will expire in June 2020. Generic manufacturers usually start developing the generic version earlier but are only allowed to sell it in the market after that time.

[browri]

I actually just checked the FDA Orange Book on this one:

https://www.accessdata.fda.gov/scripts/cder/ob/patent_info.cfm?Product_No=003&Appl_No=022117&Appl_type=N

Looks like marketing exclusivity has been granted through Jan 2020 but the patents go out to 2026. So when it goes generic in 2020 or 2021, it will be one of the pricier or "non-preferred" generics until 2026.

I personally took Saphris at 5mg but dropped down to 2.5mg because of a little akathisia. I found that 2.5mg was my threshold. However, I felt kind of "checked out" sometimes, which I really didn't like and aside from the slight restlessness, this was the reason I got off of it.

However, at that time, I was not taking an antidepressant or a stimulant, and I'm fairly certain that if I tried it again I would like it more this time.

In regards to weight, I do recall gaining a BIT of weight on Saphris, but it was nothing like my experience with Zyprexa. And I think I've actually gained more weight on Rexulti than I did on Saphris. So in that regard it is FAIRLY weight neutral. HOWEVER, I do remember that 15-30 mins after taking it I would get the usual sedation one would expect from an ODT AP but I would also get RAVENOUSLY hungry, which ultimately is likely what caused the little weight gain I experienced. In essence, Saphris's effect on weight is contingent on its appetite stimulant effects. However, I didn't feel that same ravenous hunger during the day. It was just in the evenings after I would take it.

This being said, for how sedating it was at night and the mild feeling of being off in la-la land, it was actually fairly stimulating during the day.

All-in-all I would say that Saphris is definitely worth a try for anyone and that if you're taking an antidepressant already, you may notice that your depression will improve a bit after you add Saphris.

[Amethyst674]

Thank you for your replies.  I am still on the Geodon with no sex drive and GI issues. I tried switching to zyprexa but that did not go well as I ate the whole house and it made me suicidally depressed the next day.So here patiently waiting for the PAP to send my saphris.

[browri]

46 minutes ago, Amethyst674 said:

Thank you for your replies.  I am still on the Geodon with no sex drive and GI issues. I tried switching to zyprexa but that did not go well as I ate the whole house and it made me suicidally depressed the next day.So here patiently waiting for the PAP to send my saphris.

Very odd that Zyprexa made you suicidally depressed. Despite how terrible it can be from a side effect perspective (weight gain, increased lipids and glucose) it's actually regarded as one of the more tolerable by patients because its side effects are generally silent and it has a much lower propensity for EPS/akathisia.

Saphris should be good though, and I can say that Saphris and Zyprexa are similar in some ways. Saphris should provide very good mood control and some antidepressant effect. What else will you be taking besides Saphris, if anything?

[Amethyst674]

I will also be taking:  

Medications- As of 6/23/18

 

Levothyroxine 200 mcg-  Once Daily- Category A (non-psych)

Dexilant 60 mg- Once Daily- Category B (non-psych PPI)

Effexor 112.5 mg- Once Daily –Category C

Adderal 30 mg- 1 tab twice daily-Category C

***Geodon- 60mg/40mg/60mg=Total 160 mg Daily-Category C-TO BE REPLACED WITH SAPHRIS 5 MG qhs in 2 to 3 weeks.

**Clonazepam- 1mg twice daily-Category D

Gabapentin 300 mg-PRN up to 3 times daily-Category C

 

The reason for the Categories is that I am thinking of getting pregnant.  I have a 22 y/o but I was not on Psych meds when I had her and she is healthy. I am in another relationship now. I am 44 y/o and overweight. I am also Bipolar Type 2.  I am going to go see a High Risk Pregnancy OB and ask for his opinion before I remove my IUD.  I need to eliminate as many category C's as I can and of course the D is out.  I will address this in another post. Thank you.

** Clonazepam-Need to wean off

*** I have to take Geodon 3 times a day, otherwise I get withdrawal like severe stomach pains and erratic mood.Can't wait to get off this drug as it has killed my sex drive. And this is NOT dose related.

 

Edited June 24, 2018 by Amethyst674

[Amethyst674]

I am also concerned that Geodon and Saphris are both QT prolonging agents plus I already take Effexor.  I am wondering if I could just take my Saphris 5 mg at HS even if i took Geodon that morning. I don't really trust the ARNPs in my PDOC office and she (The PDOC who is never there) is even worse.  I am switching but my appt is not till July 27 and by then I will already have my saphris.

[Amethyst674]

I will be switching to Saphris on Monday night. The PAP finally came through. I am just worried that I may have to skip my Geodon for a couple of days due to the QT Prolongation.  I don't do well when I skip my Geodon even for a few hours because of the short half life.  Would I be ok to take my Last Geodon in the AM and start Saphris that evening. If anyone has any input I would appreciate it. 

 

Thank you

[browri]

17 hours ago, Amethyst674 said:

I will be switching to Saphris on Monday night. The PAP finally came through. I am just worried that I may have to skip my Geodon for a couple of days due to the QT Prolongation.  I don't do well when I skip my Geodon even for a few hours because of the short half life.  Would I be ok to take my Last Geodon in the AM and start Saphris that evening. If anyone has any input I would appreciate it. 

 

Thank you

You should be okay. The nice thing about Saphris is because it's sublingual, you get all of the dose right up front. I believe time to peak is really <2 hours. It's quite sedating and should help to offset the missing dose of Geodon. What dose will you be starting at?

[Amethyst674]

I will be starting at 5 mg at hs once a day.  This proved to work for me the last time I was on it.  Even though I know it is a low dose.

[browri]

18 hours ago, Amethyst674 said:

I will be starting at 5 mg at hs once a day.  This proved to work for me the last time I was on it.  Even though I know it is a low dose.

Yeah I would think you should be good. That being said I've never taken Geodon before. So I don't know how the sedation compares, but I have to say of all the night-time AAPs I've taken, Saphris is a real kicker lol.

[Amethyst674]

I need help. I am feeling horrible. I have lowered the Geodon to 80 as instructed by my Dr. And I have been taking Saphris for 3 days. I  am feeling horribly depressed. I was not like this when I was on the Geodon alone. I think I am going to have to stop the Saphris which is a shame because I have 120 pills from the Patient assistance program. I needed to get off of Geodon due to GI symptoms, weight gain and no sex drive. I have exhausted all my other aap options. At this point I don't know what to do anymore. I am afraid I am going to end up in the hospital. That is how depressed I feel. And I have no PDOC to talk to at this point. I have an appointment with a new one on the 26. I thought about raising my effexor to 150. But I just don't like the way this medication (saphris)  is making me feel. 

[mikl_pls]

Here is what I would do. Plan out a titration schedule for Geodon and stick to it no matter what happens and no matter how bad you feel. Commit to it, and keep your goal in sight, which is discontinuation of Geodon, and remission of all your symptoms that you were experiencing on Geodon (hopefully).

This is the titration schedule I would do.

Geodon 40 mg bid (80 mg) + Saphris 2.5 mg hs x3 days (Yes, you'll be splitting a sublingual tablet, but you can keep the other half in foil or a sandwich bag until you take the other half the next night.)
Geodon 20 mg bid (40 mg) + Saphris 2.5 mg hs x3 days
Geodon 20 mg hs + Saphris 5 mg hs x3 days
Discontinue Geodon + Saphris 5 mg hs

 

[browri]

It is true. Titrations are rough. I know you're switching APs but you're also switching AP type from a -done to a -pine and the pharmacology changes are more than subtle considering they are both still AAPs. Have patience if you can bear it.

[Amethyst674]

On day 5 I gave up.  The next day after not taking the Saphris and only taking the Geodon, I was back to my old self again.  I did not want to die anymore.  It's just not for me and it made me remember why I got off of it in the first place. Total Anhedonia.  I see my PDOC on the 26.  Plan to stay on Geodon lower dose 80-120 until then.  Then I will figure out my next step.  Now stuck with 120 wafers of Saphris that I have no idea what to do with.  Thanks for all your support and help.